The exclusions page is where your policy actually lives

Insurance is sold on what it covers and paid out on what it does not exclude. Most people read the first part and skip the second. When a claim is turned down, the reason is usually written in a section the customer never opened.

That section is not hidden. UK rules require it to be put in front of you, in a set format, before you buy. The problem is that it arrives at the moment you are least interested in reading it: when you have already found a price you like and want to get on with booking the holiday or moving house.

Where the exclusions sit

For most general insurance sold to consumers, the insurer must give you an insurance product information document, or IPID. FCA rules fix its headings, including “What is insured?”, “What is not insured?”, “Are there any restrictions on cover?” and “What are my obligations?”. It must normally fit on two sides of A4.

The IPID is a summary. The full rules live in the policy wording, often 30 pages or more, with a definitions section that changes the meaning of ordinary words. “Unattended”, “home”, “sudden” and “pre-existing” can all mean something narrower than you would assume. If a word in the exclusions is printed in bold or capitals, it is almost always defined somewhere else, and the definition is the version that counts.

Under the FCA’s Consumer Duty, firms must communicate in a way that is likely to be understood by their customers, and provide information in good time for them to make effective decisions. That is a duty on the insurer. It does not change the fact that you are bound by what you agreed to.

The exclusions that catch people out

Travel insurance is a good example of how often this goes wrong. The Financial Ombudsman Service received 4,466 travel insurance complaints in 2023/24, up 19% on the year before. It said cases were mainly driven by insurers declining claims, with a rising number of people told that a medical condition had not been properly disclosed.

• Pre-existing medical conditions. The Foreign, Commonwealth and Development Office advises travellers to declare existing conditions, and pending treatment or tests, so that related complications are covered.
• Hazardous activities. Government travel advice says mopeds and quad bikes are not usually covered, and sports such as bungee jumping and skydiving are not usually included in standard policies.
• Alcohol and drugs. Most travel policies do not cover events that happen after excessive drinking or taking recreational drugs.
• Gradual damage and wear and tear in home insurance, such as a slow leak behind a shower or a roof that has deteriorated over years.
• Unattended belongings, which policies often define more strictly than you would expect, for example items left in a car or out of arm’s reach.

The questions you were asked matter

Many refusals are not really about exclusions. They are about what was said when the policy was taken out. The Consumer Insurance (Disclosure and Representations) Act 2012 places a duty on consumers to take reasonable care not to make a misrepresentation when answering the insurer’s questions. You are not expected to volunteer things you were not asked about.

What happens next depends on the kind of mistake. If an answer was deliberately or recklessly wrong, the insurer can cancel the policy, refuse all claims and keep the premium. If it was careless, the remedy is meant to be proportionate: the insurer is put in the position it would have been in had it known. If it would have charged more, it can reduce the claim in proportion. If it would have added an exclusion, the policy is treated as if that exclusion had been there. Only if it would not have offered cover at all can it treat the policy as void.

The Ombudsman says it looks at whether a misrepresentation was deliberate or a mistake. It also considers whether it was fair to apply a medical exclusion where the insurer asked nothing about your health.

The price tells you what you will pay. The exclusions tell you what you have bought.

What the insurer has to show

FCA rules require insurers to handle claims promptly and fairly, to give reasonable guidance to help you claim, and not to reject a claim unreasonably. Where an insurer relies on an exclusion, the Ombudsman’s approach is that it is for the insurer to show the exclusion applies.

In practice that means evidence. On gradual damage, the Ombudsman says that if it is not satisfied the insurer has shown the damage happened gradually, it is likely to tell the insurer to accept the claim. It may also uphold a claim where the damage came from an insured event, such as an escape of water, and you could not reasonably have known it was happening, provided you acted promptly once you did. Wear and tear is different: it is unlikely to tell an insurer to pay for things that have simply worn out.

On alcohol, the Ombudsman has said that travellers are not expected to avoid drink altogether, and that the insurer must establish that the exclusion actually applies to what happened.

There is also a legal limit on some technical refusals. Section 11 of the Insurance Act 2015 stops an insurer relying on a breach of certain terms, such as a requirement to fit a particular lock, if you can show the breach could not have increased the risk of the loss that actually happened. The Act’s explanatory notes give the example of a flood claim: a missing window lock could not have made the flood more likely, so the insurer should pay.

How to read the exclusions before you buy

• Read the “What is not insured?” and “Are there any restrictions on cover?” sections of the IPID first, before you compare prices.
• Look up every defined word in the exclusions. The definitions section is where cover is often narrowed.
• Answer medical and other questions carefully and in full. If you are unsure whether something counts, ask and keep a note of the answer.
• If you have a medical condition and are refused cover, charged a large extra premium or offered a policy that excludes it, the FCA requires travel insurers in those situations to point you to a directory of specialist providers, including one run by MoneyHelper.
• Check the activities list against your actual plans, including anything you might do on the spur of the moment, such as hiring a moped.
• Keep the policy wording, not just the schedule, somewhere you can find it when you need to claim.

If a claim is refused

Ask for the refusal in writing, with the exact policy wording it relies on and the evidence behind it. Check whether the clause really covers what happened, and whether the insurer asked the question it now says you answered wrongly. Then make a formal complaint to the insurer.

The insurer has up to eight weeks to send a final response. If it does not, or you are unhappy with the answer, you can take the complaint to the Financial Ombudsman Service. You normally need to do so within six months of the final response. The service is free, and you do not need to pay a lawyer or claims management company to use it.

This article is for general information and is not medical, legal or financial advice. Laws differ between countries. Read our editorial standards.