Dental Expenses Insurance Decision Reference 2025-0210

• Case Outcome: Rejected
• Year: 2025
• Reference: 2025-0210
• Date: 22 December 2025
• Subject Matter: Dental Expenses Insurance
• Finantial Sector: Insurance
• Conducts Complained Of: Rejection of claim,Failure to process instructions

Decision Ref:

2025-0210

Sector:

Insurance

Product / Service:

Dental Expenses Insurance

Conduct(s) complained of:

Rejection of claim

Failure to process instructions

Outcome:

Rejected

LEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN

Background

This complaint refers to the Complainants health insurance policy and the Provider’s

decision to decline the Complainant’s dental claim.

The Complainant’s Case

The Complainant says that she attended a dental practice on 8 April 2021 and had her

teeth cleaned. She notes that she needed to have a dentist to clean her teeth, and not a

dental hygienist, in order to for her health insurance policy to cover the procedure.

The Complainant states that the dentist on this date stated that he did not perform

cleanings. The Complainant submitted a claim for the procedure, and this was declined.

The Complainant argues that there is no difference between the procedure in terms of

outcome when a dentist or a hygienist completes the work. She notes that on a previous

occasion, she submitted a claim when a dentist cleaned her teeth and that this was

accepted by the Provider.

The Complainant is complaining about the term in her policy that requires that the dental

cleaning must be carried out by a dentist.