Not upheld: Service failures generally complaint against Vitality Health Insurance Limited
Financial Ombudsman decision DRN-3152191 of 2016-03-15T00:00:00+00:00. Service failures generally complaint against Vitality Health Insurance Limited. Outcome: Not upheld.
Decision detail
| Reference | DRN-3152191 |
|---|---|
| Decision date | 2016-03-15T00:00:00+00:00 |
| Firm | Vitality Health Insurance Limited |
| Product | Other regulated product |
| Claim type | Service failures generally |
| Outcome | Not upheld |
| Remedy | Vitality's offer of £50 compensation was deemed fair and appropriate. |
Summary
Mrs M complained to the FOS about her private medical insurance provider Vitality Health Insurance Limited, citing mislaid information, treatment delays, and embarrassment from unpaid invoices. The main issues included delays in providing written treatment authorisation confirmations and a six-month delay in paying for an authorised osteopath session in May 2015. Vitality accepted some service failures, apologised, and offered £50 compensation. The ombudsman found that while Vitality could have performed better administratively, the delays were not material as Mrs M had already received verbal authorisation, and Vitality eventually paid all treatment costs and apologised for the payment delay.
The Ombudsman's reasoning
The ombudsman found that while Vitality could have provided written confirmation of treatment coverage sooner, the delays were not material as Mrs M had already been verbally authorised. Although Vitality made an error in not paying for the May 2015 treatment until November 2015, it eventually covered the cost and apologised. The ombudsman considered the £50 compensation offer fair given the overall circumstances and level of service issues.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Vitality Health Insurance Limited, all decisions | 15 | 30% |
| Service failures generally, all decisions | 32,767 | 33% |
| Other regulated product, all decisions | 51,105 | 30% |
Source
Read the original decision on the Financial Ombudsman Service website