Not upheld: Account administration errors complaint against BUPA Insurance Limited

Decision detail

Summary

Mr J complained that BUPA failed to administer his personal private medical insurance policy fairly after the broker provided incorrect address details, resulting in Mr J not receiving policy documents. Mr J claimed he did not understand the cover and could not benefit from it, requesting a premium refund. The ombudsman found BUPA reasonably relied on the broker's address information, had no indication it was wrong, and fulfilled its obligation to provide policy information. The ombudsman rejected the premium refund claim as Mr J had the benefit of cover and could have contacted BUPA for clarification at any time. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that BUPA reasonably relied on address details provided by the broker acting on Mr J's behalf and had no grounds to suspect the information was incorrect. BUPA fulfilled its regulatory obligation to provide appropriate policy information in good time by sending welcome letter, policy certificate, and terms to the address it held. There was nothing to alert BUPA that the broker had provided wrong information, as no post was returned and Mr J did not contact BUPA or the broker about non-receipt. Mr J had the benefit of policy cover and could have contacted BUPA at any time for clarification or document copies. Therefore, BUPA was entitled to retain premiums for the risk it covered.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website