Curtailment Claim....where do I stand

[cfowles]

Hi

I have no idea if this is the correct forum, so apologies if it isn't. I am in need of some advice regarding a recent curtailment claim that has been refused.

I am 15 weeks pregnant, and so far, all is well. I suffered a miscarriage in March this year at around 11 weeks, and just after that event, my husband and I booked our first holiday in 5 years for mid June. It sort of doubled as our honeymoon (which we still haven't had) and our 3 year olds first holiday. This is all irrelevant info, but just wanted to give you a basic background so that you can judge if I'm being too emotional over the whole situation.

anyway, holiday booked, flights booked (separately) and travel insurance booked through the Post Office (underwritten by Fortis). During the conversation with the PO rep when booking the Insurance, she asked if I had any illnesses etc, to which I responded none, (truth) but that I was (at the time of booking) 8 or 9 weeks pregnant. She said that wasn't relevant and didn't matter, as long as I wasn't 32 weeks on return date. We were only going for a week, so that wasn't likely to happen. I also had EHIC for all the family.

Day of arrival, I started to have light spotting instances, which steadily got worse over night resulting in complete panic the next morning - and having gone through the exact same thing in March, I knew what to expect, whereas my first pregnancy was completely trouble free, resulting in a happy healthy baby girl (now a three year old thug!). Anyway, that morning, I called International Assistance, who told me, in no uncertain terms, to see a doctor or get myself to a hospital. So, it took 1 hour of frantic bad italian / english translations (nobody at the resort spoke a word of english and our italian is bad at best, but we tried - there was also no medical person at the resort either, anywhere, and we were out in the middle of nowhere in Sardinia) and eventually, a Taxi was booked to take us to a hospital. There was no representative there for us either. The taxi driver didn't understand ANY english at all, so it was silence all the way. He eventually dropped us off at the entrance to , what I think was, a hospital, and pointed us through the doors.

Inside the hospital, it was deserted, there was nobody anywhere and no signs - in either italian or english - to tell us where to go. Myself and my husband dragged our 3 year old around for an hour, trying to find someone, anyone that could help. I called International Assistance again and spoke to the same lady I'd spoken to before, and her exact words were "I cannot help you, you need to see a doctor, only after that can I take any information from you". Basically, don't call me again!

After an hour, we gave up, went back to the hotel and booked the next flights home (same day) at our expense, back to a different airport from where we departed (and where our car was). It was a horrendous nightmare.

The insurance company have refused to pay any kind of curtailment expense on grounds that:

1. If you have to return home early, Assistance International must be called immediately or as soon as reasonably possible to authorise any expenses. If you do not do this, we may not pay your claim.

2. Before you return home for medical reasons, you must get a doctor's certificate to confirm that this is necessary and you are fit to travel.

We understand that you did not return home early on the basis of a doctor's recommendation and although you did contact Assistance International prior to doing so, you were advised that you must see a doctor. In view of this, we very much regret that we shall not be able to accept your curtailment claim.

I am so very very cross and angry, as I COULD NOT do what they wanted me to do, despite trying and trying and trying. Did they expect me to spend the rest of my holiday camped out in a filthy hospital with a three year old, not knowing if I was losing my baby or not!???

They have advised that I write to them again to appeal against their decision, but what chances to I have? Is it worth getting an ombudsman involved - this is nearly £3000 we're talking about, and something that I cannot afford to lose at this time. They have all the necessary documentation required for the claim.

I am so sorry for rambling on for as long as I have, but I really don't know where to turn. any help or advice would be much appreciated

Regards
Charlotte

[Rob S]

Charlotte,

You have nothing to lose by making a formal complaint with the company. it has to go through their complaints procedure first and if they stand by their decision they will eventually write to you and give you a final response. Once you have that you can go to the Ombudsman. Give it a go. Often insurers won't settle unless their clients fight them for it, and most people will give up easily, so make the complaint formal and take it all the way.

[ScarletPimpernel]

It seems to me that in this case, it is unreasonable to blame AI for the lack of a hospital proximal to the resort. It is unreasonable to blame AI for non-availability of English speaking taxi-drivers, signage or the elusiveness of hospital staff, since they have no influence over any of these things. It is unreasonable to expect that medical facilities abroad will be as good (or as bad) as they are in the UK.

By the same token, it is unreasonable of an insurer to expect a tourist to have a working knowledge of foreign medical services or the language.

The lack of representatives is a matter for the tour operator.

However, I do think that it is reasonable to expect an medical assistance service to provide assistance with a medical emergency abroad. Just remind me what the company is called again? Ah yes - Assistance International...

Assistance companies work in different ways. The best will have multi-lingual staff, who can liaise directly with medical staff on the ground as well as the patient. Some have local agents in-country, to whom they pass the details so that they can do the liaison. Others rely almost entirely upon what happens locally. Personally, and with the benefit of several years experience working with assistance companies and over 1000 aeromed flights, I prefer the proactive approach, whereas AI appear have been entirely reactive.

