Aviva Medios Healthcare - are we being treated fairly?

davidstone

The Lead Complainant, Mr D, was intensely involved with OHRA in the marketing and sale of its product at the very earliest of stages and this seems to have driven his decision-making and complaint. Obviously, no one else’s decision-making could be the same as they had no such involvement. Consequently, FOS’s choice of its Lead Case can only be explained by its desire to discover anything that might be thought to have had a possible bearing on the case.

Not unnaturally, the Lead Complainant’s intense involvement with OHRA’s marketing and sales caused a focus upon Higher Level matters and on the time from when that intense involvement began. We also know that FOS has already excluded a substantial part of Mr D’s case on the basis it is the province of the new Financial Conduct Authority.

An issue not apparent is the particular type of Medios policy upon which FOS made its decision. That is especially important as the Ombudsman has expressed concern about policy fundamentals and we know each type of Medios policy possesses different fundamentals. As the complainant is easily identifiable from our Forum pages, we know the Ombudsman’s decision concerns a Medios Optional policy. Strangely though, the Ombudsman recital of background information refers to the Medios Healthcare Guarantee and not to the Medios Optional Guarantee. Whilst I am unaware of OHRA Guarantee details for a Medios Optional Policy back in 1997, I accept FOS might have made drafting errors within its Final Decision statement or possibly Mr D might have changed from a Healthcare to an Optional policy – all somewhat confusing.

All these above issues ensure uncertainties continue for policyholders until their cases are dealt with, especially as decisions must turn on the facts affecting each complainant. Also, no further FOS input can be obtained until Adjudicators return from lengthy Christmas breaks, stretching to the 2nd week of January.

The above aside, some of the Ombudsman's latest views do flag-up difficult challenges that need to be overcome if the Ombudsman is to take his views beyond affirmation of the lifetime nature of the particular Medios policy investigated, consideration of the fundamentals of other policy types, and the conclusion that Aviva misled policyholders. Her present views must necessarily be limited to Mr D’s specific complaints, the particular information made available, and the focus that was attached to that information. Changes to any of these matters could obviously cause a rethink as occurred between the Adjudication Decision and the Ombudsman’s Final Decision, albeit that change proved a backward one for Mr D.

Perhaps FOS’s backward movement is unsurprising given the unending list of financial and legal experts Aviva has at its beck and call. It is not unnatural in such situations for new directions to result, albeit that tends to bring with it a need to recast and even change supporting events. Certainly the latter is known to have occurred, as we are told Aviva misled with an earlier explanation. Apparently, once Aviva realised it had been caught-out, Aviva told the Ombudsman to ignore its previously given explanation as that had been simplistic. Next Aviva replaced it with one that was seemingly backed-up by some freshly produced presentation but made no mention of it to policyholders.

During the above detailed dialogue with Aviva, the lead complainant was forced to go it alone as the Ombudsman shunned attempts by other policyholders to get involved; obviously, that was more than unhelpful to our case.

Certain policyholders will be better equipped than others to deal with this situation. Those that rely upon others will need to appreciate that considerable work is needed and little will be known whilst that is taking place. Rather than ‘burn bridges’ those relying upon others might want to express a desire to await the results of other investigations, particularly ones that concern the same type of policy they hold. Whatever decision might be taken, the road ahead is challenging and twists and turns experienced throughout the 2 year period of complaint might or might not be repeated. Everyone must also realise that risk is inherent in all disputes, whether that be to a lesser or greater extent.

POLICYHOLDERS ALSO NEED TO REMAIN ALERT AS, ACCORDING TO THE OMBUDSMAN, IT IS NOW OFFICIAL THAT AVIVA HAS MISLED CONTINUOSLY OVER THE 2 YEAR PERIOD OF OUR COMPLAINT.

