Help! cancellation claim refused because father taken ill "not resident in uk"

[againstbankcharges]

Hi, please help! I had to cancel my holiday last summer as my father suffered a devastating stroke the day before my departure. I rushed to his bed-side in Italy where he resides and he died two days later. I informed immediately my travel insurance company, Option Insurance, who advised me to put in a claim on my return. I did this. I explained all the circumstamces and all seemed fine. I was sent a very detailed questionnaire and medical form which had to be filled in by my late father GP.

To obtrain this and his death certificate I had to travel to Italy. I incurred this extra cost as the holiday I had to cancel was an expensive safari to Kenya.

After I had sent the documents off, I have now received a letter from Inter Group Claims Services informing me that the claim cannot proceed as my insurance policy in the definition of "Relative" includes only relatives residing in the UK.

Since my first approach to the insurance company I had made clear my father was in Italy, but nobody had pointed out this clause to me before (but which is printed in the booklet).

I wonder if this exclusion of relatives living abroad in the EU is acceptable under our European rights? As an Italian living in the Uk for the last 10 years I have regularly renewed this yearly travel indurance with Options never knowing that the level of cover provided to me was inadequate as most of my relatives still live in Italy.

Do I have any ground to contest?

Thank you if you can help me

Unhappy Italian Lady

[rory32]

Thread moved to Insurance Companies Forum

[Bookworm]

Hmmm... Strictly speaking, they are totally right, of course, as travel insurance covers residents and their circumstances in the UK, and when your circumstances are different from the average, it is really up to you to check that you are covered for everything that may deviate from the norm. The fact that you were advised on the phone to claim on your return is neither here nor there, frankly, are you telling me that if you had been advised straight away that you wouldn't be covered, you would have gone to Kenya instead of Italy to your father's deathbed? Somehow, I don't think so.

 

As for the death certificate and report, there are plenty of ways to get those done which do not necessarily involve a trip there, so I don't think you can really use that either.

 

The reason is of course that when it comes to costings, a repat/curtailment to be arranged could vary too wildly in costs if they had to pay for relatives to go everywhere in the world. I do however feel that in this case, if all you are claiming for is the cancellation of your holiday, whether your relative was here or elsewhere makes no difference to their costs.

 

I don't know what you are trying to claim for, but if it is more than the cost of your cancelled holiday, it might be worth changing your claim to only that and point out what I have said as regards their costs. If they still refuse to consider it, then your only option is the Ombudsman, but whether they will accept that you have a valid argument or not, I can't say. If you never queried in the last 10 years whether your cover was actually adequate, I feel that you have to largely take responsability for this.

 

Some insurances won't specify that relatives are to be in the UK, so it might be worth hunting around, and make sure you read the wording throroughly yourself before taking the insurance, don't take the word of an agent who probably won't know the exact terms or wording on each policy.

[LemonTwist]

I've had a look at the policy wording, and this is what it says in the definitions section: "

 

'RELATIVE'

Brother, brother-in-law, common law partner, daughter, daughter-in-law, fiancé(e), grandchild, grandparent,legal guardian, parent, parent-in-law, sister, sister-in-law, son, son-in-law or spouse living in the UK.

 

So, it does specify that to be classed as a relative, the person has to be currently living in the UK. Nationality is irrelevant.

http://www.optionsinsurance.co.uk/scheme/policywording6.pdf

 

 

On page 23 it says that you are covered if you have to cancel a trip because of a relative living abroad falling ill, but only if you were planning to stay with them:

 

 

 

2 The death, injury or illness of a Relative, close Business Associate, a person with whom You have

booked to travel or a Relative or friend living abroad with whom You plan to stay.

 

 

 

 

Cases like these highlight the importance of checking the policy wording to make sure the cover meets your needs. If you buy insurance online, you can often download and read the actual wording before you even enter your details to obtain a quote.

 

Once you take out a policy, you are deemed to have agreed to the terms and conditions, regardless of whether you have read them.

 

 

 

 

 

[jamie33]

LemonTwist,

 

How much was your cancellation claim for?

 

Technically speaking you are bound by the policy wording, however they do not have to read this to you as the onus is on yourself to check that the policy meets your criteria etc.

 

You can appeal against the decision to decline your claim to the relevant managing director. If you do not accept their reason you can then approach the Ombudsman (this does not cost you anything). Depending on the amount of your claim they may pay your claim rather than risking the ombudsman siding with yourself (as this costs the insurer).

