Holiday Insurance Company Settlement

[Worried37]

Morning all,

I do hope someone can help me, saving me the time and cost of a solicitor in my initially response to a holiday insurance claim I made on behalf of my parents.

My mother was taken ill whilst we were in Spain, falling and hurting herself on the Wednesday of the first week. Having her E11 card and private insurance, one felt that as long as we were able to get her better to be able to fly home, most things would be covered.

Whilst in Spain I contacted the 24 hr emergency line with the Insurance Company my dad had booked with (CSIS). I spoke nearly daily with an allocated officer in their office who was exceptional and couldn't have been more helpful. She requested that I send all paperwork, pharmacy bills etc, via fax and keep them updated which I did. She did telephone me back sometimes to save on my mobile bill, but being in Spain I still get charged for these calls.

Eventually the doctor who mum was under gave permission for her to fly on a Tuesday (we should have left the Saturday before) and thankfully we did all arrive home safely. No nurse was needed on the flight or a special flight just for our party. The insurance company are paying the extra cost of the villa for the 4 days.

I completed the form, giving all information, including the original receipts/bills and the company Towergate Chase Parkinson (who CSIS use as their broker) duly acknowledged and said they would respond within 20 days.

On Saturday my father, gave me a letter from Towergate Chase Parkinson and showed me the cheque they had included. They will not pay for:

1. Telephone calls, all of which are itemised by my mobile company showing registered calls to CSIS, the Doctor etc.
2. They will not pay for food for the extra 4 days (all receipts included) because they have stated you would have had to eat if you were in England.
3. No recompence for faxes, email, photocopying, all of which was requested by CSIS as they consider this consequential losses.
4. They will not pay for the 10 days at the villa, ie holiday lost.
5. I had to contact Easyjet, which could be in a forum all on their own, but I digress, I had to cancel and rebook our flights at an extra cost. The insurance company asked who was in our party and will pay only for my parents and not also for my young son and myself. Is this correct because I do appreciate we were insured with a separate company?
6. They will not pay the petrol bill needed whilst spending 4 extra days in Spain, but yet they have paid for the extended hire car.

I know long winded, but I really would like some help with regard to the above and where to go next. Many thanks

[Bookworm]

They will not pay for:

1. Telephone calls, all of which are itemised by my mobile company showing registered calls to CSIS, the Doctor etc.
You will have to double-check what it says on the policy T&Cs, but from experience, you will have a hard time arguing it.

2. They will not pay for food for the extra 4 days (all receipts included) because they have stated you would have had to eat if you were in England.
Arguable, but strictly speaking, they are correct, the insurance only covers for additional costs, and those incurred in Spain would be offset against the costs NOT incurred in the UK.

3. No recompence for faxes, email, photocopying, all of which was requested by CSIS as they consider this consequential losses.
Again, check the T&Cs. The assistance company would have told you to keep receipts for everything because without receipts, you would have no chance to get anything refunded at all, but I am 100% certain that they would have given you no guarantee that those costs would be met. The reason I know this is because even though you might have thought the people you were talking to were CSIS, the assistance came in fact from an assistance company (International Medical Rescue in this instance), who would have tens and tens of different contracts with different insurance companies, all with different wordings and excesses and levels of cover. The operator to whom you spoke would have been unlikely to know at the top of his head which restrictions applied to your parents' policy and would have given you the standards speech of "keep receipts for everything", and then answered another 500 + calls that day.

I'm also certain that in the "general conditions" of the documents, there'll be a paragraph stating that you'll have to furnish at your expense such reports information and proof as may reasonably be requested, or words to that effect.

4. They will not pay for the 10 days at the villa, ie holiday lost.
What 10 days? The ones during which your mother had hurt her ankle? Yes, that is correct, travel insurance doesn't cover for loss of enjoyment.

5. I had to contact Easyjet, which could be in a forum all on their own, but I digress, I had to cancel and rebook our flights at an extra cost.
Why didn't your assistance company deal with that? They should have booked the flight, although their responsability would have only been to your parents, not you and your son.

