Vitality Health Limited · DRN-5933773

The complaint Mr B and Ms F complain about the way Vitality Health Limited handled a private medical insurance claim. What happened Both parties are familiar with the background of this complaint, so I’ll only set out what happened in brief. Mr B has a private medical insurance policy with Vitality. His policy commenced in 2022, and Ms F was added to it in 2024. In 2025 Ms F was diagnosed with breast cancer. A claim for treatment on the above policy subsequently followed, but Vitality declined it citing the policy’s moratorium underwriting. Mr B complained about that decline and Vitality reviewed matters. Having done so Vitality acknowledged its decision to decline had been incorrect. But Ms F had commenced treatment under the NHS at that point. Vitality apologised for what had happened, offered £250 compensation, and explained the other policy benefits that remained available in relation to Ms F’s diagnosis and treatment. Mr B declined the compensation though and referred his complaint to this service – telling us that the offer didn’t adequately address the impact of Vitality’s mistake. One of our investigators looked at what had happened. They thought £250 was a reasonable amount of compensation and didn’t recommend it be increased, but Mr B disagreed and said a higher amount was warranted. So, as no agreement was reached the matter was passed to me to decide. What I’ve decided – and why I’ve considered all the available evidence and arguments to decide what’s fair and reasonable in the circumstances of this complaint. Although I’ve only summarised what happened above, I have considered everything that both sides have said. I will not be addressing each point that has been made however. Instead, I will focus my decision on those matters I consider central to the outcome of this complaint. As an insurer Vitality had a responsibly to handle this claim both promptly and fairly and not reject it unreasonably. This claim was initially declined incorrectly and that isn’t disputed. Vitality has already apologised for that and has explained what policy benefits remain available to Ms F should she wish to use them. What remains in dispute is the amount of compensation warranted to reflect the impact of that decline, and for the reasons I’ll now explain I think the £250 already offered is a fair:

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• Mr B says an amount within the upper end of £750 to £1,500 would be better suited to what happened. He says that it would reflect several things, for example, the loss of the private treatment benefit, the weeks of anxiety and uncertainty faced, the extensive administrative burden endured, and the financial advantage gained by Vitality in not paying for Ms F’s treatment. • I thank Mr B for setting this out and recognise his strength of feeling about matters. But compensation is intended to represent a fair and proportionate reflection of the impact of a business mistake, and I must keep this in mind when making such an award. • Looking at that impact here, Mr B and Ms F would have been expecting Ms F’s treatment to be carried out in a private medical setting, and the loss of expectation when they realised that wouldn’t be happening would have understandably caused much upset, worry and concern. Mr B and Ms F had to lead on some of the correspondence with Vitality at times to have this claim reconsidered and progressed too. And I understand why this would have been both frustrating and a cause of inconvenience for them. All of that would have been experienced at what was already a very difficult time for the couple, with initial concerns about where Ms F would be able to have her treatment mounting too. • However, once Vitality realised the claim should have been accepted, it acknowledged the mistakes that’d been made, took steps to highlight what aspects of the policy Ms F could still benefit from, and offered compensation. I think that was the right thing for it to do. • I empathise with the situation Mr B and Ms F found themselves in, and recognise they were in no way responsible for it. But I must bear in mind that despite the loss of expectation here, there isn’t any evidence made available that indicates Vitality’s mistakes caused Ms F’s condition to worsen or her treatment to be denied for example. And, irrespective of the outcome of the claim, Mr B and Ms F were never going to be entitled to the money equivalent to the costs of private treatment. I haven’t seen anything to indicate that Mr B and Ms F are out of pocket as a result of Vitality’s mistake either. And while I understand Mr B and Ms F would like this service to make directions to Vitality surrounding its training and processes, that’s not our role. • I must also bear in mind that the very nature of receiving a cancer diagnosis would have always been difficult irrespective of Vitality’s actions. I don’t say this to detract from what happened in any way, and again have much empathy for the situation Mr B and Ms F found themselves in. But I must not overlay the impact of the actual cancer diagnosis and the treatment it required with the impact of Vitality’s mistakes. • I realise Mr B and Ms F are likely to be disappointed by this, but for the reasons given above I find that the £250 compensation offered by Vitality is a fair amount in all the circumstances to settle this complaint. Putting things right Vitality Health Limited has already made an offer to pay £250 to settle the complaint and I think that offer is fair in all the circumstances.

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My final decision My decision is that Vitality Health Limited should pay £250. Under the rules of the Financial Ombudsman Service, I’m required to ask Mr B and Ms F to accept or reject my decision before 16 April 2026. Jade Alexander Ombudsman

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