When Molly tried to make a claim for her medical expenses after she’d fallen ill on her cruise – the insurer rejected her claim.
Molly bought a policy to cover her cruise holiday. The policy booklet had a large picture of a passenger boat on the cover. But when Molly tried to make a claim for her medical expenses after she’d fallen ill on her cruise – the insurer rejected her claim. The terms and conditions of the policy stated that cruises were excluded. Molly didn’t think that was fair and complained that the policy booklet’s cover suggested cruises were covered. The insurer disagreed, so Molly brought her complaint to us.
How we helped
We considered the insurer’s obligation under the Insurance Conduct of Business Sourcebook (ICOBS) rules on insurance product sales. ICOBS states that businesses need to provide information that’s clear, fair and not misleading.
We thought the policy booklet cover was misleading. We were satisfied that Molly wouldn’t have bought the policy if it had been clear cruises weren’t covered.
Molly had been billed for medical expenses that were more than the cost of the policy. So we told the insurer to pay the medical expenses subject to the policy limit and excess, and to refund the insurance premium.