Not upheld: misrepresentation of policy cover scope complaint against BUPA Insurance Limited
Financial Ombudsman decision DRN-6018125 of 2026-05-15T00:00:00+00:00. misrepresentation of policy cover scope complaint against BUPA Insurance Limited. Outcome: Not upheld.
Decision detail
| Reference | DRN-6018125 |
|---|---|
| Decision date | 2026-05-15T00:00:00+00:00 |
| Firm | BUPA Insurance Limited |
| Product | Other regulated product |
| Claim type | misrepresentation of policy cover scope |
| Outcome | Not upheld |
| Remedy | Bupa to pay for the MRI scan (outside policy terms) and provide £150 compensation for distress and inconvenience. The ombudsman notes this offer should be accepted by Mr H if not already paid. |
Summary
Mr H, a retired armed forces member, complained that Bupa misrepresented his private medical insurance cover by not clearly excluding non-emergency overseas treatment for veterans. On 24 July 2025, he received conflicting advice about coverage for an MRI scan abroad. The ombudsman examined the policy terms, insurance certificate, and IPID, finding that the documentation clearly stated overseas treatment was not covered except for emergency treatment on temporary trips and non-emergency treatment for serving personnel stationed overseas. The ombudsman concluded the policy wording was clear and unambiguous, the conflicting advice was an isolated adviser error, and Bupa's offer to pay for the scan and provide £150 compensation was reasonable and proportionate. The complaint was not upheld.
The Ombudsman's reasoning
The ombudsman applied regulatory principles requiring financial businesses to provide clear, fair and not misleading information. The policy documentation explicitly states that overseas treatment is not covered as a standard benefit, with an exception only for serving personnel stationed overseas. The terms 'stationed overseas' and 'temporarily travelling' are unambiguous and would be understood by a veteran. While Mr H received conflicting advice on one occasion, this was an isolated mistake by one adviser, not a systemic failing. Bupa's offer to pay for the scan and provide compensation was reasonable and proportionate.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| BUPA Insurance Limited, all decisions | 913 | 23% |
| Other regulated product, all decisions | 52,408 | 30% |
Source
Read the original decision on the Financial Ombudsman Service website