Upheld: Other regulated complaint complaint against USAY BUSINESS LTD

Decision detail

Summary

Mr C complained that Usay Business Ltd mis-sold him a private medical insurance policy when renewing his coverage. His new policy did not include physiotherapy coverage as standard, whereas his old policy did, and Usay failed to advise him to purchase the additional therapies module. When Mr C later made a claim for physiotherapy treatment costing £700, it was declined. Usay initially offered £250 compensation but then withdrew it. The ombudsman upheld the complaint, finding that Usay had failed to ensure suitable, like-for-like cover despite understanding Mr C's requirements from sales calls. The ombudsman ordered Usay to pay £700 for the treatment costs plus £250 compensation for distress and poor service handling.

The Ombudsman's reasoning

As an advised sale, Usay had a duty to ensure the policy was suitable for Mr C's needs. The sales calls clearly demonstrated Mr C wanted like-for-like cover compared to his existing policy. Usay failed to highlight that physiotherapy was not included as standard in the new policy and did not advise on the therapies module. Sending policy terms after the sale was insufficient to remedy the shortcomings during the sale itself. Mr C was entitled to rely on information given by the sales adviser during the phone call to make an informed decision. Usay's inconsistent handling of the complaint and continued contact about reinstating the policy compounded the poor service.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website