Upheld: PPI mis-selling complaint against USAY BUSINESS LTD
Financial Ombudsman decision DRN-5441565 of 2025-03-31T00:00:00+00:00. PPI mis-selling complaint against USAY BUSINESS LTD. Outcome: Upheld.
Decision detail
| Reference | DRN-5441565 |
|---|---|
| Decision date | 2025-03-31T00:00:00+00:00 |
| Firm | USAY BUSINESS LTD |
| Product | Other regulated product |
| Claim type | PPI mis-selling |
| Outcome | Upheld |
| Remedy | Usay must pay: (1) the cost of surgery to Mr E's right elbow (£7,950) less the difference in premiums between the mis-sold policy (£62.69) and the alternative policy (£74.75), which equals a net deduction of £12.06; (2) 8% simple interest per annum from the date surgery was paid until settlement; (3) £500 total compensation for distress and inconvenience caused. |
Summary
Mr E complained that Usay mis-sold him a private medical insurance policy in November 2023 by representing it would cover semi-professional/professional sports training when it did not. When Mr E sustained injuries to both elbows in February 2024 while training, his claim was declined. Mr E incurred £15,720 in private surgery costs due to long NHS wait times. The ombudsman upheld the complaint, finding the policy was indeed mis-sold. However, the ombudsman determined that only the right elbow surgery costs (£7,950) would have been covered under a suitable alternative policy, as the left elbow had pre-existing arthritis that would have been excluded. Usay was ordered to pay the right elbow surgery costs less the premium difference between the two policies, plus 8% interest and £500 compensation for distress and inconvenience.
The Ombudsman's reasoning
The ombudsman found that Usay mis-sold the policy by representing it would cover semi-professional/professional sports training when it did not. The ombudsman applied the principle of placing the consumer in the position they would have been if the error had not occurred. While the left elbow injury would likely not have been covered under an alternative policy due to pre-existing arthritis, the right elbow injury would have been covered. Therefore, compensation was limited to the right elbow surgery costs (£7,950), adjusted for the premium difference between the two policies, plus 8% simple interest and £500 for distress and inconvenience.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| USAY BUSINESS LTD, all decisions | 8 | 62% |
| PPI mis-selling, all decisions | 85,732 | 25% |
| Other regulated product, all decisions | 51,105 | 30% |
Source
Read the original decision on the Financial Ombudsman Service website