Not upheld: Motor insurance, claim handling complaint against AXA PPP Healthcare Limited (trading as AXA Health)

Decision detail

Summary

Mr P complained that AXA PPP Healthcare was requiring him to pay the excess twice for the same claim because his final appointment fell after the policy renewal date of 1 April 2024. AXA declined to cover the final invoice of £90 as it was subject to the excess for the 2024-25 policy year. The ombudsman found that the policy terms clearly state the excess applies per policy year, and that Mr P was provided with clear information about the renewal date through the membership certificate, the pre-authorisation call, and the claim update letter. The ombudsman concluded that AXA acted reasonably and in accordance with the policy terms, and therefore did not uphold the complaint.

The Ombudsman's reasoning

The ombudsman found that the policy terms clearly state the excess applies per policy year, not per claim, and that if a claim spans multiple policy years, an excess applies in each year. Mr P was provided with clear information about the renewal date and how the excess works through the membership certificate, the January call, and the February claim update letter. The ombudsman concluded that AXA acted in accordance with the policy terms and provided fair, clear, and timely information, and therefore did not act unreasonably in declining to cover the final invoice.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website