Has anyone used the insurance ombudsman and been successful?

[Thetrainisinthestation]

I am having issues with a pet insurance claim not paying out in full using a very wishy washy clause

The amount they are deducting from their payout is around £600.

Has anyone gone to the ombudsmen for anything similar and can let me know how it went? Is it worth doing? Will it be time consuming?

Yes worth doing.

What was the issue?

The insurance policy has a limit per condition which the claim is within.
They have accepted the claim but have put caps on different elements of the vets breakdown

These caps are not in the policy wording.
The cap values I have since found out are a set figure that the insurance company has but does not publish them.
When you query this with them they say that they can’t publish their set caps because it changes too often.

Looking at what the ombudsman says would be a fair policy, the insurer should make it clear when things are excluded and not mislead the customer into thinking they are covered for something that they are not.

The caps imposed by the insurer to be fair should be within the policy wording and if they have to adjust them year on year then do that on a yearly basis.I’ve been a pet owner for 16 years, vet costs have generally increased but have not fluctuated so badly that an insurer can’t publish what they will pay up to surely?

Take it to them and find out. Sounds reasonable enough to me!

You need to make a complaint to the insurance company first, neither party will review the issue unless the insurer has had a chance to respond via the complaints process.

Once the insurer has provided a final response OR 8 weeks has passed then contact the Financial Ombudsman Service via their website with details of the complaint and they will take it from there.

Yes. We got messed about by our life insurance provider and eventually, after a lot of correspondence with the ombudsman and even the intervention of a media investigation, we won. You have to keep at it and not take no for an answer. You can also appeal if the ombudsman says no first time.

I had an issue with a travel policy and informed insurer I would be making a complaint to ombudsman and outlined complaint. They responded within a set number of days with a proposed monetary amount. I accepted so it didn’t end with going further but it didn’t take much work in my end. The insurer fobbed me off until I sent the formal complaint with reference to going to ombudsman.