ombudsman news gives general information on the position at the date of publication. It is not a definitive statement of the law, our approach or our procedure.
The illustrative case studies are based broadly on real-life cases, but are not precedents. Individual cases are decided on their own facts.
Travel policies tend to be fairly complex because they cover a wider range of risks than any other type of insurance – from cancellation to loss of luggage, hospitalisation and death claims. If cover were not described broadly, it might never be understood. So exclusions play an important role in defining the cover provided. For example, broadly speaking, cancellation-cover specifically excludes anything predictable.
Most holidaymakers understand that no policy offers them unlimited cover, either for what they may claim for or for how much they will be paid. But if an insurer wishes to rely on a provision which significantly reduces what the policy says it provides, it will have to show that this provision was drawn to the customer’s attention before the policy was sold. Relevant evidence here might include explanatory literature given to the customer before sale or a statement from the person selling the policy. It is clear, however, that the extended sales chain for these policies (many of which are sold directly by travel companies or high street travel agents) can give rise to justifiable concerns from customers about the sales process.
In general, our approach is to determine whether the exclusion is an important reduction to the cover marketed by the insurer. If it is, we may well conclude that it would not be fair for the insurer to rely on it to reject an otherwise valid claim.
This approach is not the same, however, as assessing the importance of the exclusion by reference to the policyholder’s particular situation. Unless the circumstances were such that the policyholder requested cover against a specific contingency, we are unlikely to conclude that the exclusion should be judged on the basis of how its operation has affected the policyholder.