Upheld: failure to make reasonable adjustments; poor communication; service complaint complaint against Simplyhealth Access

Decision detail

Summary

Mr E complained that Simplyhealth Access failed to make reasonable adjustments when communicating with him about his insurance policies and provided poor service. He alleged a handler promised to waive his first month's premium, which was not done, and that handlers were rude to him. The ombudsman upheld the complaint regarding reasonable adjustments, finding that despite knowing Mr E had difficulty reading letters, Simplyhealth failed to read out the final response letter when he requested it multiple times. While the decision not to waive premiums was reasonable, the firm failed to communicate this decision effectively. The ombudsman rejected complaints about handler rudeness and data security, finding handlers were professional and confidentiality agreements were in place. The ombudsman awarded £150 compensation for the failure to make reasonable adjustments and resulting distress.

The Ombudsman's reasoning

The ombudsman found that while Simplyhealth was not obligated to waive premiums and acted reasonably in declining to do so, it failed to communicate this decision effectively or within a reasonable timeframe. More significantly, Simplyhealth failed to make reasonable adjustments by not reading out the final response letter to Mr E despite his explicit requests and despite being aware of his difficulties with written correspondence. The ombudsman found the handlers were professional and that concerns about background staff were addressed by confidentiality agreements. The failure to accommodate Mr E's reasonable adjustment request caused unnecessary distress.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website