When I heard that the Financial Ombudsman Service (FOS) was running an event in Bristol aimed at businesses with little or no experience of the service, I was interested to attend. We’ve not had a complaint and we’ll do all we can to ensure that we never give reason to any of our clients to be dissatisfied.
It was an informal meeting where staff from the FOS and financial services firms shared their experiences, I learnt a lot and found the FOS staff engaging and helpful.
Individual consumers can take out medical insurance, however, most people are covered by a company medical insurance policy taken out by their employer. The FOS is available to both classes of policyholders, to avoid potential issues involving claims, we always recommend following the insurer’s claims process and talking to us as soon as you feel things are not going to plan.
In 2017 the FOS handled around 330 thousand complaints of which 170 thousand related to Payment Protection Insurance (PPI). Understandably the FOS could be looking forward to the 29th of August 2019 as this is the final deadline for new PPI claims. Cases involving private medical insurance remain at a low level, less than 1% of the non-PPI cases, in the financial year of 2008/9 out of 127,471 new cases only 514 disputes involved medical insurance.
Before taking a case to the FOS you must first address your grievance to your insurer or if the dissatisfaction is with your broker to them, after receiving a “final response”, if you disagree with it, then you can take the case to the FOS. The service is free to the consumer but the business you’re unhappy with must pay £550 for each case, win or lose. For smaller claims, the insurers will often pay out to avoid having to pay the FOS’s fee.
There are around 300 individuals acting as Ombudsman, each supported by an investigative team of 4-5 others. Medical insurance cases would be handled by specialists.
You can read in more detail about the types of complaints about medical insurance as there are examples of past cases on the FOS website (http://bit.ly/2BByOlt), the most common cases involve;
- Getting treatment authorised.
- Policy Terms.
- Definitions of “acute and chronic” medical conditions.
- Acute episodes of chronic conditions.
- An insurer deciding an acute condition is now chronic.
- Pre-existing conditions and “moratorium” underwriting.
- Check-ups.
- Experimental and unproven medical treatments.
- Cosmetic treatments.
- Dental treatments covered as part of medical insurance.
- Financial limits for specialists’ fees.
- Conflicting medical opinion.
- Hospital and Consultant choice.
- Cover of overseas treatments.
- Claims for rehabilitation as opposed to treatment.
- Pregnancy and childbirth.
Summary
Hopefully none of our clients will need to take a claim to the FOS, our general advice is to keep in touch with the insurer’s claims team throughout your treatment journey as this avoids most problems. That said medical insurance is a complicated arena dealing as it does with medical opinion and things are not always “black and white” with many areas of grey.
If you have any problems be sure to contact a member of our support team at an early stage.
Financial Ombudsman Service Contact Details
Consumer helpline; 0800 023 4567
Technical advice desk (for businesses and consumer advisors); 0202 7964 1400
