Not upheld: claims handling - alleged mis-selling/misleading information regarding scope of appointment complaint against Aviva Insurance Limited

Decision detail

Summary

Miss K complained that Aviva Insurance Limited mishandled her private medical insurance claim by arranging a consultation-only appointment when she expected to have a colposcopy procedure, and charged her the £250 excess for an unnecessary appointment. She had called Aviva on 16 July 2025 seeking faster private treatment for an abnormal smear test result. The ombudsman reviewed the phone call recording and found that the adviser adequately explained the appointment would be a consultation first, making clear that procedures would only occur after specialist assessment. The ombudsman concluded Aviva acted reasonably and was entitled to charge the excess as Miss K attended the authorized appointment, and therefore did not uphold the complaint.

The Ombudsman's reasoning

The ombudsman found that the adviser made it sufficiently clear the initial appointment would be a consultation only, without procedures. The adviser asked relevant questions and understood Miss K's medical needs. While Miss K focused on the colposcopy not being performed at the first appointment, the ombudsman considered this part of a course of investigations and found no incompatibility with her request for flexibility. The ombudsman was not persuaded Miss K was misled, as the need for an initial consultation before further investigations was adequately communicated.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website