Private Health Insurance Decision Reference 2023-0287

• Case Outcome: Partially upheld
• Year: 2023
• Date: 20 December 2023
• Reference: 2023-0287
• Subject Matter: Private Health Insurance
• Finantial Sector: Insurance
• Conducts Complained Of: Fees & charges applied ,Dissatisfaction with customer service

Decision Ref:

2023-0287

Sector:

Insurance

Product / Service:

Private Health Insurance

Conduct(s) complained of:

Fees & charges applied

Dissatisfaction with customer service

Outcome:

Partially upheld

LEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN

This complaint relates to a health insurance policy (the “Policy”).

The Complainant’s Case

The Complainant submits that she has been a policyholder with the Provider for many

years. The Complainant submits that her mother sadly died on 4 December 2020. The

Complainant says that her late mother (the “Deceased”) was named on the Complainant's

policy “for more than thirty years.” The Complainant submits that the Deceased’s “policy

only ceased due to her death on 4 December 2020.” The Complainant further states that

the premium for the policy in question was paid in full for 2020. The Complainant contends

that the Provider made a commitment to review claims for the period August 2020 to

December 2020, and to pay policyholders in the form of a €75.00 (seventy-five euro)

premium waiver owing to a reduced number of claims by policyholders as a result of the

Covid-19 pandemic. The Complainant submits that the Provider was in a position to make

this commitment on the basis of reduced claims by existing policyholders in the period in

question. The Complainant submits that the Provider declined to pay the premium waiver

for the Deceased.

The Complainant submits that it took “several attempts” to obtain clarity from the

Provider with regard to availability of a refund of the 2020 premium paid for the period 5