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.
Reena contacted us after getting into a dispute with her insurer over delayed treatment.
She told us she’d claimed on her medical insurance policy following an accident which left her needing physiotherapy. However, before Reena was able to start her treatment, it was put on hold due to the Covid-19 pandemic.
Reena said that, because she felt she couldn’t use the benefits of the policy, she’d cancelled it. But she wasn’t happy that she’d continued to pay the premiums while the treatment she’d wanted was unavailable. She said she’d been offered an alternative treatment, but wanted the one she’d already had authorised.
Reena explained that she’d asked her insurer either to refund her for the premiums she’d paid during this time, or to agree to pay for her treatment later on, once this was possible.
In its response to Reena’s complaint, the insurer wouldn’t agree to either option. So she asked us to step in.
What we said
In the context of the pandemic, private medical facilities were being used to support the NHS – which had affected the treatments the insurer was able to offer.
Looking at how the insurer had responded, and the terms of its policy, we were satisfied it would have provided Reena with appropriate alternative treatment. So we explained to Reena we didn’t think it was fair to ask it to refund the premiums she had paid.
Likewise, the policy terms said that treatment would only be paid for while cover was in place – even if it had been authorised before then. Reena had made the decision to cancel her policy.
Given everything we’d seen, we didn’t tell the insurer to take further action.
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