Aviva Medios Healthcare - are we being treated fairly?

how_2

The first stage of the FOS process has commenced
- an adjudicator has been appointed!

Lawton

The FSA has yet to respond to my MP.
Potentially, another Government Authority could have an interest in this matter which might have a bearing on that response.
This all seems to be adding to the timing but my MP is intent on following this through.

My MP has been so motivated by the plight of policyholders that he wrote separately to Aviva plc (the holding company of both Aviva Heath UK Limited and Aviva Insurance UK Limited – the relevant administering and insurance subsidiaries) on his own volition.
Salient responses made by Aviva plc were:
- acknowledgement that the 2012 premium increase included part of the loyalty bonus cost (ie Guaranty of no Age-Related Increase);
- premiums associated with the Medios product continue to be below the premiums new customers pay for similar cover under new products currently on market, when they should be more because of the “exceptional value-for-money” “unique loyalty bonus”.

However, being charged part of the loyalty bonus makes no sense as policyholders paid for a full Guaranty and not for some unquantified partial relief of Age-Related Increases.

Also, being competitive with current market prices for New Entrants (of some undisclosed policy) is unlikely to appease policyholders SUPPOSEDLY already benefitting from years of protection from Age Related Increases.

As for the loss of life-time cover availability and breach of the New Entrants’ obligation, there were no responses.
Silence also extended to the underlying unauthorised modification of Terms & Conditions, the related massive non-compliance with FSA rules, and the misrepresentations on New Entrants within Terms & Conditions for 2010, 2011, and 2012.

Whilst the Aviva plc letter concluded with the hope “that the FOS investigation will allow us to address Mr #’s concerns and agree a way forward to our mutual benefit”, I hope that other avenues might provide policyholders with additional options.

how_2

Just spoken to FOS Adjudicator.
Impression gained was that she views case as poisoned chalice and wants to shift file onwards to Ombudsman as soon as possible.
Am considering whether to follow that route, irrespective of any initial advantage gained by Aviva.

Lawton

Yet a second Aviva plc response has been received from my MP.

We are now told that the contested element of 2012’s premium increase is 12%.

Not surprisingly, the latest explanation Aviva plc gives for that increase is a blur and spin on guilt already acknowledged by its subsidiary, Aviva Health UK Limited.

As for New Entrants, a distortion of the Guaranteed Loyalty Bonus wording is given by Aviva plc with the claim that the pricing reference level is “always ... the same as a new entrant”.
That’s somewhat different from the actual Policy wording “you will never pay more than a new entrant”.

Amazingly, Aviva plc tells policyholders that they have a good deal through:
- use of average figures that are meaningless, if only because the comparison is with the Healthier Solutions product where there is a difference of 400% between the top and bottom of its premium charge (dependent upon no claims discount);
- re-inventing a New Entrant’s premium that’s no longer in existence and is based upon the wrong concept of always paying the same as a new entrant.

Then we are told
“We (Aviva) remain committed to the Medios product ....”
That’s the absolute opposite to what Aviva Health UK Limited was telling many Financial Intermediaries last September.

Ah, almost forgot – the remaining 90% element of policyholders’ claims is something “we (Aviva plc) have been advised that we should not be responding to ........!!!

All of this brings many phrases to mind, from “double talk”, to “speaking from both sides of mouth”, and even to cover-up.
However, policyholders are already familiar with Aviva’s bad behaviour through the continued unauthorised change/breach of its Guaranteed Loyalty Bonus.

Perhaps, Aviva plc’s emerging to head the front line of this debacle comes at the same time as the FSA’s ‘cold embrace’.
Certainly, the pressure is now on Aviva plc - especially brave as institutional shareholders’ patience is presently at its most taut due to Aviva plc’s continued performance failure.

My MP remains on the case and continues to await the FSA’s response.
He has proved not to be backward in embarking down avenues of his own choice as has occurred with Aviva plc.

mwng

Anybody heard anything else from FOS? We send our stuff in in Feb and were told we would hear back this month..

how_2

Apologies mwng, I should have been clearer in my 28 May message.

The Adjudicator copied Aviva’s defence as her judgement.
She is well-meaning, inexperienced and under an enormous case load.
Not a lot of time for engaging the thought process.
Anyway, all a bit meaningless at this stage.
Mind you, that doesn’t mean she’s wrong as the choices are limited to YES or NO .

One must be pragmatic about the FOS process.
Providers throw cases at FOS just because they know they get a 50/50 chance of a result.
All we can do is the same - it’s rather like throwing dice.

When you get your decision, just pick yourself up and send it to the more experienced Ombudsman.
Having said that, some of them are average and others can be good.
One just has to be lucky and not get too fervent as that is guaranteed to result only in worry.

Guess your case will be coming up in weeks as Adjudicator is just ensuring parcel correctly prepared for Ombudsman queue.

02Jim

Had letter from FOS. Ajudicator.....'I am unable to recommend that your complaint should be upheld.....consumers have the right to review their case - as the final stage.' Can anybody suggest the best way to go now. I presume others have or will receive similar letters.

davidstone

What did your Adjudicator letter say O2Jim?

