We interpret this to mean that there is no cover for claims where the policyholder was aware of a deteriorating situation – or should have been.In his 1987 Annual Report, the first Ombudsman, James Haswell, discussed how an accident can occur “in slow motion”.We do not consider it fair to reject these claims because of the gradually operating cause exclusion when the policyholder has no way of checking whether any accident has occurred.We would not expect a householder to carry out regular checks to ensure that his pipes – whether underground or Theming & integration embedded in a building – are undamaged.
However, if the policyholder is then inactive, he may well see his claim fail at some later date. We have recently received some complaints about new insurance schemes which have been arranged by credit card providers.There is normally no charge made under such schemes for the insurance cover and no record is kept of which cardholders might or might not be covered.Only at the time of a claim under the insurance will it be determined whether the claimant was covered.This type of scheme, attractive as it may be for cardholders, clearly suffers from the uncertainty of knowing whether a particular individual is covered.
In the absence of specific wording which has been clearly brought to the cardholder’s attention, the benefit of the doubt will be given to the complainant.Many cardholders will have believed they were covered and the scheme insurer was on risk even though they may not in fact have complied with the strict criteria for cover.
It would surely be easier for all concerned if there were some way of the cardholder registering his interest under the scheme before going on holiday.The 1998 Annual Report referred to complaints concerning exclusions for alcohol-related claims under travel insurance.
We were particularly concerned about liability for the cost of repatriating bodies of deceased holidaymakers.