It is accepted that concerns must grow further as this debacle extends into a third year. Yet Aviva could have cleared up some of this mess with explanations to policyholders but it either chose not to do so or needed the time that’s passed and advisers’ inputs to create a new direction that might best be saleable to FOS.
Consequently, the distress and inconvenience already caused policyholders must continue for 2014’s premium. The same goes for other policyholder complaints. The resultant ongoing worry and uncertainty is especially depressing as, inevitably, it must extend to policyholders’ families over the lengthy Christmas break; unfortunately, that is a definite as protecting family health is uppermost in the psyches of people within the age group affected.

Barry_Man

Following davidstone's insightful posting above, I, for one, would find it useful to understand the key differences between the different Medios policies. davidstone refers to Medios Healthcare and Medios Optional, whereas I have Medios Executive Plus (hereinafter MEP). I believe there may have been a "plain" Medios Executive as well.

As far as I am aware, the key thing that differentiated MEP was that there were no age related increases. It also had a policy excess that was derived (by a known formula) from the annual premium. The excess was also reduced by 1/3 for each claim free year until it reached zero. Any claim in a year would push the excess right back up to 100%.

I appreciate that various aspects of this will have been touched on earlier in this lengthy series of posts, but I feel it would benefit from a fresh concise summary.

Any takers?

02Jim

I have a Medios Executive Plus policy. It has no age related increases or any policy excess of any kind. I think % excess could have been applied if I'd chosen.

My ability to 'Thank' for posts disappeared although has reappeared again. Anyone else had that problem?

Napier

Just to help I am posting below the different types of Medios policies.
Information came from a download of an Aviva document GEN2107 11/2011 but no idea whether it is still available.

Please appreciate that this must have been the status of those policies at November 2011 but what went on before could have been different.

However, I reckon davidstone has a route that could well be different from anything said in his post.
He's telling us to hold back and let those guys with knowledge have a go, but he also gives health warning about risk of outcome.
If we hold back we get the benefit of any presentation done by the 'experts'.

Here goes with the download information anyway:

Medios
At a glance
Aviva is one of the largest providers of private healthcare and
income protection policies in the UK, covering over 2 million
people. This size and strength in the market means you can
have peace-of-mind that a private health insurance policy
should bring.
Our Medios product range of healthcare products have been
developed to provide extensive private medical treatment for
individuals and their families, whilst offering additional
benefits that you may not find on other private healthcare
policies. The Medios product range includes Healthcare,
Executive Plus and Optional.
This Medios at-a-glance guide provides you with an overview
as to the benefits of the policies and should be used in
conjunction with advice from your insurance intermediary.
As with all private healthcare polices there are some exclusions to what is covered. This includes pre-existing medical conditions and
chronic conditions.
The benefits and exclusions listed above does not form a policy summary. For more information refer to the relevant policy wording.
What makes Medios different?
The key benefits of all Medios products include:
■ Treatment in any private facility in the UK - no restrictive list of hospitals (unless selected)
■ No overall limit on the amount you can claim. Some individual benefits do have limits
■ In-patient and Day-patient Psychiatric treatment – up to 100 days per year
■ Home nursing
■ Discount for families and multiple policyholders
■ 24-hour GP and Stress Counselling telephone helplines
■ Access to Personal Health Manager – our online health tool.
Additional benefits of
Medios Healthcare
■ GP referred physiotherapy
■ Complementary
therapy/treatments including
acupuncture, homeopathy,
osteopathy and chiropractic
■ Overseas emergency
treatment up to £20,000 per
year
■ Only one age-related
premium increase over the
life of the policy
■ Choice of excess – the larger
the excess the smaller the
premium.
Additional benefits of
Medios Executive Plus
■ GP referred physiotherapy
■ Complementary
therapy/treatments including
acupuncture, homeopathy,
osteopathy and chiropractic
■ No age related increase – the
age you take out the policy is
the premium age band you
stay in, for the life of the
policy
■ Choice of excess – the larger
the excess the smaller the
premium
■ Reducing excess – for every
year that no claim is made
the excess reduces by a third
■ Day-patient cash benefit.
Additional benefits of
Medios Optional
■ In-patient and Day-patient
Psychiatric treatment – up to
100 days per year
■ No age related increase – the
age you take out the policy is
the premium age band you
stay in, for the life of the
policy
■ Day-patient cash benefit
■ Modular Policy, choose from
two levels of benefit to suit
you
■ NHS Cash benefit.

