Not upheld: service failure in claim handling - hospital referral errors complaint against BUPA Insurance Limited

Decision detail

Summary

Mr R complained that BUPA provided unsuitable hospital recommendations for his son's spine x-ray in March 2025, with the first hospital only accepting consultant referrals and the second lacking an x-ray facility. BUPA apologised for these errors and offered compensation that was increased from £150 to £600. Mr R claimed the delay contributed to his son's scoliosis diagnosis and requested additional compensation. The ombudsman found no medical evidence supporting the causal link between BUPA's two-month delay and the scoliosis, noting the spinal issues likely pre-existed based on a previous authorisation from May 2024, and determined the £600 compensation was fair and reasonable.

The Ombudsman's reasoning

The ombudsman found that while BUPA made errors in recommending unsuitable hospitals, it provided alternative options and apologised for the mistakes. Although the errors caused distress and inconvenience, including Mr R taking unpaid leave and his son missing school, the £600 compensation was considered fair. The ombudsman rejected Mr R's claim that BUPA's two-month delay caused the scoliosis diagnosis, noting that Mr R had been given authorisation for the x-ray almost a year earlier, suggesting the spinal issues pre-existed and were not solely caused by BUPA's actions.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website