Not upheld: misleading information / failure to provide clear information about policy limits complaint against BUPA Insurance Limited

Decision detail

Summary

Mr R complained that BUPA misled him into believing that twenty approved therapy sessions would be fully covered by his policy, when in fact his £1,000 annual therapies allowance was exhausted by the tenth session at £110 per session. BUPA's confirmation letter stated both the twenty-session approval and the £1,000 allowance limit, and Mr R received regular updates showing session costs and remaining balance. The ombudsman found the communications were clear and not misleading, and that Mr R had sufficient information to calculate that twenty sessions would exceed his allowance. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that the initial confirmation letter clearly stated both that Mr R was covered for twenty sessions and that the cost would come from his limited therapies allowance of £1,000. The letter included a statement that Bupa would inform him if there was anything he needed to pay, which should have alerted him to the possibility of exhausting the allowance. Furthermore, Mr R received regular update communications clearly showing each session cost £110, which would have allowed him to calculate that twenty sessions would exceed his £1,000 allowance. The ombudsman concluded that Bupa's communications met regulatory requirements for clarity, fairness and timeliness, and that the firm was entitled to assume Mr R could receive and monitor communications via his digital account without requiring special adjustments.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website