Medical insurance - Refused claim: sports injury

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Based on resolver’s experience to date, if you are an amateur sportsperson you should let your insurer know when taking out medical insurance. They may advise that you need specialist sports insurance which is likely to have a higher premium as the risk is considered much higher. If you have standard medical cover you should read your policy small print carefully before making a claim as cover varies greatly between different insurers – as do the exclusions. Some policies will not cover “self-inflicted conditions” such as dangerous sports injuries.

If you disagree with your insurer’s findings you should complain to the company directly. Ask for an address for customer services, and write giving clear details of your case - such as what happened, when, and why you do not consider your injury to fall within one of the exemptions in your policy. If you are not happy with the outcome 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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