Private Health Insurance Decision Reference 2022-0130

• Case Outcome: Rejected
• Reference: 2022-0130
• Date: 11 April 2022
• Year: 2022
• Subject Matter: Private Health Insurance
• Finantial Sector: Insurance
• Conducts Complained Of: Rejection of claim,Failure to process instructions, Failure to provide product/service information

Decision Ref:

2022-0130

Sector:

Insurance

Product / Service:

Private Health Insurance

Conduct(s) complained of:

Rejection of claim

Failure to provide product/service information

Failure to process instructions

Outcome:

Rejected

LEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN

This complaint concerns a private health insurance policy.

The Complainant’s Case

The Complainant submits that on 3 February 2020 he contacted the Provider to check the

cover under his policy regarding maternity benefit for his wife for homebirth expenses. The

Complainant states that he and his wife arranged for homebirth services through a midwife,

hereto referred to as “Ms. M”. He states that Ms. M made some visits to his house to

prepare for the homebirth while his wife attended the public scheme for her normal pre-

natal care. The Complainant maintains that because his wife had medical complications she

could not go ahead with the homebirth and was admitted to hospital as a public patient for

delivery in July 2020.

The Complainant states that the partial expenses for the midwife in providing the homebirth

services amounted to €700 which the Complainant submits he paid. The Complainant

submits that in September 2020 he made a claim to the Provider for the midwife expenses

using the receipt from the midwife, through the Provider’s online app but his claim was

rejected by the Provider on 25 September 2020.