holiday insurance wont pay out!!!

[amelia]

I was wondering if anyone can help!! I booked my holiday with haystravel and received free travel insurance. However 5 days before my family and I was due to fly my cousin, my mums nephew died. As you can imagine we were and still are grief stricken as we were so close however I informed the insurance company of what happened and I got all the relevent info they needed. I received a letter though saying to check my terms and conditions as cousin and nephew are not classed as close relative in there T+C . so my family and my mams lost all our money but how can an insurance company determine a close relative!! and how would we have any idea my cousin was going to die!! I just think it's really unfair and was wondering if they can get away this, I know its in the T+Cs but it doesnt seem right.

[blitz]

A close or imediate relative is usually one or sometime 2 jumps away from yourself.
One 'jump' would include partner, children, brother, sister, parents.
Two would therfore include also: aunt/uncle, grandchildren, grandparents.

Cousins would therfore be another step down a family tree, unfortunatly when it comes to something offical like this the insurance company has to draw the link somewhere, no matter who 'close' you are personally to them.

If it is in there t&c to what they define as close, which you agreed to then yes they are in the right.

[Bookworm]

Unfortunately, you often get what you pay for.

Most travel insurances have different T&Cs, some include more distant relatives, some don't. The insurance, however cruel it may seem, has not done anything wrong in this instance.

[amelia]

Thanks so much for replying!! Its just like I thought you ppl just confirmed what I already knew but its worth looking into because we lost £3000.00. Next time I will get my own insurance and make sure its a really good cover because you just don't know whats around the corner!! Anyway thanks again guys!!!

[Bookworm]

Very wise. I m so sorry you had to find out that way.

Word to the wise: Be very careful about revealing pre-existing conditions, no matter how benign they may seem, or how irrelevant. Many inscos will try to wriggle out on small things. If in doubt, discuss. And never accept the all-in insurance package from tour op or hol company unless it fits your purpose. And don't forget that if a travel agent told you one thing, but the document said something different, the assistance company will HAVE to act on the written word. Not a pleasant situation if you're in a hurry to get home.

SO check and double-check for yourself the T&Cs of a policy, don't take the T/A word for it.

And (while I'm at it, lol) ALWAYS take a European Health Insurance Card (EHIC) with you in EEC countries.

EHIC and Health advice for travellers : The Department of Health - P&G: Health advice for travellers

Hope you manage to get a holiday soon.

[mooreda]

in respect of this claim; my experience as a Technical Claims Advisor, the insurer despite what it says in the terms and conditions regarding "close relative" has to be reasonable in it's interpretation of the policy.

If you, as a "claimant" consider your Mum's nephew to be a close relative in so far as you are in regular contact with his person etc the Ombudsman would not look favourably on the insurer for rejecting the claim. There is in fact NO CLEAR DEFINITION of a "close relative" as far as the law is concerned irrespective of what the insurance company thinks.

You need to consider making a complaint explaining that you/and or you Mum regard your Mum's nephew as a "close relative" because ............... and give your examples.

If the insurer still refuses to provide financial assistance then I would encourage you to escalate your complaint to the Financial Ombudsman Service. Travel Insurance Firms (or more than likely their appointed agents who process the claims) are known to try and wriggle out of paying anything.

[amelia]

Thankyou mooreda that is really helpful however not sure how to put it into words how close we were, I mean we were brought up brother and sister but dont know how to put into words for the insurance company to accept that. Do you think I should definately write and try to explain however if I get the brush off shud I write to the financial ombudsman service.

[mooreda]

i wouldn't give up - have just had a look at my annual travel insurance policy - it stipulates in the definition "close relative" -

means mother, father, sister, brother, wife, husband, daughter, son, grandparent, grandchild, parent-in-law, son-in-law, daughter-in-law, sister-in-law, brother-in-law, step-parent, step-child, step-sister, step-brother, aunt, uncle, cousin, nephew or niece.

please explain again - is it your nephew or your mum's nephew that resulted in you cancelling your holiday? Please also post a copy of your policy wording that the insurer is relying on to reject your claim. I will see if I can help further.

[mooreda]

I would write the following:

Dear Sir/Madam

COMPLAINT ABOUT TRAVEL INSURANCE POLICY No 123456

I am in receipt of your letter dated 1st October 2006 declining my claim.

Of course I have read your comments and referred to the terms and conditions of my policy. I do however firmly disagree with your decision.

It is my understanding irrespective of the policy terms and conditions that there is no clear definition of "close relative" as far as the law is concerned. I further contend that in the majority of cases, other travel insurers stipulate in their policy wording that they consider a "nephew" or "niece" to be a "close relative".

In so far as the policy terms and conditions are concerned, as you state, you do not consider a "nephew" or "cousin" to be a close relative and I am of the view that the policy wording is both unfair and unreasonable in light of my circumstances.

