Not upheld: Unknown / needs review complaint against USAY BUSINESS LTD

Decision detail

Summary

Mr and Mrs S complained that Usay Business Ltd mis-sold them a private medical insurance policy by failing to disclose limitations on hospital and consultant choice. They discovered upon making a claim that they could not choose a hospital near their home. The ombudsman found the policy was suitable for their needs and that they received adequate information through written documents and a 14-day cooling-off period, despite the adviser's failure to explain the hospital list during the sales call. The ombudsman concluded that even with fuller explanation, Mr and Mrs S would likely have proceeded with the policy. The ombudsman upheld Usay's offer of £200 compensation as fair and reasonable for the lack of clarity during the sales call.

The Ombudsman's reasoning

The ombudsman found that as an advised sale, the firm needed to ensure the policy was suitable and provide sufficient information. The policy was not fundamentally unsuitable as Mr and Mrs S had not expressed a requirement for unrestricted choice of hospitals or consultants. Although the firm failed to explain the hospital list during the call, Mr and Mrs S received adequate information through written documents and had a 14-day cooling-off period to query or cancel. The ombudsman concluded that even with fuller explanation, Mr and Mrs S would likely have proceeded with the policy. The £200 compensation fairly reflected the impact of the loss of expectation.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website