Not upheld: Travel / life insurance claim disputes complaint against Medicash Health Benefits Limited
Financial Ombudsman decision DRN-5285617 of 2025-02-28T00:00:00+00:00. Travel / life insurance claim disputes complaint against Medicash Health Benefits Limited. Outcome: Not upheld.
Decision detail
| Reference | DRN-5285617 |
|---|---|
| Decision date | 2025-02-28T00:00:00+00:00 |
| Firm | Medicash Health Benefits Limited |
| Product | Other regulated product |
| Claim type | Travel / life insurance claim disputes |
| Outcome | Not upheld |
| Remedy | None. Complaint not upheld. |
Summary
Mr H complained that Medicash partially settled his healthcare cash plan claim by refusing to cover a third-party booking website commission fee. Medicash agreed to pay 50% of the practitioner's fee but declined to contribute to the commission. The ombudsman found the policy terms clear and unambiguous, covering only practitioner fees. Since Mr H could have booked directly with the practitioner to avoid the commission, the ombudsman determined Medicash's settlement was fair and in line with policy terms, and did not uphold the complaint.
The Ombudsman's reasoning
The ombudsman found the policy terms clear and unambiguous in specifying coverage for amounts paid to qualified practitioners. The commission fee charged by the third-party booking website is separate from the practitioner's fee and falls outside the policy's scope. Mr H had a reasonable alternative by booking directly with the practitioner, making it fair for Medicash to decline contribution to the commission.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Medicash Health Benefits Limited, all decisions | 20 | 38% |
| Travel / life insurance claim disputes, all decisions | 20,052 | 31% |
| Other regulated product, all decisions | 47,449 | 30% |
Source
Read the original decision on the Financial Ombudsman Service website