What could Assistance International have done to assist in this case:

- they could have found out what medical resources were available locally, and directed the patient to the one most suited to the presenting symptoms, or the nearest emergency department
- they could have arranged for the patient to speak to their own medical adviser, so he could take a history and decide what to do next
- they could have arranged transport to the hospital
- they could have arranged for someone to speak to the treating doctor, in his own language, to determine what his findings were and discuss the next step
- after the patient was unable to find anyone to see her by her own efforts, they could have taken over and resolved the issues - they can always ring the nearest British Consulate
- they could have explained the potential consequences, medical and financial, of organising your own repatriation
- if the decision was to repatriate, they could have made all the necessary arrangments including arrangements for you to be seen upon your return

After all, they are supposed to be the experts to whom you can turn in an emergency. They could have done all the above within the terms of the policy - and looking at a standard Fortis wording, that's exactly what they should have done.

Assistance International is an insurer's in-house setup, and it strikes me that they seem to be more concerned with minimising their own costs and losses than in the wellbeing of the patient.

It is not unreasonable for an insurer to insist that repatriation is medically necessary (and there may be a difference between what the patient wants, and what is medically necessary), but surely that is why they have an assistance company - to check it out and then organise a repat that is both clinically safe and cost-effective.

I am always amused by the stricture that one should obtain a note from a local doctor stating that the patient is fit to fly. It always strikes me as an abrogation of responsibility. It assumes that the doctor has a knowledge of the physiology of flight, the operating environment of aircraft, and other factors. Most doctors do not, and I have seen many patients who have been 'fit to fly' who were patently not, and who could have suffered as a result. In any case, the decison to allow a medical case to travel is ultimately for the aircraft captain; many airlines require clearance from their own doctor first.


What can you do?

Raise a formal complaint to the insurers - details of the procedure will be on the policy document.

Ask them to reconsider their decision, and explain why AI did not in fact assist you, despite your best effort to follow their instructions. It was their failure to help that made it impossible for you to comply with the terms of the policy. Keep it objective.

They may try to say that as you have a history of miscarriage, you should have contacted them before travelling; they could also say that you were under medical treatment at the time of travelling, but I doubt either would stand up.

If you get an unsatisfactory response, you can ultimately go to the Financial Ombudsman Service. You can see from here Travel Insurance - case studies that they tend to uphold complaints.

[cfowles]

Thank-you, that is a really helpful response, and I agree entirely that it is unreasonable to blame AI for the lack of hospital staff, signage and taxi drivers...it is good to know exactly what their responsibility is, or can be, in such situations, and I am grateful to you for taking the time to comply a concise and helpful response, it is much appreciated.

I have complained to the insurers stating the below, although not as thorough as you have outlined; and so again, it is a waiting game.

Once again, I appreciate your time

Regards
Charlotte

[ScarletPimpernel]

Glad to help - feel free to click my scales!

You can always keep a few points in reserve in case they don't get their answer right first time. Exactly where were you staying? - I have an idea for another point you could use, particularly if it goes to FOS.

[cfowles]

We were staying in South Sardinia, Resort called Costa Rei. The nearest hospital was an hour's drive away.

[ScarletPimpernel]

Well, if AI's staff had googled Costa Rei and 'ospedale' they'd have found, within about 15 seconds, not only the hospital's details, but those of the local doctors, pharmacies and 'pronto soccorso' (mini A&E places) in the area. Hardly rocket science.

Mind you, I'd expect an assistance company to have a database of at least regional centres. I doubt very much that this will be the first time a British tourist has needed medical help in the area.

And, as it turns out, there's a pronto soccorso in Costa Rei itself, so they could have directed you there in the first instance. Alternatively, they could have suggested that you call the Guardia Medica, the Italian national out of hours GP service, or better still, done it for you, or got the tour operator to do it. But then I'm forgetting - doing nothing is easiest.

[cfowles]

Hmmm, good to know, again, thanks. I'll certainly be using this. It's a shame, because it was lovely weather........much better than here anyway, but then, that isn't hard!!!!

I'll let you know how I get on

Regards
Charlotte

[cfowles]

UPDATE!

I received a telephone call on my mobile from Fortis Insurance this afternoon. Basically, he said that (in a round about kind of way - obviously not verbatim as I was sat in the car trying to not look like I was catching flies :o)

"although in the letter of the law, we were within our rights to reject the claim, we have looked at the exceptional circumstances surrounding this and it appears that they were really not in your control. We will pay your claim and the cheque is going out into the post to you tonight!"

So, I just wanted to say thank-you very much for the advice. It is definitely worth pursuing a claim if you truly believe circumstances were against you.

Thanks again...

Charlotte