Not upheld: Service failures generally complaint against Heath Crawford Ltd

Decision detail

Summary

Mr and Mrs T complained that their insurance broker, Heath Crawford Ltd, failed to inform them about enhanced private medical insurance cover for cancer that became available in 2014. Mr T was subsequently diagnosed with cancer in 2015 and his claim was limited to 12 months under the existing policy, whereas enhanced cover would have provided longer coverage. The ombudsman found that while Heath Crawford should have informed them of the option, Mr and Mrs T would not have taken it up because it would have required removing Mrs T from their joint policy, which was impractical given her serious medical history and inability to obtain enhanced cover independently. The complaint was not upheld and no compensation was awarded.

The Ombudsman's reasoning

The ombudsman accepted that Heath Crawford failed to inform Mr and Mrs T about enhanced cover in 2014, but concluded that compensation could only be awarded if Mr and Mrs T would have acted differently and suffered loss as a result. The ombudsman found it unlikely they would have removed Mrs T from the policy to allow Mr T to take individual enhanced cover, given they had been jointly insured for many years, Mrs T had already claimed for serious illness, and the evidence showed they were seeking to reduce rather than increase cover and premiums in 2014. The ombudsman reasoned that the benefits of enhanced cover would not have been sufficiently attractive to overcome the serious implications for Mrs T's coverage.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website