Casualty & General Insurance Company (Europe) Ltd · DRN-5964402

The complaint Mr E complains that Casualty & General Insurance Company (Europe) Ltd declined a claim on his pet insurance policy. What happened Mr E made a claim on his policy for vet’s fees after his dog needed treatment in August 2025 for an aural haematoma in his left ear. Casualty & General declined the claim, because Mr E’s dog had had treatment for an aural haematoma in his right ear in October 2023, which was before the policy started. It said this was a pre-existing condition which was not covered by the policy. Mr E complained but Casualty & General didn’t change its decision. Our investigator said it wasn’t fair to decline the claim as he wasn’t persuaded the condition claimed for was the same as the condition that had been treated in October 2023. He asked Casualty & General to pay the claim, together with £100 compensation for the distress and inconvenience caused to Mr E. Casualty & General disagrees and has requested an ombudsman’s decision. It says the left ear aural haematoma treated in August 2025 is a continuation or recurrence of a pre-existing bilateral condition first recorded in October 2023, so the exclusion for pre-existing and related and bilateral conditions applies. 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 considered Casualty & General’s comments carefully but I don’t think it was fair in this case to decline the claim as a pre-existing condition, for the following reasons: • The relevant industry rules and guidance say insurers must deal with claims promptly and fairly, support a policyholder to make a claim, and not unreasonably reject a claim. They should settle claims promptly once settlement terms are agreed. • The starting point when deciding whether the claim was declined fairly is the policy terms. • The policy covers treatment costs and Mr E has a valid claim for treatment costs, unless there’s an exclusion that applies. • There is an exclusion for pre-existing conditions, which are defined as “… any diagnosed or undiagnosed condition, related condition or bilateral condition which has happened or has shown signs or symptoms of existing in any form in the last 24 months before the policy start date…” • The onus is on Casualty & General to show it’s fair to apply the exclusion in the circumstances of the case.

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• The policy says where there is a bilateral condition (which affects parts of the body of which there are two, such as eye and ears) this will be treated as one condition regardless of when the treatment happened. But I still need to consider if it’s fair to apply the term strictly in the circumstances of the case. • To decline the claim fairly, Casualty & General needs to show the condition claimed for was present in the 24 months before the policy started (or was related to or had the same cause as the issue that was seen before previously). • Casualty & General’s vet adviser said aural haematoma is not a primary disease. In their view, the two events were connected. They explained how otitis creates the conditions that lead to haematomas. Hypersensitivity disorders and allergies are considered a leading primary cause. But the treating vet is clear that in their professional opinion there’s no evidence of an underlying disease, and the left ear haematoma in 2025 was a new and separate condition. • Otitis externa and aural haematomas can be caused by different things. There may often be an underlying allergy, but there can be other causes. I appreciate both ears showed signs of otitis externa in October 2023, and Mr E was given advice about both ears, but the treatment was primarily to the right ear, with surgery to treat the haematoma in that ear. There were no further issues for almost two years. • If Mr E’s dog had been suffering with allergies I’d expect to see that recorded in the records, with advice or treatment for it, but that’s not the case here. • The evidence is contradictory. On the one hand, the Mr E’s vet is clear the two issues are not connected while, on the other hand, Casualty & General’s veterinary adviser says it’s unlikely they are not connected. On balance, I’m persuaded the treating vet’s opinion, the long gap between the two incidents, and the lack of ongoing signs in the clinical history indicate the 2025 haematoma is not related to the pre-existing issue. While it’s possible the problems were due to an underlying allergy, I don’t consider the evidence of that persuasive. • Even if there is a connection between the conditions claimed for and the previous issues, it wouldn’t generally be fair to refuse a claim if the consumer couldn’t reasonably have known there was a problem. As far as Mr E was aware, there had been one isolated event in October 2023, which had been treated and resolved quickly. He wasn’t told his dog had ongoing allergies and wouldn’t have been aware when he bought the policy that there was an ongoing issue. So Casualty & General should not apply the exclusion, and should settle the claim in the line with the remaining policy terms. Mr E has explained how upsetting it was to have the claim declined. He had to find the money to pay the vet’s fees, which put him in a difficult position financially and caused a lot of strain. In the circumstances, I agree it’s fair to compensate him for the distress and inconvenience has was caused. My final decision I uphold the complaint and direct Casualty & General Insurance Company (Europe) Ltd to: • Pay the claim in line with the remaining policy terms and, as Mr E had to pay the vet’s fees himself, pay interest on the compensation from the date he paid the fees to the date of settlement at 8% a year simple.* • Pay compensation of £100 to Mr E for the distress and inconvenience caused to him.

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If Casualty & General Insurance Company (Europe) Ltd considers that it’s required by HM Revenue & Customs to deduct income tax from that interest, it should tell Mr E how much it’s taken off. It should also give Mr E a tax deduction certificate if he asks for one, so he can reclaim the tax from HM Revenue & Customs if appropriate. Under the rules of the Financial Ombudsman Service, I’m required to ask Mr E to accept or reject my decision before 22 April 2026. Peter Whiteley Ombudsman

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