Consumer complains insurer should honour treatment after policy is cancelled

Insurance Distress and inconvenience Up to £100

Stuart contacted us after his insurer said it wouldn't pay for treatment it had originally agreed to pay for.

What happened

Stuart had the benefit of private medical insurance through his work.  He required a further course of physiotherapy for an ongoing knee problem. The insurer confirmed that this shouldn’t be a problem but advised that it would require a report from his physiotherapist, which it would arrange.

Later that day the insurer updated its records and noted that Stuart’s employer had cancelled its company policy the previous day. The insurer quickly contacted Stuart and apologised, it also offered Stuart a retail voucher for £25. Stuart rejected that offer and said the insurer should honour the treatment it had agreed to earlier.

What we said

We didn’t agree with Stuart that the insurer had any obligation to provide the physiotherapy treatment. The contract had been cancelled and the policy clearly explained that this meant no further cover would be provided. We accepted that if the insurer had updated its records sooner, Stuart would have been saved the disappointment of thinking he would receive further treatment. However, as he had been notified of the correct position quickly and his expectation the claim would be met had been short lived, we felt that the insurer’s apology and gesture in the form of a voucher was fair.