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Claim or complaint to your private medical insurer (UK)
England, Northern Ireland, Scotland and Wales · in English
€2.00This document is sold blank, to print and complete by hand.
Made for use in England, Northern Ireland, Scotland and Wales
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This document is sold blank, to print and complete by hand.
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For a policyholder anywhere in the UK whose private medical insurance should pay for treatment. One letter for two moments: a claim for treatment you have had or need, or a challenge to the insurer's refusal or reduction of a claim. It sets out the treatment and the amount, your reasons, recalls the insurer's duty to pay within a reasonable time, and turns into a formal complaint with the eight-week limit and the free Financial Ombudsman Service. Sent by email. Sold blank, to complete by hand, as it holds health data.
- Made for use in England, Northern Ireland, Scotland and Wales
- Last updated October 28, 2026
- Document in English
Where a UK document reproduces the words of legislation or of a government publication — UK, Scottish or Northern Irish — it contains public sector information licensed under the Open Government Licence v3.0.
Published byDocMuse
When to use this document
- Your private health insurer in the UK has refused to pay for your treatment.
- The insurer paid less than the hospital bill and you want the difference.
- You paid for a private scan or operation and want to claim it back under your policy.
- You want to make a formal complaint to your health insurer before going to the ombudsman.
What you fill in
The details the document asks for.
- Sender
- Sender's address
- Town or city
- Sender's postcode
- Date
- Insurer
- Insurer's address
- Recipient's postcode
- Policy number
- Claim number
- What the letter is about: a new claim, or a refused or reduced claim
- Treatment: what, when, where, by whom and the cost
- Claimed amount
- Grounds
- Phone
- Attachments
Common questions
- What should I check before claiming on private medical insurance?
- Read the policy for the steps it requires: many insurers want you to call for pre-authorisation before treatment, to use a specialist or hospital on their list, and to pay any excess. Check the exclusions and how the policy was underwritten, as conditions you had before joining may be excluded for a period. The NHS and, in Northern Ireland, Health and Social Care are free at the point of use and do not refund private treatment, so a refund comes only from the policy.
- How long does a health insurer have to answer a complaint?
- Under the Financial Conduct Authority's rules an insurer has eight weeks to send a final response to a complaint. If you are unhappy with the response, or receive none in eight weeks, you can take the complaint to the Financial Ombudsman Service, free, normally within six months of the final response. The Ombudsman can order the insurer to pay a claim, with interest, up to its award limit.
- Can the insurer refuse a claim because of something I did not mention?
- Only within the Consumer Insurance (Disclosure and Representations) Act 2012. You had to take reasonable care to answer the insurer's questions accurately; if you did, it cannot refuse a claim for a misrepresentation. If a misrepresentation was careless, the insurer's remedy depends on what it would have done had it known: exclude the condition, pay a proportion of the claim or, if it would not have insured you at all, cancel the policy and refund the premiums. A deliberate or reckless one lets it cancel the policy and refuse all claims.
How you can sign this document
- Print it and sign by hand. The signature lines in the document are left blank on purpose — sign on them in ink.
- Sign it yourself with a qualified electronic signature. If you already hold a QES — Evrotrust, B-Trust, StampIT, ZealiD or any qualified provider on the EU Trusted List, on a card, a USB token, in a mobile app or in the cloud — our signing guide explains step by step how to sign this exact file without invalidating it. Step-by-step help, and a way to check it worked
DocMuse sells documents, not legal advice. Acceptance always depends on the recipient's rules and your local law.
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