Partially upheld: Service failures generally complaint against Medicash Health Benefits Limited

Decision detail

Summary

Mr B complained about how Medicash handled a health cash plan claim for glasses. After his policy started on 29 April 2024, Mr B called Medicash on 3 May to ask about qualifying periods and was told he had full use of his benefits. He then purchased glasses and submitted a claim on 4 May. When Mr B chased the claim on 14 May, Medicash told him it wouldn't be paid until his first premium was received, but gave an incorrect premium due date. The ombudsman found that while Medicash was entitled to refuse payment until the premium was received under the policy terms, the firm should have clarified this when Mr B first called, causing him unnecessary distress. The complaint was upheld in part with £50 compensation awarded.

The Ombudsman's reasoning

The ombudsman found that Medicash acted fairly in refusing to pay the claim until the first premium was received, as this was in accordance with the policy terms. However, Medicash had two clear opportunities (on 3 May and 14 May) to inform Mr B that his claim would not be paid until after the first premium payment was received. By failing to do so, Medicash caused Mr B unnecessary distress and inconvenience, particularly when Mr B was chasing the claim status.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website