King & Wood Mallesons
King & Wood Mallesons is a global law firm with around 2,700 lawyers and more than 30 offices across the world. It is the first global law firm to be headquartered in Asia.
A health insurance claim was declined by King & Wood Mallesons’ insurer on a technical basis, leaving the company materially disadvantaged and having adverse implications for the employee concerned. An appeal was made, but rejected by the insurer again.
Our Health Management team consulted with the client to understand the rationale behind the insurer’s position, and from this we developed an approach designed to overcome the technical issues behind the claim being declined.
Utilising the expertise of specialist clinicians from our sister company Capita Health and Wellbeing, a gap was found in the insurer’s position. This enabled our team to prepare and manage an appeal for King & Wood Mallesons, which was heard by the Financial Ombudsman Service.
The expertise of our senior Health Management consultants combined with specialist assistance from our sister company enabled the client to better understand and present their case for redress.
On the basis of the evidence produced and presented by us, the Financial Ombudsman Service overturned the earlier appeal decision and found in favour of our client, awarding full payment plus interest.
The expertise of Capita’s Health Management team, allied with their ability to call on the views of specialist health professionals from the wider Capita group, really enabled us to get a full understanding of our position. The subsequent appeal was managed perfectly and we were naturally delighted with the end result.
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