Allianz Insurance Plc · DRN-6124801

The complaint Mr and Mrs D made a claim for pre-authorisation costs on their Allianz Insurance Plc (‘Allianz’) pet insurance policy, which Allianz declined to cover. Mrs D says Allianz treated her and Mr D unfairly. What happened The details of this complaint are well known to both parties, so I won’t repeat them here. Instead, I’ll focus on giving my 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. Having done so, I don’t uphold Mr and Mrs D’s complaint for broadly the same reasons set out by the investigator. Before I explain why, I wish to acknowledge the various submissions Mrs D has made. Whilst I’ve read everything she’s said, I won’t be addressing it all. That’s not intended to be disrespectful. Rather it’s representative of the informal nature of the Financial Ombudsman Service. Instead, I’ll concentrate on the crux of Mr and Mrs D’s complaint, namely whether Allianz treated them unfairly. The relevant law in this case is The Consumer Insurance (Disclosure and Representations) Act 2012 (CIDRA). This requires consumers to take reasonable care not to make a misrepresentation when taking out a consumer insurance contract (a policy). The standard of care is that of a reasonable consumer. And if a consumer fails to do this, the insurer has certain remedies provided the misrepresentation is - what CIDRA describes as - a qualifying misrepresentation. For it to be a qualifying misrepresentation the insurer has to show it would have offered the policy on different terms or not at all if the consumer hadn’t made the misrepresentation. CIDRA sets out a number of considerations for deciding whether the consumer failed to take reasonable care. And the remedy available to the insurer under CIDRA depends on whether the qualifying misrepresentation was deliberate or reckless, or careless. Allianz thinks Mrs D failed to take reasonable care not to make a misrepresentation when she declared that her pet had not shown any signs of illness or injury when she took out the policy. I can see from the screenshots Allianz have provided that Mrs D was asked a specific question in relation to this, and I can see information was available next to that question that would likely explain what that meant. So, in my view, Mrs D ought to have been aware that she was under a duty to provide material evidence. And she was specifically prompted to do so when she took out the policy. I’ve looked at the pet’s clinical history, and my judgment is that Mrs D knew (or should have known) that Allianz would have wanted to have been told about her pet’s clinical history and particularly the fact that the day after cover was taken out, Mrs D took her pet to the vet

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because it was experiencing neurological symptoms. The clinical notes record that Mrs D noticed her pet was very unsteady on its feet and was prone to falling over, especially when tired. The notes go on to record the vet’s observations, namely “marked dysmetria but able to move independently Very suspicious of Cerebellar hypoplasia – discussed possible referral but owner declined.” During a call with Allianz in June 2025 Mrs D said that her pet was experiencing these symptoms a couple of days before taking out the insurance. So it’s clear to me these were symptoms known to Mrs D before cover was taken out. I realise Mrs D says that these symptoms had nothing to do with the subsequent pre- authorisation request for investigations into seizures her pet has experienced more recently, but there was an obligation on her to disclose any signs or symptoms her pet had had before cover was in place. And having reviewed Allianz’ policy terms, and in line with what they’ve told us about their underwriting criteria, had she done so, Allianz would have placed an exclusion on the policy for the pet’s neurological system regardless of whether this was related to the initial problem her pet was exhibiting signs of before the policy was in place, or as a result of some other cause. And because the cause of the pre inception symptoms is currently unknown Allianz said the exclusion would remain until the pet had a period of 12 months where it was symptom free of any neurological issues going forward. In this case I’m satisfied that Mrs D’s misrepresentation was a qualifying one. Allianz have said Mrs D’s misrepresentation was careless, which means they’re entitled to decline the claim for pre-authorisation and place the exclusion they would have placed on the policy for the pet’s neurological system, as they have here. I don’t think Allianz did anything wrong by doing this and I take the view they were entitled to treat Mrs D’s claim in this way. I turn now to Mrs D’s submissions that she didn’t provide Allianz with misleading information when she took out the policy and that she thought the cause of her pet’s unsteadiness was because she was too young. At the time of taking out the policy Mrs D says she hadn’t seen a vet for this as yet. But the day after she took out the insurance, she consulted a vet about her pet’s symptoms. She was offered the option to investigate them further but declined this. I appreciate Mrs D says she was advised not to as the risks associated with anaesthetising such a young pet as these were too high, but there is nothing in the pet’s clinical notes that support this. But this doesn’t to my mind mean the problem was not one she ought not have have been alive to before she took out cover. The questions Mrs D was asked when she took out the policy were: “Has (the pet) shown any sign of illness or injury or been unwell whether now or in the past? This is regardless of whether or not the pet was seen by a vet for the problem. And “Has (the pet) ever showed any symptoms of an injury or illness and didn’t need the vet?” Mrs D’s knowledge of the symptoms her pet was experiencing led her to raise them with a vet the day after she took out cover. She was, by her own admission, aware of those symptoms beforehand. Allianz’ questions were in my view clear and unambiguous about the question of signs or symptoms. In light of all of that, I think Allianz did make it clear enough that they wanted to know about the problems the pet was experiencing in advance of agreeing to provide cover. So, I’m not persuaded it was reasonable for Mrs D to indicate ‘no’ in response to those questions as she did. And for the reasons I’ve set out above, I think Mrs D did make a qualifying misrepresentation, and that Allianz would have applied the exclusion they have now had she answered the question asked of her accurately. And if things had gone as they should have, Allianz would likely have made that exclusion clear to her at that point given its policy terms also explain this would likely occur in those circumstances.

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I appreciate that Mrs D doesn’t currently know whether the problems her pet is experiencing are linked to the earlier problems it had before the policy was in place. Neither have been investigated and diagnosed. Allianz have said that if Mrs D goes ahead with an investigation into her pet’s current problems, and it is found that they are not being caused by any neurological condition and is unrelated to the pre inception problems her pet had, they would reconsider her claim. I think that’s reasonable in the circumstances, and I wouldn’t expect Allianz to do anything further unless it receives persuasive evidence to support the current claim is unrelated to the earlier problem the pet had and is not neurological in nature. My final decision For the reasons set out above, I don’t uphold Mrs D’s complaint against Allianz Insurance Plc. Under the rules of the Financial Ombudsman Service, I’m required to ask Mrs D and Mr D to accept or reject my decision before 15 April 2026. Lale Hussein-Venn Ombudsman

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