Upheld: Home insurance claim disputes complaint against Medicash Health Benefits Limited

Decision detail

Summary

Mr H complained about Medicash's handling of a claim for prescribed contact lenses under a group cash plan. Mr H submitted his claim via the app and simultaneously sent a confirmation email as proof of purchase. The initial claims handler only reviewed the app submission and requested additional documentation. Medicash subsequently made unclear and inconsistent requests for supporting evidence, citing missing letterhead or logo without having informed Mr H of this requirement. Although the claim was ultimately accepted and paid within six days, the ombudsman found that Medicash caused unnecessary frustration through its unclear communication and inconsistent application of requirements, and ordered £25 compensation.

The Ombudsman's reasoning

While Mr H should have submitted all documentation via the app as required by Medicash's process, Medicash's handling of the claim caused unnecessary frustration through unclear communication and inconsistent application of its requirements. Medicash did not explain why the confirmation email was insufficient, later citing missing letterhead or logo without having informed Mr H of this requirement. The ombudsman found that Medicash should have accepted the claim once it became aware of the confirmation email, particularly given that it had previously accepted similar documentation from Mr H. Although the claim was ultimately paid within a reasonable timeframe, the assessment process involved avoidable confusion and frustration.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website