EQUINE AND LIVESTOCK INSURANCE COMPANY LIMITED · DRN-5993722

The complaint Miss H complained that EQUINE AND LIVESTOCK INSURANCE COMPANY LIMITED (THE) unfairly and unreasonably refused to accept and pay her claim for cancelling her wedding under her wedding insurance policy. What happened Miss H took out this wedding insurance policy provided by E&L in November 2023 for her wedding due to take place in October 2025. In June 2025, Miss H cancelled her wedding due to mental ill health brought about by a series of other issues. On investigating the claim, E&L found that Miss H had suffered similar previous mental ill health issues in February 2017. The policy has an exclusion for cancellation from a pre- existing medical condition. So E&L didn’t accept her claim. Also it required a consultant to confirm the diagnosis, but Miss H had only disclosed her GP’s confirmation. Miss H didn’t think this was fair as she hadn’t suffered any mental ill health issues since 2017 so she felt she had answered the questions asked on the application form correctly. As E&L wouldn’t change its stance she brought her complaint to us. Ultimately the investigator didn’t think E&L had done anything wrong. Miss H disagreed as she felt relying on this exclusion breached the Consumer Duty as E&L in the sales process had failed to ensure she could reasonably understand the terms to be applied. On that basis her complaint has been passed to me to decide. 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’m not upholding this complaint. I do appreciate Miss H will be very disappointed, so I’ll now explain why. I’m also really sorry Miss H had to cancel her wedding and I can only imagine the distress and upset that caused her and her partner. However no insurance policy covers every eventuality that might occur. It’s very common to have exclusions in wedding policies and indeed other policies like travel policies which does not provide cover if the reason for the cancellation was due to a pre-existing medical condition. So I don’t find this exclusion unusual or significant either. It’s common industry practice for all sorts of cancellation insurance. More importantly as I’ll discuss below I consider this exclusion was appropriately highlighted too. That also means there is no requirement to

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have such exclusions limited to a time period like Miss H suggested of say five years as it’s not the basis under which these sorts of policies are underwritten and therefore priced either. Insurers are entitled under the regulations of the Financial Conduct Authority (FCA) to decide what risks they want to cover and what risks they don’t want to cover. This remains part of their commercial discretion. So there is no regulation which requires an insurer such as E&L here, to limit its exclusions concerning pre-existing conditions to something like five or whatever number of years. And that is not something I have any authority or remit to change either. It’s not for this service to tell any insurer what to insure or how to insure it. Further, these sorts of policies are sold on what is called an ‘unadvised basis’ under the regulations. This means that E&L provides no advice about whether this policy was suitable for Miss H’s needs. It’s only duty was to ensure the relevant policy documents were available at the time Miss H was applying for this policy so she could make that decision for herself. E&L confirmed its Insurance Product Information Document (IPID) and policy document was available for Miss H to read at the time of her application. I can see that these documents are available on its website too. In the IPID, it says the following under ‘what is not insured?’; ‘Any claim arising from the death, injury or sickness of the policyholder, bride, groom, civil partner, or member of the wedding party which is due to a pre-existing condition making it inappropriate, or impossible to continue with the wedding.’ In the policy document itself in the definitions section it defines ‘pre-existing condition’ as the following: ‘Pre-Existing Condition’, an injury or illness which (i) first showed clinical signs, happened or existed before the commencement date/time shown on Your policy schedule or (ii) is the same as or has the same diagnosis as or is caused by, related to or results from an injury, illness or clinical signs displayed before the commencement date/time shown on Your policy schedule or (iii) has required medical treatment (including consultations or advice) within 12 months of the commencement date/time shown in Your policy schedule.’ And the policy says the following is covered as a reason for the cancellation: ‘Your death, injury or sickness or that of a member of Your Wedding Party which would make it inappropriate, or impossible to continue with the Wedding.’ Immediately below that under ‘exclusions’ it says the following is specifically excluded: ‘7. Any claim arising from Your death, injury or sickness or that of a member of Your Wedding Party which is due to a pre-existing condition and would make it inappropriate, or impossible to continue with the Wedding.’ So, I consider E&L detailed this exclusion fully in its policy documents as the regulations of the FCA required it to do. I can see these documents were available for Miss H to read before buying the policy also as they are available on E&L’s website. I consider this exclusion was clearly expressed and designed by E&L to be understood by its customers, which it was supposed to do under ICOBS 6.1.5R. It was properly highlighted in the IPID policy summary too. There is no duty on any insurer to ensure each customer reads every clause, or to ensure they understand every clause too. That remains the duty of the customer and if they didn’t understand anything then it was incumbent on them to phone E&L and ask their queries directly. And if they didn’t read the available policy documentation,

