Not upheld: claims handling delays and service failures complaint against AXA PPP Healthcare Limited

Decision detail

Summary

Ms C complained about AXA PPP Healthcare Limited's handling of two insurance claims: a knee injury claim in February 2025 and a request for authorisation of ongoing psychological treatment in April 2025. For the knee claim, Ms C experienced difficulties with AXA's webchat service, repeated requests for the same information, and disconnected chats before approval on 27 February 2025. For the psychological treatment claim, AXA failed to meet its 12 working day review commitment, did not respond to three chasers, and only authorised the claim on 7 July 2025—approximately five weeks after Ms C submitted the required evidence. AXA paid £250 in total compensation (£50, £100, and £100 in separate payments). The ombudsman found AXA's settlement fair and reasonable, concluding that while the mistakes caused unnecessary trouble and inconvenience, they were relatively modest, resolved within weeks, and did not prevent Ms C from receiving treatment or negatively impact her medical conditions.

The Ombudsman's reasoning

The ombudsman acknowledged that AXA made clear claims handling mistakes in both the knee claim (repeated requests for information, disconnected chats) and psychological treatment claim (failure to meet 12 working day review commitment, lack of response to three chasers, delay of approximately five weeks). However, the ombudsman found these mistakes were relatively modest in nature, resolved within a few weeks, and ultimately did not prevent Ms C from receiving the treatment she needed. The ombudsman found no persuasive evidence that Ms C's medical conditions were negatively impacted by the delays. The ombudsman determined that the total compensation of £250 already paid was fair, reasonable and proportionate to reflect the likely impact of AXA's mistakes.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website