The UK Insurance Ombudsman was created in 2001 by the Financial Services Act in order to settle disputes between insurers and clients. Other countries like Australia and New Zealand also have Insurance Ombudsman offices.
The types of disputes that come up most often in the UK related to Travel/ International Health insurance policies were where the client either didn’t understand an exclusion or was unaware of it, or there were limits in a policy that were either not understood, emphasized by the insurer, or not plainly disclosed.
The Ombudsman will look at how the policy was sold and determine the information disclosed to the consumer, and ensure that the information was available. One situation was a case were a trip and flights had to be cancelled and the consumer lost money and was told by the agent/ insurer that trip cancellation of flights and travel was covered by the policy. What wasn’t disclosed was that there was an arbitrary low limit on this benefit of $2000 and the loss was $6000. The Ombudsman ruled that this fact was probably not plainly disclosed by the insurer, and they ruled in his favour. The insurer paid!
Isn’t it nice as a consumer to know that you have a powerful advocate on your side that can overrule the very occasional, sometimes arbitrary decisions that insurers make to deny or limit a claim. With a UK governed policy you don’t have to hire a lawyer to get someone to review decisions with the power to force an insurer to pay. If you are unhappy with any decision of the Ombudsman there is another level of redress you can seek though another functionary; the Independent Assessor.
The UK Ombudsman in the case of travel insurance rules 45% of the time in favour of the consumer in travel insurance disputes. In general their findings are 58% in favour of consumers. 90% of all cases were settled informally after the intervention of the Ombudsman.
IMG Europe is governed by the Financial Conduct Authority and their Travel and International Health insurance claim settlement decisions are subject to review by the Ombudsman in the event you choose to dispute anything.