Barry_Man

Thanks Napier. That's very useful indeed.

From that I have extracted some key points as:

Medios Healthcare:
Overseas emergency treatment up to £20,000 per year
One age-related premium increase.
Choice of excess – the larger the excess the smaller the premium.

Medios Executive Plus:
No age related premium increase.
Choice of excess – the larger the excess the smaller the premium.
Reducing excess – for every year that no claim is made the excess reduces by a third

Medios Optional:
No age related premium increase.
Modular Policy - two levels of benefit.


Only Healthcare seems to have the overseas benefit. It could be argued that this is of little value as most people would (surely) have travel insurance (which would cover a lot more than £20,000 anyhow). Although the overseas benefit might cover conditions that would no longer be covered by travel insurance (without a hefty extra premium).

It would seem that Optional does not any special excess terms - does it have a standard (fixed) excess, I wonder?

It also seems that Executive Plus is the only one where the excess reduces to zero with no claims (over a 3 year period).

I know from my old documentation that Executive Plus had a choice of 4 levels of excess (0%, 30%, 40%, 50%). The %age being calculated in relation to the premium. The higher the excess %age, the higher the discount on the premium. Anyone know if Healthcare worked the same (but presumably without the benefit of excess moving towards zero over 3 claim free years)?

Note that I have not listed anything that relates to the benefits (other than the Healthcare overseas cover) as these will have been refined over time and I know that the Executive Plus policy does have some of the benefits listed (in Napier's extract) for Optional (even though they are not listed under Executive Plus).

Anyone have anything else to add / clarify?

harrop_2

What has happened seems to have been fairly analysed by davidstone.
He left us with one conundrum on the wording of the Optional Guarantee.
Also he suggested possible reasons, and anyone of them might be the answer.
Certainly, nothing can be made of the last available download information on product differences as it might have been considerably different years before.
However, this was all about what had taken place – the past.

In relation to the future, davidstone said few things.
One was that difficult challenges needed to be overcome.
Another was that risk and disputes go together.
No giveaways with anything said there!

Maybe where we are now should not surprise us.
According to Mr D’s Forum comments, he was a broker involved in obtaining national PR support for the product from 1996 and onwards.
His other activities were likely to have been related ones.
Obviously, Mr D is a broker, heart and soul.
However, when it came to the analysis of documentation it is clear that the Forum relied on others.

We also know Mr D sought to be reasonable in seeking an accommodation with Aviva.
However, Aviva seems to have used him as nothing came of that and Mr D’s resulting frustration was communicated to Forum readers.
Then Aviva’s top legal and financial experts were let loose on Mr D in the dialogue with the Ombudsman.
They saw him coming and maybe the result was inevitable as he stood little chance on his own in areas he was unfamiliar with.
That left the Ombudsman in a lonely situation.
Even the legal beavers insisted upon talking over her to extol Aviva’s commercial freedom to do anything – one was left believing we live in a world ruled by anarchists!

Yet against all this, I and others know that we have been unfairly treated by Aviva.
We believe that extends well beyond Aviva having misled on premium increases.
The truth has a habit of always coming out.
Hopefully davidstone and those like him can encourage that to happen.
The remainder of us might well heed davidstone’s suggestion ‘not to burn our bridges’.

alanjg1

I’ve had the Medios Healthcare Policy since 1995.

I’ve just received a letter from the Ombudsman to inform me that Aviva “has confirmed it is willing to offer compensation of £700 in order to acknowledge the distress and inconvenience caused by its misleading communication regarding the premium increases you received in previous years”.

