‘My insurer turned down my claim for a caesarean section, even though it was essential’

Insurance Distress and inconvenience Up to £5,000 Medical Conditions

Jasmine made a complaint because the insurer declined her claim for a caesarean section. 

What happened

Jasmine made a complaint to us because her insurer declined her claim for a caesarean section.

When she’d bought the policy she had explained that she had difficult childbirths in the past. So it was important to her, if she was given medical advice to have a caesarean, she’d be covered. She said she’d made this clear when she bought the policy.

Jasmine experienced a considerable amount of stress when she was informed later in her pregnancy that her insurer wouldn’t accept her claim, and felt she was misled to believe she was covered. 

What we said

We looked into the sale, which had taken place via a broker. We found that Jasmine had been told that she’d be covered if her consultant told her she needed a caesarean. We also asked for more medical evidence from Jasmine to find out why her consultant thought there was a specific risk to her life as a result of natural labour. We also checked with two leading insurers to find out if they’d have offered Jasmine cover. Both said it was unlikely they’d have offered her cover.

We explained to Jasmine that we didn’t think it was fair for the broker to pay the cost of her caesarean as, if she’d been given the right advice, it was unlikely she’d have got cover from another insurer.

But we told the broker to make an award of £2000 to reflect the distress and inconvenience caused to Jasmine, particularly throughout the later stages of her pregnancy.

We also directed the broker to refund the premiums as the policy wasn’t suitable for Jasmine.