Not upheld: Service failures generally complaint against BUPA Insurance Limited
Financial Ombudsman decision DRN-6298932 of 2026-06-29T00:00:00+00:00. Service failures generally complaint against BUPA Insurance Limited. Outcome: Not upheld.
Decision detail
| Reference | DRN-6298932 |
|---|---|
| Decision date | 2026-06-29T00:00:00+00:00 |
| Firm | BUPA Insurance Limited |
| Product | Other regulated product |
| Claim type | Service failures generally |
| Outcome | Not upheld |
| Remedy | No additional remedy. The £50 compensation already offered by BUPA is deemed fair and sufficient. |
Summary
Ms S complained that BUPA poorly handled her daughter's physiotherapy claim after the BUPA-recommended provider was not BUPA-recognised and therefore not eligible for funding. BUPA provided Ms S with alternative provider lists, but none were suitable for treating children as young as her daughter, forcing Ms S to pay privately for treatment. BUPA declined to reimburse the costs but acknowledged causing inconvenience by providing an incorrect initial list and offered £50 compensation. The ombudsman found BUPA's decision not to fund the non-recognised provider was reasonable under the policy terms and that the £50 compensation was fair, therefore not upholding the complaint.
The Ombudsman's reasoning
The ombudsman found that while the situation was disappointing for Ms S, BUPA cannot guarantee a suitable provider can always be found from its list. The policy terms clearly state cover is limited to BUPA-recognised providers. Although BUPA provided an incorrect initial list, it quickly provided an updated list of paediatric providers. The ombudsman concluded BUPA did not act unfairly in declining to fund treatment with a non-recognised provider, and the £50 compensation for the inconvenience of the incorrect list was fair and reasonable.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| BUPA Insurance Limited, all decisions | 916 | 22% |
| Service failures generally, all decisions | 34,193 | 32% |
| Other regulated product, all decisions | 47,449 | 30% |
Source
Read the original decision on the Financial Ombudsman Service website