‘It took my insurer four months to settle my medical insurance claim’

Travel Insurance

Diane made a complaint because it took her insurer four months to settle her claim.

What happened

Diane made a complaint because it took her insurer four months to settle her claim. She said this was far too long and had caused her to worry because the hospital where she was being treated started sending her letters about the outstanding bill.

Diane complained to her insurer. Unhappy with the outcome, she referred her complaint to us.

What we said

We asked the insurer to provide their case handling and contact notes. We could see that Diane had submitted her claim form four months ago and the insurer had asked the hospital for information within a week.

The hospital didn’t provide Diane’s records for two months but, when we checked the contact logs, the insurer hadn’t chased the hospital up during that period. The notes showed that the insurer did chase the hospital at the eight-week point and received the notes. But it was a further three weeks before the insurer referred this to their medical officer who confirmed the claim should be paid.

The settlement was paid around four months after the claim was submitted. We worked out there was about eight weeks of actual delay. We also checked the letters the hospital sent to Diane. The letters threatened her with court action.

We explained to the insurer that we thought they should have chased the hospital up sooner, and if they had, it was most likely they’d have got the notes quicker. And if they’d then passed this onto their medical officer within a reasonable timeframe, Diane’s claim would have been settled more quickly. We explained that the letters had caused Diane distress because they threatened court action. So we said the insurer should pay £150 for the distress caused.