The insurance company asked who was in our party and will pay only for my parents and not also for my young son and myself. Is this correct because I do appreciate we were insured with a separate company?
Even if you had been with same insurance, it wouldn't have made any difference, as they would only have paid for 1 person to stay behind to assist pax. As you were with a different company, you really have no grounds whatsoever to ask this insurance company to pay for any of your costs, in the same way you wouldn't ask your parents' home insurance to cover you if your house was burgled, would you?

6. They will not pay the petrol bill needed whilst spending 4 extra days in Spain, but yet they have paid for the extended hire car.
Petrol is never covered on hire cars, whether in the UK or abroad. The same would apply if you had a courtesy car in the UK.

I know long winded, but I really would like some help with regard to the above and where to go next. Many thanks.

I think that they are penny pinching, and you might want to try and push for at least some of your phone bill to be covered (the calls from your mobile to spanish numbers, no chance, as they'll argue you could have mitigated your loss by phoning from a spanish landline, so no need for international phone calls), but otherwise, I don't think you have much of a hope. You can try to take it to the Ombudsman, but to be brutally honest, I don't see that they are doing anything but apply the letter of the policy, so the Ombudsman is not terribly likely to go in your favour, IMO.

Save yourself the cost of a solicitor, what you stand to gain, if anything, would not cover his hourly fee.

[Worried37]

Many thanks Bookworm for your quick informative response, but one which still doesn't say "yes ask for the telephone calls to England" "yes ask for the faxing etc".

Maybe I'm having a blonde day, but the answers, albeit informative, seem to be on the fence.

[ladybird17]

It really depends on the T & C's in the policy, Worried.
They vary so much - a few years ago my Mum had a fall in Cyprus & broke her knee - my Dad was with her but their insurance still paid out for me to travel there & back & the cost of the hotel for the week. We made sure that the Doctor treating her in Cyprus wrote a letter stating that it was vital I was there.
On the other hand, last year I had to get hospital treatment in Canada - my insurance stumped up for everything - apart from the parking costs at the hospital which were about C$20 - so you really have to read the small print and be sure of your facts.

[Worried37]

Thanks Ladybird, I am going to go through mum & dad's booklet and highlight/mark all that I think is relevant and then when I compile my letter I can quote their clauses etc.

Will keep you informed x

[ScarletPimpernel]

There's not much to add to Bookworm's excellent answer. I agree that there is not much mileage in going to the Ombudsman.

In particular, I think the assistance company should have organised the flights (my experience is that many insurers won't cover costs unless this is the case), and they should have ensured that the airline gave specific medical clearance for the patient to fly.

[livelylad]

Originally Posted by Worried37

Many thanks Bookworm for your quick informative response, but one which still doesn't say "yes ask for the telephone calls to England" "yes ask for the faxing etc".

Maybe I'm having a blonde day, but the answers, albeit informative, seem to be on the fence.

The highlighted bit is exactly what you have recieved. Your questions have been answered in full detail by the moderator who has arguably the best knowledge on this subject.

I think that they are penny pinching, and you might want to try and push for at least some of your phone bill to be covered (the calls from your mobile to spanish numbers, no chance, as they'll argue you could have mitigated your loss by phoning from a spanish landline, so no need for international phone calls), but otherwise, I don't think you have much of a hope. You can try to take it to the Ombudsman, but to be brutally honest, I don't see that they are doing anything but apply the letter of the policy, so the Ombudsman is not terribly likely to go in your favour, IMO.

This is not sitting on the fence, this advises you that your chances of suceeding are slim to say the least. Hardly sitting on the fence!

[Worried37]

Thank you for highlighting the last question livelylad, but my comment at the end with regard to "sitting on the fence" was not aimed at one specific answer by the moderator so please, this did not need to be highlighted.

I shall be obtaining a copy of the booklet of all items covered/or not from the insurance company (or easier still from my father). I can then work through this, their response and the answers I have been given on this forum.

[livelylad]

I still fail to see where Bookworm has sat on the fence, I read Miss Bookworms answers as specific regarding the T&C's or the balance of her experiance/probability, not a fence in sight.