THE Insurance Ombudsman upheld a complaint of one elderly woman whose insurance company was refusing to settle a claim for medical expenses.

Differences had arisen concerning what was described as a "substantial" claim, running into thousands of pounds, for cardiac treatment and a series of operations undergone in 1994.

The complainant, according to the ombudsman, was "living in fear" that the hospital would move to settle its bill by seeking a charge against her house, after the insurance company refused to pay out on her medical policy.

The company had rejected her liability under the policy, claiming that her medical condition had arisen during the waiting period imposed by her policy, which expired in September 1993. The company relied on two pieces of evidence to establish this, it said, and as such was not liable for the medical expenses the complainant had incurred.

Her hospital notes showed her to have beef suffering from chest pains for more than a year before her admission to hospital, while her own doctor had referred her for tests to establish the cause of her chest pains. She had, however, been previously diagnosed with hiatus hernia, which had caused chest pains in the past, and subsequently denied suffering from cardiac difficulties before consulting her doctor in April 1994.

The ombudsman decided that the company had not sufficiently proved the woman had started to suffer from a cardiac complaint during the waiting period, saying the complainant's medical records indicated that her chest pain could have been caused by another condition.

The company subsequently had to settle her claim.