Medical insurance - Proposed pay out too low

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Based on resolver’s experience to date, if a proposed medical insurance payout is too low you should contact your insurer as soon as possible to raise your concern. If you disagree with the claim findings you should contact your insurer and write giving clear details of your case - such as what happened, when, and why you think you think the proposed payout is inaccurate. It will be useful if you can attach evidence of the costs you have accrued or will be accruing (i.e. receipts and quotations) and evidence of the necessity of the treatment (i.e. a letter from your doctor or specialist). Their customer services team should assure you that they will contact you within a timeframe with an update regarding your dispute. resolver can assist you in submitting, recording and reminding you who and when to escalate to.

If your insurer refuses to increase the payout then as a last resort you can contact the Ombudsman, which will act as a mediator in your case. resolver recommends that you submit your concern in writing, and resolver can assist you in submitting, recording and reminding you when and who to escalate to.

Resolver can help you resolve this issue quickly, free of charge and without the hassle. We can also help you with the next step of writing your complaint. Click on the link below to create your email.
You should know
  • If you’re making a complaint about making an insurance claim rather than a mis-sold policy, check your documents to see who the “underwriter” is. You’ll need to make a complaint to that organisation.

If you cannot resolve your issue you cannot raise your case to the Ombudsman until 8 weeks after you have first raised your complaint with your provider, or you have received a ‘letter of deadlock’ from the company stating that they cannot resolve the issue as you have asked. Your complaint must also not be older than 9 months. For an accurate decision by the Ombudsman you should provide a detailed file of your communications and supporting documentation. In addition make sure you explain what you want as an outcome as this will help assess your case.

 

 

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