Not upheld: premium pricing and renewal cost increase complaint against Western Provident Association Limited (trading as WPA)

Decision detail

Summary

Mr and Mrs L complained about a significant increase in their private medical insurance premium with WPA for 2025, rising by £671.76 (23%) from the previous year. The increase was partly due to their eldest son turning 18 and being reclassified as an adult, and partly due to increased demand for private medical facilities and services. Mr L argued the increase was excessive and disproportionate, and requested more detailed information about the premium calculation. The ombudsman found that WPA had applied the increase consistently to all similar policyholders in accordance with its internal guidelines and actuarial data, and therefore had not treated Mr L unfairly. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman applied the principle that insurers are entitled to decide what risks they cover and what they charge, provided they exercise judgment fairly and consistently. The key test was whether Mr L was singled out for additional costs or whether increases were applied consistently. Since the same increase was applied to all policyholders in similar circumstances, including the reclassification of the son at age 18, and the pricing was based on actuarial data and market conditions, WPA had not treated Mr L unfairly. The ombudsman noted that while more detailed transparency would be desirable, WPA's information provision met regulatory obligations.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website