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Case studies

Our case studies provide examples of how we've helped people, based on real-life cases.

They set out our usual approach to settling complaints about financial businesses, but are not a definitive statement of the law or our procedure. 

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Reena’s medical treatment was delayed due to Covid-19

Reena was unhappy that her insurer wouldn’t refund her premiums when her medical treatment was delayed due to Covid-19. We established that the insurer had offered an alternative treatment – at a time when its facilities were being used by the NHS. We decided the insurer had acted fairly.

Private Medical Insurance Covid-19

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‘My insurer wouldn’t pay for my breast reduction surgery because they said it was a cosmetic treatment’

Leila’s insurer declined her claim for breast reduction surgery she made through her private medical insurance policy. The insurer said cosmetic treatments such as Leila’s surgery weren’t covered under the policy terms.

Private Medical Insurance

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‘My insurer won’t pay for my preventative treatment’

Talia complains her private medical insurer won’t cover her for preventative treatment.

Insurance Private Medical Insurance Medical Conditions

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‘My insurer turned down my claim for an acute flare-up of my chronic condition’

Dylan raised a complaint when his private medical insurance claim was turned down. The insurer believed the claim arose due to him having a chronic condition.

Insurance Private Medical Insurance

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Insurer wouldn’t pay for treatment at eye appointment because it was not pre-authorised

Erin complained when her insurer refused to pay for treatment at her eye appointment.

Private Medical Insurance Insurance

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