Not upheld: Account administration errors complaint against Medicash Health Benefits Limited

Decision detail

Summary

Ms U complained that Medicash refused to reinstate her private medical insurance policy after it was cancelled due to non-payment of premiums caused by a bank error. Following Ms U's payment of arrears in September 2024, she claimed she was told the direct debit would continue, but Medicash subsequently sent a new direct debit mandate which Ms U did not complete. Medicash cancelled the policy in October 2024 when premiums remained more than six weeks in arrears. The ombudsman found Medicash acted in accordance with its policy terms and took reasonable steps to notify Ms U, placing responsibility on her as the policyholder to ensure premiums were paid. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that Medicash's policy terms clearly permitted cancellation when premiums were more than six weeks in arrears. Although Ms U claimed she was told the direct debit would be reinstated, Medicash subsequently sent a letter requesting a new direct debit mandate, which should have alerted her to take action. The ombudsman considered Medicash took reasonable steps by sending correctly addressed letters and was not obliged to pursue alternative contact methods. The ombudsman placed responsibility on Ms U as the policyholder to ensure premiums were paid and to verify that the direct debit had been reinstated after paying arrears in September 2024.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website