Not upheld: Service failures generally complaint against Medicash Health Benefits Limited
Financial Ombudsman decision DRN-4646059 of 2024-03-25T00:00:00+00:00. Service failures generally complaint against Medicash Health Benefits Limited. Outcome: Not upheld.
Decision detail
| Reference | DRN-4646059 |
|---|---|
| Decision date | 2024-03-25T00:00:00+00:00 |
| Firm | Medicash Health Benefits Limited |
| Product | Payday / short-term credit |
| Claim type | Service failures generally |
| Outcome | Not upheld |
| Remedy | None |
Summary
Mrs J complained that Medicash unfairly cancelled her health insurance policy and discriminated against her by offering an alternate policy not available to the general public. Mrs J had made numerous valid claims over several years for treatments related to pre-existing conditions, leading Medicash to withdraw her cover. The ombudsman found that Medicash acted within its contractual rights by providing 31 days' notice of cancellation and that offering a tailored alternate policy to customers with similar claims history did not constitute unfair treatment or discrimination. The complaint was not upheld.
The Ombudsman's reasoning
The ombudsman found that Medicash acted within the contractual terms which permitted withdrawal of cover with 28 days' notice. The decision to withdraw cover based on claims costs is a legitimate commercial decision for an insurer. The offering of an alternate policy tailored to customers with similar claims history does not constitute discrimination, as Medicash was not obliged to offer any alternative and the restricted availability is justified by the claims history requirement.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Medicash Health Benefits Limited, all decisions | 20 | 38% |
| Service failures generally, all decisions | 34,193 | 32% |
| Payday / short-term credit, all decisions | 9,917 | 50% |
Source
Read the original decision on the Financial Ombudsman Service website