“The amount of compensation was calculated linked to the premium increases you received in 2012 and 2013. I consider this offer to be in line with offers previously awarded by our service as a resolution to complaints of a similar nature to yours. I am therefore satisfied that, within the remit of our service, this payment offers a reasonable resolution to your complaint”.

He then goes on to say that if I accept the offer, to sign and return the enclosed settlement form. He requests a decision a.s.a.p. and in any event by end of January 2014.

If I feel unable to accept the offer, he asks to be informed why, so that he can consider any further points.

He informs me of my right to ask him (the ombudsman) to review my complaint- as the final stage in their process. But he hopes that now an offer has been made by Aviva, I will not feel the need to take my complaint further.
It seems to me that he wants to ‘put this issue to bed’, hence what feels like pressure to accept.

I’m unhappy with the fact that Aviva have now locked the option to change my selected excess from year to year. I’m not sure if this has been addressed by the ombudsman.

Any comments, advice, similar stories will be appreciated.

Thank you.

Guardog

Like everything else, it depends on what you want.

If you are happy with the money, then take it.
Unfortunately, the problem of being locked into a specific excess is not likely to change on the basis of the decision on Mr D.
If you think otherwise, take it up with the adjudicator and then go to Ombudsman if you do not like the given reasoning.
Your downside should solely be delay whilst you await the Ombudsman’s decision, as the award should not go away.

If on the other hand you reckon the big hitters on this site might have a better result than Mr D, presumably you would want to benefit from that by waiting until their cases are decided.
You might even reckon the big hitters only have a small chance of changing events but still want to wait and see, just in case.
If that is the case, tell that the adjudicator – he should know who they are and if he doesn’t come back and ask and a code name will be arranged with the adjudicator.
It would be unfair if you were excluded from the work results of experts.
Even if they fail, there is no reason for your award to be lost.
Also you could then still fight on your point of concern.

There is a lot at stake on this so you need to consider the ramifications of rushing to accept, especially as you have invested so much time already.
Be awful if others picked up the jackpot and you walked away with just £700.
Also it is unfair of the adjudicator to exclude you from any benefits that others might achieve.
However, some people have had enough.

That is the reason it depends on what you want.

wexler

What an effrontery!

This adjudicator and his colleagues have a cheek.
We must remember we can and should complain about bad treatment from any one of them.

They have taken months - no years - to do something and then expect a response in 2 weeks!
Who does this person think he is?

They pick one of our number to put our case for us.
The person chosen has no legal or financial background.
In this Forum we have seen several times that he saw no problems with documents and then others followed and pointed out a mass of problems.

Who knows what he should have challenged and did not!
For all we know Aviva could have got away with murder – in the metaphorical sense.
Also the person chosen seems to have been sitting on the same side of the table as Aviva at one time or another!!!!

What input did we have?
Well thats easy – we were excluded.

I am furious.

I want the guys who have been working their butts off for us to go into bat.
There is no way I am going to see that not happen and therefore lose out big time.

Its incredible the unfairness of this adjudicator and his colleagues.
A pal has told me that when you speak to the adjudicator he does not seem bothered.
Even ducks and dives to avoid saying Mr D was an Optional policyholder.
Not the first time he has been ducking and diving on issues from what I hear.

Well it is about time we bothered him!!!!!!!!!!!!
And it is about time he started to care and to do his work properly!!!!!!!!!!
Oppressing us and stopping us taking the best way forward is incredible behaviour.

02Jim

I've had the same letter as alanjg1 almost word for word with an offer of aprox £700- which I will definitely not be accepting & would urge anybody else that they are trying to buy off with this paltry sum not to take it. I'd be extremely grateful if someone could help formulate a reply to the FOS that everyone else in this situation (which I expect there are a number) can use, so we are all singing from the same hymn sheet. Thanks.