Not upheld: unfair policy administration and premium increase based on residency change complaint against William Russell Europe SRL

Decision detail

Summary

Ms N complained that William Russell unfairly changed her country of residence on her international private medical insurance policy from country A to country H at renewal, resulting in a substantial premium increase. William Russell made the change based on claims history showing nearly all treatment over two years was received in H with no claims in A. The ombudsman found the change was reasonable and fair, as the claims evidence indicated Ms N was residing in H rather than A, and the residency change was necessary to calculate the correct premium as required by the insurer. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that William Russell, acting as intermediary and administrator, reasonably amended Ms N's country of residence based on objective claims evidence showing she had been residing in H rather than A for an extended period. Although Ms N stated her residency was still A, the evidence of almost exclusive treatment in H over two years supported the conclusion that she was living in H. The ombudsman was satisfied William Russell acted appropriately to ensure the correct premium was calculated as required by the insurer.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website