Not upheld: Home insurance claim disputes complaint against BUPA Insurance Limited

Decision detail

Summary

Mr G complained about BUPA's handling of multiple insurance claims under his private medical insurance policy, including delays in processing an eye condition claim and a subsequent cyst claim that led him to seek treatment abroad. BUPA acknowledged service failings and paid Mr G reimbursement, interest, and £900 compensation. The ombudsman found BUPA's initial request for claim validation information was reasonable, its errors were appropriately remedied, the compensation was fair, and the foreign treatment was not caused by BUPA delays. The ombudsman also found an alleged discriminatory remark was a reasonable analogy in context. The complaint was not upheld and no further action was required.

The Ombudsman's reasoning

The ombudsman found that BUPA's initial request for GP information to validate the claim and confirm it was not pre-existing was reasonable under the policy terms. While BUPA made errors in not accepting the further completed form and in reimbursement processing, these were acknowledged and remedied through reimbursement, interest, and £900 compensation. For the cyst claim, the short timeframe between the appointment request (22 March) and foreign treatment (28-29 March) meant BUPA did not cause a delay necessitating foreign treatment. The 'corner shop' remark was used as an analogy in context and was not unreasonable or derogatory. The £900 compensation was found reasonable for substantial distress over a sustained period caused by BUPA's errors.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website