VHI claim complicated by legal action
A READER from Dublin sent us a mail after becoming aware of a VHI practice which he says does not appear to be in the best interests of their members.
“I was unfortunate to have been involved in a car accident recently and sustained an injury which required medical intervention, an MRI and steroid injections initially but I will need surgery later in the year,” he writes.
He went to a private hospital which has a direct payment arrangement with VHI Healthcare to see an orthopaedic surgeon and was directed to have an MRI scan. After the scan came back, he was prescribed a course of steroid injections to ease the pain.
“I completed a VHI Healthcare claim form at the time of my MRI and again two weeks later when I was having the steroid injections administered. On the form I declared that I was taking a legal action against the driver of the car who had caused the accident,” he writes.
Weeks later he received a letter from the insurer saying his claims had been placed “on hold” until his solicitor returned a standard legal undertaking to them. “The undertaking requires the claimant’s solicitor to undertake to reimburse VHI Healthcare for all medical expenses incurred on their member’s behalf in the event of a successful legal action,” he says.
His solicitor said he could not provide the requested undertaking as the VHI Healthcare wording is unconditional and requires full repayment of all relevant treatment costs, regardless of whether they have been recovered in full in the legal action.
“My solicitor provided me with a copy of a circular issued by the Law Society in 2004 advising legal practitioners against issuing such an undertaking but instead to provide an undertaking to repay only those costs that are recovered as a result of a legal action.”
This undertaking was issued, but a month later our reader received a letter from the hospital where he had been having treatment to say that his health insurer had not honoured payment and that if the matter was not resolved they would pursue him for payment directly.
“When I contacted VHI Healthcare, I was told that they do not accept any undertaking other than the one that they issue printed on VHI Healthcare-headed paper, although they had not responded to my solicitor to advise him of this fact and the first time I became aware of this is when the hospital contacted me directly.
“I spoke to a representative of VHI Healthcare’s third party claims department who agreed to talk directly to my solicitor to try to reach a resolution once I gave them written permission to do so – using another standard VHI Healthcare form.”
That was returned by registered post and, although it was delivered to VHI Healthcare more than a week ago, the insurer has not been in contact with our reader’s solicitor.
“Although the situation regarding solicitor’s undertakings has been going on for more than eight years, VHI Healthcare do not appear to have addressed the matter or engaged with the legal profession to reach a resolution.
“I now find myself in the position that despite paying almost €2,000 per year for health insurance and being claim-free since I joined over 20 years ago, I effectively do not have cover.
“I am faced with a situation where I am likely to have to reimburse the hospital directly for treatment which I have already received and I am likely to also have to pay for the surgery as I think it unlikely that the hospital will accept me giving them a completed VHI Healthcare claim form as payment when previous claims have not been honoured.”
We contacted the VHI and were told the “issue has now been resolved with the customer and his solicitor and benefit will be paid for his treatment”.