[LemonTwist]

In this case I think it would be very unlikely that the ombudsman would side with the policyholder, as the definition of "relative" is specified clearly in the policy. I don't think it is likely that an insurer would pay a claim just because they are afraid the ombudsman might side with the policyholder - if they know they are in the right they will stick to their decision to decline the claim regardless.

 

As the policyholder has had the policy for 10 years, I imagine the ombudsman would expect her to know what she is covered for. I've had a look at a couple of other policy wordings - the 2 policies that I looked at didn't specify that a relative has to live in the UK, so I think in this case they chose the wrong insurer.

 

She says that nobody pointed out the exclusion to her when she bought the policy, but I don't think she can say the policy was mis-sold. The salesperson can't be expected to point out every single aspect of the terms and conditions, otherwise the phone call would need to last for a very long time!

 

Anyone has the right to go to the ombudsman once they have exhausted the company's internal complaints procedure, but in this case I really don't think it would be worthwhile. The ombudsman service was set up to help people who have been treated unfairly by companies. I think that if people lodge a complaint purely out of spite for a company, it will simply slow the system down for people who have genuinely been treated unfairly by their insurer.

 

Of course I feel sorry for what has happened to the original poster, but I really do think people should try to take more care when selecting a policy, particularly if you have special circumstances or if it is a non-standard risk.

[Guest Old_andrew2018]

Hi

I have to agree your policy states resident in the UK, however I think there is a chancge of the insurance company reassessing you claim

this is a letter I wrote to an insurance company altered slightly here

I hope it is usful, in addition take a look at this link to an adjudication

by the FSO it is similar to your case however the relative (mother) was resident in kenya, and the son on holiday in Holland

Travel Insurance - case studies

Lemon Twist if you are still on line if so can you comment on the link and precedent (if there is one) and kindly edit this letter I am not a natural writer you will understand

 

Your name

Address 01

Address 02

 

Date

 

 

Insurance Company

Address

Dear Sir or madam

Complaint

Re: - insert your policy number

I acknowledge receipt of your letter dated insert date, regarding my claim, made on a Annual Insurance Policy, I note that Insert companies name intend to reject this claim.

I ask that you reconsider this decision, as I have at all times acted in good faith, and conscientiously,

am I correct in noting that if my father had been resident in the United Kingdom then my claim would have succeeded?

I feel that this is in fact unfair, and your company chooses to rely on this term and condition (resident in the UK) in order to reject claims, this is an unusual condition.

I have since looked at terms, and conditions, for other companies providing travel insurance, whilst I have to agree definition of who they consider to be close relatives is quite similar I have not found any reference that requires then to be resident in the United Kingdom.

I await your response, may I take this opportunity to thank you in advance for your assistance in this matter.

Yours Faithfully

 

 

 

Insert Your name

[Guest Old_andrew2018]

sorry I must add that it is worth waiting to see if a member can edit the letter,

[Guest Old_andrew2018]

sorry I must add that it is worth waiting to see if a member can edit the letter,

hi

not heard anything for a while have you been succesful

[BADGER 69]

The fact that the policy was resticted to the UK may contravene EU legislation. EU law may require it to cover the EU.

[againstbankcharges]

Thank you for the advice and the text of the letter. I will try to send it to Options and see what comes of it.

 

Just this may interest you: my boyfriend who was to go on holiday with me, is insured with axa, and they are also turning the claim down.

 

Axa has no clause excluding relatives abroad, however, they quote "pre existing conditions".

 

My father being 82 years old was on stable doses of cardiovascular medication for years, as most people are at that age. He had suffered 2 minor hart attacks in his late 50s and a very minor ischemic epoisode two years ago which left no consequences to his health.

 

Before the stroke suddenly killed him, he was in good health (as his doctor specified in the medical form I had to have filled in). He had recently been on a week holiday touring Norway and before then, touring Spain. The week preceeding the stroke he had been working full time on the family farm. Hardly a sick man. AXA however, because of the medication, claim "pre existing conditions".

 

What can he do?

[Bookworm]

Not a lot. Whether your father was a sick man or not or had the same medication that "most people" get at that age (a sweeping generalisation, incidentally), it was up to your boyfriend to declare what pre-existing conditions your father had or didn't have, as it would have influenced the insurer's decision whether to insure him or not and/or whether to increase the premium.

[Guest Old_andrew2018]

Thank you for the advice and the text of the letter. I will try to send it to Options and see what comes of it.