According to how, the Adjudicator solely trotted out the Aviva defence - on 2012’s premium increase.
Aviva’s attack on our Guaranty was apparently not dealt with – as Aviva refuses to engage on that issue, as we all know.

Consequently, how focussed upon going direct to the Ombudsman rather than argue with an inexperienced Adjudicator.
It was always going to be an Ombudsman decision anyway.

For your information, the Adjudicator did attempt to correct her narrow focus.
However, it appears she was hauled back by her superiors and told to limit her comments and, accordingly, to limit the evidence she relied upon to the narrowest of areas.
That was the only way forward to support an extreme position that ignored contractual matters; illustrated by explaining she issued her judgement on the premium increase without even knowing whether the complainant had the benefit of the Guaranty!!

You will need to take your complaint to the Ombudsman as how has already said.
What you say depends upon what the Adjudicator letter said and obviously what you complained about.
how also seems to have fairly explained the probability of success with the Ombudsman.

02Jim

My letter to the to the Adjudicator followed closely Guarddog's template (2-05-2012). The Adjudicator only addressed: 'Complaint - Your complaint is that you are not happy with the premiuim increase of your Private Medical Insurance (PMI) policy'
I have a letter from 2004 from Norwich Union in response to a letter I sent to them voicing my concerns even back then; the last para says: 'I can confirm you do have a policy, which locks you in at the age you join, in your case at 50. This means you will always pay what a 50 year old new entrant would pay for the same policy, while you remain with us. However, you will always be subject inflationary increases, which include medical costs.'
Any other thoughts on my follow up letter to the Adjudicator willingly accepted.

davidstone

Hi O2Jim.
Have looked at Exec Plus documentation.
Interestingly, a New Entrants’ link does exist despite protection being from policy inception – seemingly an excellent policy but for Aviva.
Shouldn’t be a problem with changes as Guardog’s draft is based upon writer being an innocent that needs someone to unravel what’s happened to them – such complainants tend to get a more sympathetic hearing from Ombudsman.

Your response needs to be balanced in continuing to present you as an innocent and you need to avoid Adjudicator bashing, other than putting questions that an innocent might reasonably ask.

Last thing Adjudicator wants or you want is for her to redo her decision. Adjudicator does not want to as she knows it is going to Ombudsman whatever she does and she has a heavy case load that has got to be shifted; also, her superiors have apparently already told her not to extend her findings for rather obvious reasons. Nor do you not want her to redo decision as Adjudicator has already ‘struck her colours to the mast’ and will fight hard to avoid changing her positions and therefore appearing foolish – much easier to present existing judgement as one based upon limited evidence.

Your sole objective is to damage the judgment she issued - based upon the knowledge that Aviva refuses to engage in dialogue on Guaranty matters (see Lawton's 1 June comment). A possible draft is below.


Your ref:

Dear Ms T H......

In my # letter I complained that Aviva had removed all the policy’s essential characteristics and, consequently, my Guaranty had been lost. Consequently, you will know from that letter and from your review of any policy document that particular lost characteristics were:
1. a premium that applies to the Age-Band on joining,
2. continuing New Entrants so the applicable premium for relevant Age-Bands could be determined,
3. availability of lifetime cover.

Your letter dated # only dealt with my complaint concerning 2012’s premium. That is puzzling as your web site states FOS will “look at what you say” and that has not occurred as only point 1 was addressed. Accordingly, please at least confirm you have contacted “the business to get their side of the story” on unanswered points 2 and 3 so I know you have not taken sides?

Your not asking for more detail on the unanswered points causes the belief that other complainants have provided that detail for points 2 and 3. Please confirm that is so and that you have contacted “the business to get their side of the story” on that detail? My reason for asking is that I am especially puzzled how Aviva stopped New Entrants and destroyed lifetime cover due to Aviva’s initial documentation, on taking-over from OHRA, stating it “may alter the standard terms of the policy at any renewal date” and clearly these were not standard terms but fundamental to the policy offering.

I also would like FOS to consider any other implications of Aviva’s breach of its New Entrants obligation as I have only recently become aware of that event. In particular, I question whether there would have been any purpose in my continuing for 2010, 2011 and 2012 had I also known about Aviva’s full attack on my Guaranty.

Please also note that the term of my policy exceeds 12 years and it is not a 1 year insurance contract. Only the premium review is annual and that review documentation is solely an addition to the policy schedule. Your review of the policy should already have made you aware of those aspects.

On your decision not to uphold my complaint on 2012’s premium increase, you concluded premium matters were Aviva’s “commercial judgement”. Consequently, please explain how you factored into that conclusion:
- the premium applicable to my Age-Band in accordance with my Guaranty;
- the part of 2012’s premium increase caused entirely by Aviva’s breach of its New Entrant’s obligation when it unilaterally stopped New Entrants in January 2010 and therefore caused greater risk in terms of claims being submitted;
- the enclosed Aviva copy letter from 2004, which stated “This means you will always pay what a 50 year old new entrant would pay for the same policy, while you remain with us. However, you will always be subject inflationary increases, which include medical costs”.

I require this information to determine whether to make any additional support to my complaint, which I then want an Ombudsman to review. My preceding comments and questions indicate the reasons I no longer seek your views on the most crucial aspects of my complaint as you determined to ignore them.

Yours sincerely

O2Jim