Insurance Claim (Health) - Value of BYGOF?

[JRM]

I recently purchased two pairs of prescription glasses. They were purchased collectively as 'Buy One Get One Free' and under the terms of my Health Insurance policy I am able to claim for one of these.

Glasses A: £125
Glasses B: £0 (but RRP of £95)

The one that I am entitled to claim were 'free' and as such my insurer is refusing my claim valuing them at £0. In the real world they are clearly not free, the cost is built into the offer regardless of how the seller chooses to allocate this between individual items.

Does anyone have any experience with regard how to value item B? I thought A+B / 2 seemed reasonable. My insurer disagrees and in what I believe to be a rather heavy handed approached, has cancelled my insurance under the guise of a "false or misleading" claim. I intend to appeal.

Thanks in advance,

[des8]

Re: Insurance Claim (Health) - Value of BYGOF?

Could you post up a copy of the policy wording, or give us link to where we may find it on line?

I'm inclined to agree with your view.
If you own an item (whether or not you purchased it or received it as a gift) the item if insured should be replaced (or you given monies worth).
The fact it cost you nothing has no impact on its value.
However I would like to check policy wording, just in case there is an unfair condition hidden away.

[JRM]

Re: Insurance Claim (Health) - Value of BYGOF?

Des8, Please see the attached:

https://www.healthshield.co.uk/wp-co...ARY2016v21.pdf

To be honest I'm unsure what, if any, legal issue is at play here. I agree with you that if stolen their value is derived irrespective of the cost to me at the time. To site your example, the replacement of a gift.

However, in this instance I am entitled to recover their upfront cost and I don't see my insurers value of £0 as equitable. I did have in my possession a voucher that entitled me to a discount of Glasses A but this could not be used in conjunction with the BOGOF. Perhaps the value is the difference of the voucher to reflect the difference in price I paid to get the second pair?

As above, I have the right to appeal internally and thereafter if the decision is not reversed I'll consider pursing it because I resent the accusation of fraud. This system is new to my firm, I submitted the claim before the provider had rolled out training and I had someone from the provider talk me through my submission. To go from that, to black mark on my Insurance History seems like a step too far too quick.

[des8]

Re: Insurance Claim (Health) - Value of BYGOF?

Why did you not claim for Glasses A @ £125?
Were they not covered because they were perhaps tinted?

When I read your first post I thought this was a claim against an insurer for replacement glasses that had been lost or something.
Hence I was referring to replacement values.
I did not realise it was a health cash plan contract.(me reading too quickly!)

I would agree with the plan that if your glasses were free, they would not pay for them.
This sort of plan is designed to meet the cost of appliances & treatment, and so if there is no cost there is no reimbursement.

I think you should plead a misunderstanding of the policy and ask them to reverse their decision to cancel the policy.
This could be important as the cancellation could impact on ANY other insurance you try to effect. (All proposals ask if you have ever had insurance cancelled and, if yes, why. There is also a central data base [IFR] kept by insurers.)