Heath Crawford Ltd · DRN-6241709

The complaint Mrs J complains that Heath Crawford Ltd mis-sold her a private medical insurance policy. What happened Mrs J switched her private health insurance policy to an insurer I’ll refer to as ‘V’. Heath Crawford provided her with advice about switching her policy. Mrs J claimed on the policy but V declined the claim and added an exclusion to the policy. Mrs J complained to Heath Crawford that that the policy had been mis-sold because she’d wanted to ensure that she had continuous cover for an existing health condition. Heath Crawford said the advisor had acted on the information provided during the application process and they weren’t aware that Mrs J was taking an over-the-counter supplement. Unhappy, Mrs J complained to the Financial Ombudsman Service. Our investigator looked into what happened and didn’t uphold the complaint. She thought the advisor had acted reasonably based on the information provided by Mrs J. So, she didn’t think the policy had been mis-sold. Mrs J didn’t agree and asked an ombudsman to review the complaint. In summary, she said she disclosed fibroids and heavy bleeding during the sales calls and that she took a supplement containing iron. She said that the advisor ought to have told her that this would have caused a fibroid exclusion. These further comments didn’t change our investigators thoughts about the overall outcome of the complaint as she couldn’t identify that Mrs J had disclosed the supplement during the application process. So, the complaint was referred 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. Heath Crawford Limited provided Mrs J with advice about switching her policy. The relevant rules and industry guidelines say they needed to ensure that the policy was suitable for her demands and needs. And they needed to ensure that Mrs J was provided with clear, fair and non-misleading information so that she could decide if the policy was right for her. I’m very sorry to read of the circumstances which lead to Mrs J making a complaint. I can understand, and empathise with, her disappointment and frustration. However, I’m not upholding this complaint because: • Heath Crawford isn’t responsible for V’s decision to apply the exclusion or the terms of that exclusion. That’s a commercial decision that an insurer is entitled to take. And, in this case, taking medication or ongoing symptoms would have led to an exclusion being placed on the policy. • Based on the evidence that’s been presented I’ve not seen compelling or persuasive

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evidence that Mrs J disclosed that she was taking the iron supplement before the policy was taken out. I’ve listened to the phone calls which took place and this wasn’t discussed with the advisor. During the call she was asked about previous symptoms, treatments, medications and advice. But this wasn’t mentioned. • During the application process Mrs J was also asked whether she experienced symptoms, received any advice from a healthcare professional or received treatment/had treatment planned or expected within the last three years. The medical questions explained that this included over the counter medication. Mrs J didn’t mention that she was taking the iron supplement which was related to symptoms of fibroids and/or heavy bleeding. And Mrs J’s GP records refer to menorrhagia and irregular bleeding within the relevant timeframe. • Heath Crawford were entitled to rely on the information Mrs J provided during the sales process. As I’m not persuaded, they were, on the balance of the probabilities, told about this information I don’t think they were in a position to address this when providing advice. I’m satisfied that they took reasonable steps to understand from the insurer what the implications of the health information Mrs J disclosed was on the policy they recommended. • Although Mrs J was reassured by the advisor that the policy covered her pre-existing conditions, this was based on the information presented at the time of the sale. So, this hasn’t persuaded me that Heath Crawford acted unfairly when they provided this reassurance to Mrs J. My final decision I’m not upholding this complaint. Under the rules of the Financial Ombudsman Service, I’m required to ask Mrs J to accept or reject my decision before 28 April 2026. Anna Wilshaw Ombudsman

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