The Financial Ombudsman Service (FOS) has backed a medical insurer and rejected a customer’s complaint after her treatment was delayed due to the Covid-19 pandemic.
It published the case as a follow-up to its annual complaints figures to illustrate the type of complaints it was receiving through the sector.
In this instance it noted that the customer it named as Reena was unhappy that her insurer would not refund her premiums when her physiotherapy treatment was delayed due to Covid-19.
The insurer had offered an alternative treatment while its facilities were being used by the NHS to deal with the pandemic, but Reena was not satisfied with this.
As a result she cancelled her policy but was unhappy that she had continued to pay the premiums while the treatment she wanted was unavailable and asked the insurer either to refund the premiums paid during this time, or to agree to pay for her treatment later on, once this was possible.
The insurer rejected these options and Reena complained to the FOS.
Unfair to refund premiums
However, the FOS noted that having considered the insurer’s response and the terms and conditions of the policy, it was satisfied with how the insurer had acted.
“We explained to Reena we didn’t think it was fair to ask [the insurer] to refund the premiums she had paid,” the FOS said.
“Likewise, the policy terms said that treatment would only be paid for while cover was in place – even if it had been authorised before then. Reena had made the decision to cancel her policy.
“Given everything we’d seen, we didn’t tell the insurer to take further action.”
In its latest data published last month, the FOS revealed it received 1,476 new complaints about health and dental insurance in 2020-21, up by 45% from 1,021 the previous year.
However, the rate of complaints being upheld dipped slightly to 16% of health complaints from 19%.