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then it’s not something the regulations allow a consumer to rely on in order to make an insurer pay the claim. So I think E&L adhered to all its duties under the Consumer Duty, contrary to what Miss H has said. It provided the documents, its language use was clear and understandable and it processed her claim in writing. I’ve also looked at E&L’s website and checked under its ‘Frequently Asked Questions’ and it clearly details the following: ‘What happens if we have to cancel or rearrange our wedding due to the illness of death of one of the wedding party members, but this was caused by an illness that was present before the policy start date? Unfortunately, this situation is not covered under the policy. If a member of your wedding party has a pre-existing condition that leads to death, injury or illness and it makes continuing with the wedding impossible, the policy won’t cover it.’ So, I also consider its website also explained the matter under the Q&A section as I would have expected it to do. E&L gave us a copy of the questions Miss H was asked when she applied for the policy. These are as follows: 1. ‘Have you or any other person to whom this policy will apply ever: a. Received a police caution, been convicted of criminal offence or have a prosecution pending? b. Had insurance refused, cancelled, declared void or had special terms imposed by any insurer? c. Been subject to any declaration of bankruptcy, involved in a company insolvency or liquidation or had any County Court Judgement registered against you? d. Made any insurance claims (whether paid or not) or suffered any events that make have given rise to a claim within the last 3 years? 2. Have there been any claims made against you or any person to whom this insurance applies in the last 3 years in respect of injury to other persons or loss or damage to other persons’ property? 3. To the best of your knowledge and belief, does the bride, groom, civil partner, any other person named in the policy schedule as the policyholder, their parents or guardians, grandparents or either party’s children, siblings, best man, bridesmaids, flower girls, page boys or ushers have any previous or existing medical conditions? I confirm I have read the Declaration Statement and have provided honest, truthful and complete answers to the Declaration Questions; I accept and understand that withholding or providing incorrect information may invalidate my insurance cover and any claims may be declined.’ Miss H answered ‘no’ to questions 1a, 1b, 1c, 1d, question 2 and question 3. And answered yes to the declaration statement. So she said effectively that no one in the wedding party, including her, had any previous or existing medical conditions and that she had answered these questions honestly, truthfully

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and completely. Once a consumer has done that, then in real terms the onus to show this is true shifts to the consumer as E&L made sure it asked the relevant questions. However when E&L asked for her medical notes and records, sadly she had clearly suffered some mental ill health problems in 2017 before she bought the policy. Similar type medical ill health problems caused her to cancel her wedding in June 2025. It’s very possible that the cause of the mental ill health issues might have been different, however the definition of what constitutes a pre-existing condition details that if the diagnosis ‘is the same as or has the same diagnosis..’ as an ‘illness or clinical signs displayed before the commencement date/time shown on Your policy schedule’ then it is a pre-existing illness and therefore not covered. The diagnosis was the same in both instances of Miss H suffering this mental ill health condition. E&L also weren’t satisfied that this was diagnosed by her GP only, and not also a consultant, which Miss H found unfair, as most NHS patients might be diagnosed with a mental health condition by their GP. However as the investigator said this requirement is standard again across cancellation policies because insurers and E&L here are entitled to clear, independent verification of the cause of the cancellation which is triggering the claim payment. So I don’t find this unusual either. It’s part of the policy terms and Miss H is deemed to have agreed those policy terms when she decided to buy this policy also. Therefore, in view of the policy documents, and policy provisions, it’s clear to me that given Miss H cancelled her wedding given a reoccurrence of a previous mental ill health condition it was clearly a pre-existing condition and therefore not covered by this policy. Further had she answered the question asked on the application correctly and disclosed she had previously suffered from this mental health condition, it was likely that E&L might well have excluded any reoccurrence of this condition from cover too. In that case her claim wouldn’t have been covered either. My final decision So, whilst I do understand and appreciate Miss H will remain very disappointed, for these reasons it’s my final decision that I don’t uphold this complaint. Under the rules of the Financial Ombudsman Service, I’m required to ask Miss H to accept or reject my decision before 28 April 2026. Rona Doyle Ombudsman

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