 

Just this may interest you: my boyfriend who was to go on holiday with me, is insured with axa, and they are also turning the claim down.

 

Axa has no clause excluding relatives abroad, however, they quote "pre existing conditions".

 

My father being 82 years old was on stable doses of cardiovascular medication for years, as most people are at that age. He had suffered 2 minor hart attacks in his late 50s and a very minor ischemic epoisode two years ago which left no consequences to his health.

 

Before the stroke suddenly killed him, he was in good health (as his doctor specified in the medical form I had to have filled in). He had recently been on a week holiday touring Norway and before then, touring Spain. The week preceeding the stroke he had been working full time on the family farm. Hardly a sick man. AXA however, because of the medication, claim "pre existing conditions".

 

What can he do?

he must look at the Financial services ombudsman web site there are case studies, look at them as you will see over 60% of all complaints win their case some complaint were very similar to both yours and your boyfrindx Travel Insurance - case studies

 

The ombudsman service will only act once you have exhusted the insurance companies own complaints procedure

[Guest Old_andrew2018]

Hi

I hope everything is proceeding well, I took my insurance company sometime to see sence

[Guest Old_andrew2018]

its been sometime since your last posting, any news

 

Regards

 

Andy

[girlynutnut]

Your boyfriend could always try arguing that he had no knowledge of your father's medical condition and therefore was in no position to disclose them to the insurer. He can only be expected to declare that which he has knowledge of and, as your father isn't his close relative, they may accept this.

[LemonTwist]

Your boyfriend could always try arguing that he had no knowledge of your father's medical condition and therefore was in no position to disclose them to the insurer. He can only be expected to declare that which he has knowledge of and, as your father isn't his close relative, they may accept this.

 

I don't think that's a very good idea. Even though the 2 heart attacks were minor and had no lasting effects, they are still considered to be "material facts" and would need to be disclosed to the insurer, particularly as he was taking medication for them. Also, if the couple live together, it seems likely that they would have talked about the father's medical condition at least once?

[againstbankcharges]

Hi, I had a reply and the insurer still refuses to accept my claim, now for 2 reasons: the non uk residence of my father and the pre-existing condition.

The whole story makes me feel bad, so I am giving up on this one. I regret having paid insurance for many years for nothing, so to avoid further disappointment I am not taking out any further travel insurance, nor I will in the future.

[Guest Old_andrew2018]

If that was their final reply/answer, you have an oppertunity to take it to

the financial ombudsman, in a couple of links I gave you there are case studies, I think you have a good chance of success in the case quoted in the link they found for the complainant.

It is a free service for members of the public, I believe that the insurance companies are levied.

A relative using the service was awarded compensation.

I am aware that it is indeed your decision, I really suggest you do complain to them.

Travel Insurance - case studies

 

Regards

 

Andy

[Bookworm]

As for not taking travel insurance in the future, sorry, but that is one of the dumbest things I have heard in a long time.

 

Let me put this in perspective for you with a few random examples:

1 day inpatient in a Spanish clinic - £500. If it has to be in ICU, £1000.

Repatriation by air ambulance from a European country - STARTS at £25k.

Broken leg - 2 extra seats needed to keep leg elevated if you can get on your original flight, otherwise, 3 seats needing to be purchased + transport at both ends.

 

Need I go on? Unless you have considerable private means, despite your anger at the insurance company here, I would strongly advise you to rethink this and next time, make sure that you take an insurance which

appropriately covers your needs.

[Guest Old_andrew2018]

thats good advice I've a colleague who has recently beaten cancer they have travel insurance, however the cancer and associated problems (for want of a better word) aren’t covered, however an accident, theft, and anyother loss is still covered.

Andy

[ScarletPimpernel]

I completely agree with Bookworm - not taking travel insurance is madness.

 

When I was involved in air-ambulance and repatriation work, I took part in the repat of a number of uninsured patients. Even though we tried to keep the costs down, in every case the funding needed caused major problems for the patients and their families.

 

The key is to shop around well ahead of travel, read the documents carefully to make sure the cover is what you need. Many insurers will vary the cover if asked.

[girlynutnut]

I agree totally with the others about taking out travel insurance. I handle medical emergencies and repatriations over £100,000 for an insurer. Believe me, when you get ill in USA you wanna make sure you're insured. I've had cases where uninsured customers and their relatives have had to sell their homes to fund their treatment and air ambulance home.