Claims Are Increasing Across all Markets, Including Medical Insurance

Across the 2023/24 financial year, the Financial Ombudsman Service (FOS) took on 11.7% more private medical insurance (PMI) or dental cases.

Data released this morning reveals that the Ombudsman took on 1,621 new cases, made 313 decisions, and upheld 27% of complaints. In comparison, the previous financial year saw 1,451 cases with a 16% uphold rate.

Across protection sectors, trends remained similar to the previous year, except for whole of life assurance (reviewable), where the Ombudsman upheld 10% more complaints.

Delving into specific product segments:

Income Protection: There were 792 enquiries, with the Ombudsman handling 635 new cases, making 173 decisions, and upholding 24% of complaints. The previous year had 634 new cases with a 20% uphold rate.
Critical Illness Cover: The most recent year saw 689 enquiries, 588 new cases, 104 decisions, and a 16% uphold rate. The prior year had 498 new cases and a 12% uphold rate.
Term Assurance: There were 1,230 enquiries, 935 new cases, 176 decisions, and a 20% uphold rate, compared to 931 new cases and a 14% uphold rate in the previous year.
Whole of Life Assurance (Reviewable): The Ombudsman processed 549 enquiries, took on 480 new cases, made 62 decisions, and upheld 37% of complaints. The previous year had 571 new cases and a 27% uphold rate.
Whole of Life Assurance (Non-Reviewable): There were 531 enquiries, with 401 new cases, 74 decisions, and a 21% uphold rate, compared to 500 new cases and a 19% uphold rate in the 2022/23 financial year.

Who are the Financial Ombudsman?

The Financial Ombudsman Service offers a free and user-friendly service to resolve complaints between consumers and financial service providers. We ensure disputes are settled fairly and impartially, with the authority to provide appropriate remedies.

What Sectors do they support?

The FOS address complaints about a broad range of financial products and services. Below, you’ll find a list of these products and services, along with links to information about our standard approach to resolving related complaints.

Home, travel, motor, wedding and other types of insurance
Bank accounts, payments, cards, cash machines and other banking services
Fraud and scams
Mortgages including early repayment charges, valuations and equity
Loans and other types of credit like car finance or debt and repayment problems
Investments
Pension and annuities
Payment protection insurance (PPI)
Other complaints – including complaints involving the impact of Covid-19, economic and domestic abuse or power of attorney.

How to Make a Claim

The Financial Ombudsman have an interactive tool that can start the process of making a claim, it’s called their ‘Compliance Checker’ and can be found here: https://www.financial-ombudsman.org.uk/make-complaint

If you are simply unhappy with the level of service you have recieved from your Insurer, or feel like the cover isn’t up to scratch, it’s worth asking one of our team to assess how suitable it is. We can offer you a free market appraisal, and if appropriate help you switch across to another Health Insurer. Get in touch with us here.

All the best – My Health Pal