DRN-6195783

The complaint Mr P and Mr W are unhappy with the service received from Aviva Insurance Limited in connection with their private health insurance policy. What happened The details of this complaint are well known to both parties, so I won’t repeat them again here. I’ll focus on giving the reasons for my decision. 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. That includes all points made by Mr P along with all other evidence. I won’t respond to each of these. I hope he and Mr W understand that no discourtesy is intended by this. Instead, I’ve focussed on what I think are the key issues here. The rules that govern the Financial Ombudsman Service allow me to do this as we are an informal dispute resolution service. If there’s something I’ve not mentioned, it isn’t because I’ve overlooked it. I haven’t. I’m satisfied I don’t need to comment on every point to fulfil my statutory remit. In considering what is fair and reasonable in all the circumstances of the case, I’ve taken into account all relevant law and regulations, regulator’s rules, guidance and standards, codes of practice and good industry practice at the relevant time. This includes the Consumer Duty. Shortly after the policy was first taken out, Mr P and Mr W requested that the direct debit billing date be changed, which Aviva agreed to do. Due to the change in direct debit collection date, it also issued a new policy number. But I think this should’ve been made clearer to Mr P and Mr W at the time. Aviva accepts that, due to internal factors when changing the billing date, there were errors. This also meant that it didn’t collect premiums due for the following months. Because of this, Mr P and Mr W owed almost £700 in monthly premiums. Due to Aviva’s mistakes, it initially offered to waive half of the outstanding balance in premiums. However, Mr P and Mr W say they didn’t receive Aviva’s communication about this. By way of its final response dated 29 May 2025, Aviva then agreed to waive premiums up to 7 April 2025, meaning that if Mr P and Mr W wanted to continue with the private medical insurance policy (and maintaining the underwriting date on the policy) they would need to pay the outstanding premiums due for April and May 2025 (as well as the forthcoming premium due for June 2025). Aviva also apologised and said relevant feedback and training will be given to the colleagues involved.

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Mr P and Mr W didn’t accept the offer to waive premiums up to 7 April 2025. Whilst I can understand what they say about losing faith in Aviva, I’m satisfied that Aviva’s offer at the time was fair and reasonable. It had also promptly accepted its errors, apologised and said feedback would be given. Had Mr P and Mr W paid the premiums due for April, May and June 2025, the policy would’ve continued with a start date of December 2024 and to acknowledge its errors Aviva had agreed to waive several earlier premiums which hadn’t been collected. They would’ve still been covered under the policy and able to make a claim (subject to the remaining terms of the policy). The premiums weren’t paid. Although, it was Aviva’s initial errors which led to the premiums not being collected, I’m satisfied that Mr P and Mr W were reasonably made aware that for the policy to continue, premiums from April 2025 would need to be paid. As this didn’t happen, I’m satisfied that it was reasonable, and in line with the policy terms, for the policy to be cancelled in June 2025. Our investigator clarified with Aviva whether it would be willing to reinstate the policy now. Given the time that has passed, it has said that it wouldn’t be willing to do so. I think that’s fair and reasonable in the circumstances of this case. I know Mr P and Mr W may have been deprived of making claims which may have been covered under the policy. But I don’t think it would be fair and reasonable for Aviva to be responsible for this. Had Mr P and Mr W agreed to pay the outstanding premiums for April and May 2025 (and continue to pay the monthly premium going forwards), their private health insurance would’ve been in place for them to claim on. However, I do accept that Mr P and Mr W were put to unnecessary distress and inconvenience because of Aviva’s errors. That includes having to communicate with Aviva to try to understand what was going on and unnecessary upset caused by receiving incorrect and confusing information (including at one point being told in around March 2025 that the policy had been cancelled and then being told it was active, but premiums hadn’t been paid). I’m also satisfied they would’ve been confused by not being given clearer information about receiving a new policy number after the direct debit date was changed (and why this was). I’m satisfied that £250 compensation fairly reflects the impact on Mr P and Mr W. I know Mr P and Mr W say that significantly more compensation should be paid but I’m satisfied £250 compensation is fair and reasonable. My final decision I direct Aviva Insurance Limited to put things right by paying Mr P and Mr W £250 compensation for distress and inconvenience. Under the rules of the Financial Ombudsman Service, I’m required to ask Mr P and Mr W to accept or reject my decision before 12 May 2026. David Curtis-Johnson Ombudsman

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