Upheld: Service failures generally complaint against Medicash Health Benefits Limited

Decision detail

Summary

Ms S complained about how Medicash Health Benefits Limited handled her claim for a £25 dental treatment contribution. Although Medicash initially requested additional documentation, which Ms S found difficult to provide due to system limitations, the core issue was poor customer service during a 27-minute phone call on 9 March 2023. The adviser was unclear about upload capabilities, spoke over Ms S, came across as rude, and hung up abruptly. While Medicash apologised days later and processed the claim on 14 March 2023, the ombudsman found this insufficient and upheld the complaint, awarding £50 compensation for distress and inconvenience. The ombudsman rejected Ms S's claims regarding overdraft fees, finding no undue delay in claim processing.

The Ombudsman's reasoning

Medicash acted reasonably in initially declining the claim as the documentation provided did not meet the contractual requirements. However, Medicash acted unfairly and unreasonably in its handling of the phone call on 9 March 2023. The adviser's tone was unfortunate, the explanation about document upload was unclear and confusing, and the abrupt termination of the call without explanation was not fair or reasonable. While Medicash apologised days later, this was insufficient given the nature of the poor service. There was no undue delay in processing the claim, so overdraft fees cannot be attributed to Medicash's actions.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website