Upheld: Unknown / needs review complaint against HEATH CRAWFORD LTD

Decision detail

Summary

Mr G and Mrs W complained that Heath Crawford mis-sold a private medical insurance policy by failing to adequately highlight that the new policy with underwriter B excluded certain scans and consultations that were covered under the previous policy with underwriter A. Mr G discovered this limitation when a claim was declined and cancelled the policy in June 2025. Heath Crawford offered to reimburse excluded costs up to cancellation and later offered £250 compensation. The ombudsman upheld the complaint but found Heath Crawford's offer fair and reasonable, as it effectively provided like-for-like cover at a lower premium than Mr G would have paid for full cover, and rejected claims for costs incurred after cancellation as these would constitute free cover. The ombudsman required Heath Crawford to pay £250 compensation.

The Ombudsman's reasoning

The ombudsman accepted that Heath Crawford made a mistake by failing to adequately highlight the policy limitation. However, the firm's offer to reimburse the cost of excluded scans and consultations up to the cancellation date effectively provided Mr G with like-for-like cover at the lower premium of £3,000, which was better than any option available to him had the limitation been properly disclosed (either £3,000 for reduced cover or £3,800 for full cover). The ombudsman rejected claims for costs incurred after cancellation, as this would provide free cover without premium payment, which was never a realistic option. The £250 compensation adequately addresses the non-financial loss from disappointment and loss of expectation.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website