Not upheld: claims handling - clarity of communication and timeliness complaint against BUPA Insurance Limited

Decision detail

Summary

Mr P complained about Bupa's handling of a cash plan claim for two osteopathy sessions. Bupa sent conflicting SMS messages - one confirming payment of £70 and another stating the claim couldn't be processed due to missing receipt information. Mr P was confused because both sessions cost £70 and he didn't know which was accepted. After Mr P emailed Bupa, it clarified that only one invoice had been received and asked him to resubmit the missing invoice, which he did and was paid. The ombudsman found the SMS message could have been clearer but was sufficiently informative, Bupa provided contact details, and Bupa responded to Mr P's emails within its service standards, so the complaint was not upheld.

The Ombudsman's reasoning

The ombudsman applied FCA rules requiring insurers to handle claims promptly and fairly. While acknowledging the SMS message could have been clearer, the ombudsman found it was sufficiently clear that Bupa could not process the claim and provided contact details for questions. Bupa responded to Mr P's communications within its stated service standards of five working days. The ombudsman could not determine what happened with the portal submission but found Bupa's response to notify Mr P of the problem was reasonable.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website