Admiral Insurance (Gibraltar) Limited · DRN-6199533

The complaint Miss C complains Admiral Insurance (Gibraltar) Limited unfairly declined her pet insurance claim. Any reference to Admiral includes the actions of its agents. What happened The circumstances of this complaint are well known to both parties and as our Investigator detailed what happened, I won’t repeat events here. Rather, I will focus on the reasons for my decision. What I’ve decided – and why I’ve considered all the available evidence and arguments to decide what’s fair and reasonable in the circumstances of this complaint. I’ve also kept in mind Admiral’s responsibilities as an insurer to handle claims promptly and fairly, and to not unfairly decline a claim. Having done so, I’m not upholding this complaint. Before I explain why, I want to reassure the parties that while I have reviewed everything, I will only focus on what I consider key to determining the complaint. This isn’t meant as a discourtesy but rather reflects the informal nature of this Service. Claim declinature It’s not in dispute Admiral unfairly applied the pre-existing medical condition exclusion when initially assessing Miss C’s claim. It has acknowledged it got this wrong. So, I find I don’t need to comment on this further, other than to say this understandably caused Miss C avoidable upset - but I’ll address this fully later. When assessing the claim again, Admiral said the behavioural treatment for Miss C’s dog (“H”) wasn’t covered because H’s behaviour wasn’t the direct result of a previous injury or illness. It referred Miss C to the policy document which says: “Behavioural treatment shall be covered up to the sum of £2,000 but only treatment that is to address changes in behaviour as a direct result of a previous injury or illness is covered under this policy.” I find the term makes it clear that to be covered the behaviour must be a direct result of a previous injury or illness. This term featured in both the Insurance Product Information Document (IPID) and policy booklet, both of which were shared with Miss C when taking out the policy. Admiral’s position is H’s medical history does not indicate the behaviours were a direct result of an injury or illness. I agree. Whilst there’s mention of H fearing cars, this followed H running in front of a car where H fortunately, wasn’t physically harmed. So, there wasn’t an injury.

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Notably, the behaviourist who saw H reported their behaviours were “situationally induced anxiety reactions, arising from life events rather than an ongoing pathological condition.” As the behaviourist didn’t attribute the behaviours to an injury or illness, I find Admiral’s conclusion the treatment wasn’t the direct result of an injury or illness to be reasonable. And so, its decision to decline the claim is in line with the policy terms. Miss C says the term is unfair as it’s not possible to know if the behavioural issues are the direct result of an injury or illness unless and until a consultation is carried out. I accept that might be the case in some circumstances, but as there is no injury or illness for the behavioural issues to be the result of, I don’t find that’s relevant here. Customer service Miss C also complains about the customer service she received. For example, she says Admiral delayed progressing her claim, wasn’t forthcoming with information - which meant she had to chase matters up - and provided an incorrect contact telephone number. She also had to spend time appealing its initial decision to decline her claim, which it later acknowledged was incorrectly reached. I find Miss C’s observations fairly reflect what happened, so I agree Admiral’s customer service could have been better. Admiral hasn’t disputed Miss C’s experience either. It’s apologised for the inconvenience and upset she was caused by these events and has paid £175 compensation to recognise this. Whilst I accept Miss C was caused avoidable upset and inconvenience by Admiral assessing the claim incorrectly at the start, I must keep in mind that ultimately, the claim was still declined. So, despite its mistake, the claim outcome didn’t change. When I consider this, together with Admiral’s overall handling, I find £175 compensation fairly and reasonably recognises the difficulties Miss C experienced, and so, I won’t be directing Admiral to increase the compensation. My final decision My final decision is I don’t uphold this complaint. Under the rules of the Financial Ombudsman Service, I’m required to ask Miss C to accept or reject my decision before 16 April 2026. Nicola Beakhust Ombudsman

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