“I am immensely proud of our team this week in resolving a complaint for one of our corporate clients, which has been ongoing for 11 months. This is a great example of the unsung work we do for our clients, which many don’t realise is included as standard when you work with Engage.” – Nick Hale, Director.

Case Study

Engage Health Group had been looking after the Private Medical Insurance policy for one of their small corporate clients for two years.  This involved managing the renewal process each year, negotiating with the incumbent insurer around benefits and premium, and delivering employee presentations to ensure the benefit was well communicated.

An employee of the client called their Private Medical Insurer to begin a claim in December 2017, but was misadvised, resulting in the employee having to pay £4,500 towards their treatment. This was naturally a surprise to the employee, but confused by policy terms & conditions, the claims process in general, and not wanting to delay essential treatment, they went ahead and paid.

When this was discovered by Engage Health Group, they insisted upon a review of the claim which included listening to all calls between the insurer and employee, liaising with the specialist consultant and piecing together what was a complex number of interactions.

Following this process, Engage’s view was that the insurer hadn’t acted in an appropriate way and they therefore submitted a formal complaint to the insurer on two separate occasions, citing that the employee should be reimbursed. Both of these attempts were declined outright by the insurer who felt the claim had been managed adequately.

Having been dissatisfied by this response and the lack of urgency from the insurer in question, Engage escalated the complaint to the Financial Ombudsman Service (FOS) and after several months of back and forth dialogue, their entry level complaint assessors also sided with the insurer.  The insurer did concede at this point, however, that it had taken an exorbitant amount of time to assist the claimant at the time, and as a gesture of goodwill, offered the employee £250 compensation to close the complaint.

Undeterred and buoyed by the belief that they were in the right, Engage made a final attempt and escalated the complaint further to a senior ombudsman at the FOS.  Another three months of dialogue took place and Engage insisted that the senior ombudsman listen to the numerous telephone call recordings between the insurer and the employee, as they had.  They also supplied an itemised breakdown of how the interactions unfolded, coupled with their own analysis of where the service failure had occurred.

After 11 months of rejection, Engage (and the client) were delighted to receive a call from the FOS in November 2018 confirming that they had reviewed the situation, listened to all calls, considered the detailed analysis and as a result, had agreed with Engage that the employee was misadvised by the insurer.

The FOS were apologetic for the difficulty faced during this time and admitted that very few complaints are pursued in this way, but that the final result was the correct one.  From here, they instructed the insurer to immediately reimburse the employee the full amount, along with 8% interest for the 11 months the employee was unjustly without their money.

Word from our client…

“After handing the matter over to Engage Health Group, I asked if they could raise a complaint with my insurer after being given substandard information which had resulted in me paying approx. £4,500 in hospital fees. Despite their best efforts, all attempts to resolve the matter directly with the insurer were unsuccessful.  Not one to give up easily, Engage suggested that I take the matter to the Financial Ombudsman Service, which I agreed to. They then prepared and submitted my complaint to the FOS. Over the next 8 months, Engage was constantly chasing the complaint to ensure it was progressing. At one point a junior investigator at the FOS issued a decision in favour of the insurer, however the rationale behind the decision indicated that she clearly had not understood the complaint. Engage insisted that the complaint was fielded by a senior person who finally agreed with the complaint and ordered the insurer to refund the entire contribution to me.

This was a tremendous result, and entirely down to Engage’s tenacity and determination.  From start to finish the service provided by Engage Health Group has been extremely professional and personable, and I cannot recommend them highly enough.”

Final thought…

As a relatively small client, some might argue that the work put in here over 11 months was not commensurate with the clients’ “value”, and many may have given up at the first hurdle.  Every client who chooses to work with Engage gets first class service, irrespective of whether they have 3 employees or 300, and when we make a commitment to offer great service to our clients, it’s imperative that we fulfil that promise when the time comes.

As an independent brokerage/consultancy, we work with and value all of our insurer partners, but importantly, we work for the customer.  This is the great benefit of an independent intermediary and one that many perhaps don’t appreciate when sourcing their employee benefit provision via other channels.

Many customers utilise our service because they want to review their employee benefits packages and ensure they are getting the best possible value and coverage, but the ongoing service and continued advocacy we provide on their behalf is what really sets us apart.

Investing in the right Employee Benefits provision for your team is a great way to ensure that they feel valued, and a healthy, engaged workforce is good for business.  If you would like us to cast an expert eye over your current health insurance or other employee benefits, or have been dissatisfied with the service your current intermediary provides, please get in touch and give us the opportunity to impress you.