How to complain about a declined UK health insurance claim, what the insurer must do, the eight-week rule and how to escalate to the Financial Ombudsman Service.
Complaining about a health insurance claim decision
If your insurer declines, short-pays or delays a claim, you have a formal, free route to challenge it — first through the insurer, then through the Financial Ombudsman Service.
The complaints sequence
| Stage | What happens | Timescale |
|---|---|---|
| 1. Formal complaint to the insurer | Put it in writing, quote the claim number, state the outcome you want | Acknowledged promptly |
| 2. Insurer investigation | The insurer reviews and issues a final response letter | Up to 8 weeks |
| 3. Financial Ombudsman Service | Free, independent adjudication if you are unhappy or 8 weeks pass | Refer within 6 months of the final response |
| 4. Ombudsman decision | Binding on the insurer if you accept it | Varies by case complexity |
What makes a complaint succeed
- Quote the specific policy clause the insurer relied on and explain why it does not apply.
- Supply your consultant's written clinical view where the dispute is medical.
- Evidence what you were told at pre-authorisation, including reference numbers and dates.
- Show the financial impact clearly and state the remedy you want.
- Keep it factual — the Ombudsman decides on evidence and fairness, not tone.
Our role
For clients placed through PremierPMI we draft and run the complaint ourselves. Our own complaints procedure is published, and Tesha Family Ltd is authorised and regulated by the Financial Conduct Authority, FRN 1029667 — so our conduct is subject to the same Ombudsman route.
PremierPMI is a UK private medical insurance broker specialising in whole-of-market placement across 10+ leading UK health insurers including Bupa, AXA Health, Aviva, Vitality, WPA, Freedom Health, The Exeter, General & Medical and National Friendly. FCA regulated (Tesha Family Ltd, FRN 1029667). Speak to a broker on 020 4525 0884, WhatsApp 020 8064 2273, or email contact@premierpmi.co.uk.
Talk through your cover with a specialist PMI broker
PremierPMI's brokers are available Monday to Friday 9am to 5:30pm. Call 020 4525 0884, message us on WhatsApp 020 8064 2273, or email contact@premierpmi.co.uk. You can also request a callback or meet our team.