The Financial Ombudsman Service publishes complaint volumes and uphold rates for named firms every six months. The uphold rate — the share of complaints decided in the customer's favour — is the most useful single number. But raw complaint counts mislead: bigger insurers get more complaints simply because they have more customers, so always compare rates, not totals.
- ✓The FOS publishes firm-level complaint data every six months — free and searchable.
- ✓Uphold rate beats complaint volume: big insurers get more complaints because they're big.
- ✓Compare a firm's uphold rate against the sector average, and watch the trend over several periods.
Why complaints data is worth your time
Most of what you can read about health insurers — star ratings, awards, glossy review pages — is either marketing or heavily shaped by it. Complaints data is different. When a customer exhausts an insurer's internal process and escalates to the Financial Ombudsman Service, an independent body investigates and publishes the outcome in aggregate. The insurer doesn't control the numbers and can't opt out of being named once it passes the reporting threshold.
That makes FOS data one of the few windows into the moment that actually matters: what happens when something goes wrong and you and the insurer disagree. A policy is a promise, and complaints data is a record of disputed promises.
Where to find it and what's in it
The FOS publishes half-yearly complaints data on its website, naming every business that generated enough cases to report. Alongside it, the FCA publishes firm-level complaints data drawn from insurers' own records — including complaints that never reached the ombudsman — which it helpfully expresses per 1,000 policies. Between the two, you can see:
- Complaint volumes. How many cases the FOS received about a firm in the period, split by product type.
- Uphold rates. The percentage of resolved complaints where the ombudsman found in the customer's favour — the closest thing to a published fairness score.
- Complaints per 1,000 policies. In the FCA's dataset — the number that corrects for company size.
- Trends. Because both datasets are published on a cycle, you can see whether a firm is improving or deteriorating.
The caveats that stop the data misleading you
Used naively, complaints data punishes size and rewards obscurity. Keep these corrections in mind:
| Trap | Why it misleads | The fix |
|---|---|---|
| Raw complaint counts | Bupa-sized insurers have millions of members; a small mutual has thousands. More customers means more complaints, however good the service. | Compare rates, not totals — uphold rate, or complaints per 1,000 policies. |
| One period in isolation | A single six-month window can be skewed by one systemic issue or a claims backlog. | Look at two or three periods and read the direction of travel. |
| Mixed product lines | Some firms' figures blend PMI with cash plans, travel or other lines with different complaint profiles. | Use the product-level splits where published; compare like with like. |
| Low uphold rate alone | It can also mean customers with weak cases complain more at some firms — context matters. | Read it alongside what people complain about in the ombudsman's commentary. |
One more structural point: a complaint reaching the FOS at all means the insurer's internal process didn't resolve it. Firms that handle disputes well in-house generate fewer ombudsman cases in the first place — which is exactly why per-policy complaint rates from the FCA dataset are a useful companion number.
Compare insurers on more than price
A ten-minute method before you buy
- Shortlist first. Pick two or three insurers on cover and price — complaints data is a tie-breaker, not a starting point.
- Look up each firm in the latest FOS data and the FCA complaints tables, filtering to health or medical insurance where possible.
- Compare uphold rates to the sector average, not to zero. Every large insurer gets complaints; the question is relative performance.
- Check the trend across the last couple of publication rounds.
- Weigh it with everything else — claims process, hospital list, exclusions. A clean complaints record doesn't fix a policy that excludes what you need.
Frequently asked questions
Where can I find Financial Ombudsman complaints data on health insurers?
On the Financial Ombudsman Service website, which publishes half-yearly data naming each firm with enough cases to report, including complaint volumes and uphold rates. The FCA separately publishes firm-level complaints data from insurers' own records, expressed per 1,000 policies — useful because it corrects for company size.
What is a good uphold rate for a health insurer at the ombudsman?
There's no fixed pass mark — compare each insurer's uphold rate against the average for its sector in the same period. A rate clearly below the sector average suggests the firm gets more decisions right first time; one clearly above it means the ombudsman overturns that insurer more often than its peers.
Do more complaints mean a health insurer is worse?
Not by itself. Bigger insurers generate more complaints simply because they have more members — raw volume mostly measures size. The numbers that correct for this are the uphold rate and, in the FCA's dataset, complaints per 1,000 policies. Always compare rates, never totals.
Can complaints data alone tell me which health insurer to choose?
No. It's a strong tie-breaker between insurers you've already shortlisted on cover, hospital list and price — it tells you how firms behave in disputes, not whether the policy suits you. Read it alongside claims processes, exclusions and structured satisfaction surveys before deciding.