Private Health Insurance Decision Reference 2022-0375

• Case Outcome: Rejected
• Reference: 2022-0375
• Date: 29 November 2022
• Year: 2022
• Subject Matter: Private Health Insurance
• Finantial Sector: Insurance
• Conducts Complained Of: Delayed or inadequate communication,Lapse/cancellation of policy, Premium rate increases

Decision Ref:

2022-0375

Sector:

Insurance

Product / Service:

Private Health Insurance

Conduct(s) complained of:

Delayed or inadequate communication

Lapse/cancellation of policy

Premium rate increases

Outcome:

Rejected

LEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN

This complaint relates to a health insurance policy held with the Provider.

The Complainant’s Case

The Complainant submits that in April 2018, his father removed him as a member from a

family policy. The Complainant states that he was not aware that he had been removed

from cover, as he was not notified by either his father or the Provider. He submits that he

was without health insurance for more than a year, without knowing this, and that following

his discovery of this, he sought health insurance from the Provider in 2019 and was informed

that because there had been a break in cover between policies, there would be a waiting

period applied to the new policy for certain aspects of cover. The Complainant states that

if he had been aware that the break in cover, would result in waiting periods, he would have

ensured that he had cover immediately following his removal.

The Complainant states that in September 2019, he sought to make a claim on the policy in

respect of a desired medical procedure, but he was unable to have this treatment because

the Provider declined to cover it. The Complainant states that the Provider was previously

aware of his medical history and that the procedure was routine, and not due to any

worsening of the condition. The Complainant states that he was not a new customer, and

he believes that it is unfair that he is being required to go through the waiting periods. He

says that it is as if being a customer for 26 years, has “amounted for nothing.”