A giant victory for man, a small victory for mankind

Don't you just love it when something you expect to go wrong, goes right? Allow me to explain. I've just won a HUGE victory against a GIANT medical insurance company, proof positive that sometimes, with a bit of grit and perseverance, the 'little man' can occasionally win against the corporate giant.

What happened is that a couple of years ago, I had surgery on my eyes to cure a problem that was affecting my vision. Well, the surgery cured one problem but created another, worse one. I won't go into the gory details lest to say that I required further surgery to rectify the damaging side effects of the first surgery. The procedure I required was defined by my medical insurers as 'cosmetic' and they refused to cover it. The truth is that under normal circumstances, the procedure I had would have been cosmetic. However, I did not elect to have it and I would not have chosen to have cosmetic eye surgery. After what I'd just been through with the first surgery, I never wanted to see a doctor again. The eye surgeon who performed the second 'cosmetic' surgery was so convinced of my absolute need of it that he had offered to take me onto his NHS patient list. As I had medical insurance and as members of my family were concerned about the MRSA virus and didn't want me treated in a large teaching hospital, I chose to have the surgery privately. I was convinced that the insurer would eventually see sense and cough up.

Prior to the second surgery, my insurance company sent me for various silly tests (all of which were 'rubbished' by my surgeon) and then had an 'independent expert' prepare a report which, they said, proved that the surgery was unnecessary and therefore cosmetic. Their expert was appointed and paid by them. He never examined me nor spoke to either of my two surgeons. To me, that bore none of the hallmarks of independence.

So, after taking legal advice, as the claim was relatively small I elected not to involve lawyers but to put the case in front of the Financial Ombudsman. The Ombudsman required all sorts of forms to be filled and evidence to be submitted. This was a long and drawn out procedure but, after a year or so of consideration, the Ombudsman's adjudicator found in my favour. Great, now (I thought) I'll wait for the cheque.

But no, the insurance company decided to appeal to the highest level at the Ombudsman's service and submitted a further whining letter explaining why they should not have to pay out in this case. At that point, they did not submit any new evidence. We were accordingly able to (metaphorically) tear that letter to bits.

It took a further seven months for the Ombudsman to uphold their own adjudicator's decision and unequivocally find in my favour. The medical insurance company is now obliged to pay me in full plus a whopping 8% interest on the total amount dating back to day I first put the case to the Ombudsman - now just short of two years. I'm currently waiting for the cheque which, if it doesn't arrive, will be generated by means of an enforcement order issued by the Ombudsman against the insurer. You could say that in these straightened times, it's proved to be rather a good investment.

It's a right and fair decision about which I feel wonderfully, happily and gloriously smug. So, don't let the bastards grind you down! There are remdedies. Fight for your rights!