I would be grateful if you could re-consider your decision and provide me with a final response on behalf of the insurance company. In the alternative I propose to escalate my complaint to the Financial Ombudsman Service.

[Bookworm]

Originally Posted by mooreda

in respect of this claim; my experience as a Technical Claims Advisor, the insurer despite what it says in the terms and conditions regarding "close relative" has to be reasonable in it's interpretation of the policy.

If you, as a "claimant" consider your Mum's nephew to be a close relative in so far as you are in regular contact with his person etc the Ombudsman would not look favourably on the insurer for rejecting the claim. There is in fact NO CLEAR DEFINITION of a "close relative" as far as the law is concerned irrespective of what the insurance company thinks.

You need to consider making a complaint explaining that you/and or you Mum regard your Mum's nephew as a "close relative" because ............... and give your examples.

If the insurer still refuses to provide financial assistance then I would encourage you to escalate your complaint to the Financial Ombudsman Service. Travel Insurance Firms (or more than likely their appointed agents who process the claims) are known to try and wriggle out of paying anything.

I quite disagree.

BECAUSE there are no clear legal definitions of a "close relative", this is where the T&Cs will take an all important part. And I can assure you that this is the line both the underwriters and the Ombudsman will take, having dealt wth thousands of those cases myself. And it will go like this:
"Did this policy cover for nephew or niece?". "No". "Complaint rejected".

The DWP doesn't consider uncle or aunt as close relative. And Parliament publications Hansard state: "I have always understood "close family" to mean children, parents, siblings and spouse".

In fact, I can tell you that the reason policy wordings now specify their definition of a close relative is because there used to be arguments just like this when it only stated "close reative", and the u/writers ended up paying rather then try to unravel this. So now they state what they will cover as close relative, so as to be no ambiguity.

In this instance, it will boil down as to what each insurance will cover for. You pay more for a cover that broadens the scope, and therefore increases the "risk" to the insco.

The fact that other insurers include it is neither here nor there. There are no 2 identical policy wordings. There are no unfair or unreasonable terms, as OP didn't have to accept that insurance, so the UCTA wouldn't apply. There was no unilateral imposition, as OP could in fact have got herself a different insurance that would have covered her for all eventualities.

What you suggest is the equivalent of taking a home insurance that doesn't cover you for water damage, then complain when they won't pay up after a flood.

Amelia, I'm sorry it's not what you want to hear, but I really think you're on a hiding to nothing here. Write back by all means, but please don't pin any hope on it.

[Tiriam]

I'm sorry to hear of your loss. As other people have said you need to read the definition on your policy as to what is classed as an relative. All policies are different, and in a lot of cases you get what you pay for. If it doesn't state that it includes your cousin then you won't be able to claim.

As an alternative you could try writing to the travel company and appealing to their better nature (if they have one), focusing on how much you were looking forward to your holiday, your disappointment with the insurance and the trouble it is causing you at this difficult time, and that you would expect more from reputable companies such as this, and that there will be no chance of repeat business from you or anyone that you know, or words to that effect.

You might find that they will offer you something as compensation in order to protect their reputation, but i doubt you will get a refund though. Hope this helps.

[mooreda]

I stand by what I said earlier and noted your comments bookworm but I do recall about a year ago an article appearing in "Ombudsman's News". There was quite a large article covering travel insurance complaints and one case in particular mirrors that of Amelia's predicament. If I remember correctly, the Ombudsman found in the favour of the claimant and instructed the INSCO to pay out even though the terms and conditions of the insurance did not within it's definition mention "cousin". I will try and find it if I can.

[amelia]

ok guys I will explain how we related, Its my cousin and my mams sister son so it her nephew however my mum and dad and my family were all 1 big booking on our hols and insurance details but because they dont cover nephew or cousin none of us could claim. I will type what our inssurance policy wording says about close relative.

CLOSE RELATIVE: Spouse or common law partner, parent, parent-in-law, step-parent, legal guardian, children (including legally adopted and step-children, and daughter/son-in-law), sibling (including step-siblings and sister/brother-in-law), grandparent, grandchild, or fiance(e) of an insured person.

[Bookworm]

There's really no ambiguity there, is there? My previous advice stands. Very sorry.

[mooreda]

i agree bookworm!

i wouldn't give up though Amelia - complain that you think the wording is unfair considering the fact that the person in your view was a close relative etc. You've got nothing to loose by taking your case to the Ombudsman. You never know you may find they will take your view. I have tried to find the report on Ombudsman's new's as I definately recall a similar case where they agreed with the complainant that the policy wording was unfair.

[amelia]

thanks every1!! I will write and put my point across like you say I have nothing to loose and I will keep you guys posted on the outcomes.