please help me need advise about my holiday claim as thay not paying me a penny back!!

[t88mme]

hi ya

i booked my holiday back in feb last year for myself,my other half and my little girl

i paid the deposit and my travel insurance with t/cook

but a few months later my other half could not get the time off work

so i paid to changed the name for my mum to take his place

but my insurance would not change the name so my mum took her own insurance out with the post office

i paid the rest off the holiday off in full about two months before we was traveling

but two days before we was going my granmother died unexpected

so i wented back to t/cook and told them what happened as we was to upset to travel and we was the only family lefted to sort all the stuff out !

i ask if i could still keep the holiday but go a later date

but thay said i could not do that only think i could do is claim my money back off my travel insurance

so i sent all the forms off to mine and my mums insurance thay told us we will have to pay them£50 ex per person

a few weeks later the post office sent my mum a cheque -the £50

still had nout off mine till the 2nd jan 2009 saying really sorry for your loss but we are not going to pay you a penny as when i took my travel insurance out i should of told them my granmother had heart probs but my granmother was not traveling with us or had nout to do with the holiday

the letter off my granmother doc to the insurance said it was sudden unexpected (she did have heart probs but had it most of her life over 30 years)

so what can i do about this can anyone help me with and advise

thanks

[Ross-co]

Hi

 

Contracts of insurance are strange animals and in theory they can withold money for anything they consider to be a "none disclosure" such as your Grandmothers heart problems.

 

In reality though there is no reason for you to disclose such a thing unless they specifically asked about elderly relatives.

 

I would write back to them and challenge their decision on the grounds that your grandmother wasn't travelling and that it was completely unforeseen.

 

Keep us informed.

[littleladyellz]

Hiya

 

I work for an insurance company in claims and complaints and i deal with travel claims.

It really depends on the policy you have taken out and what it states about declarations for non travelling relatives.

If you let me know which policy you have i can probably tell you if you have a chance to dispute.

You wont be able to go to FOS without following the complaints procedure.

If you need me to check the wording i will let you know.

[t88mme]

hi not sure on the cover think it was just a standard one as thay did not ask just said do you need travel insurance and said yes and booked it as a famliy for 3 and paid £40 for it

i dont have nout as most of the info was sent off to the cliams department??

[Mr lex]

I spoke to the F.O.S. this morning over another insurance problem, this is how it works :-

 

1st, Complain to the insurance company in writing over their handling of the case. They have eight weeks to give you a final decision.

 

2nd, Contact the F.O.S, they will take all your details and issue a complaint pack.

 

3rd, The F.O.S will then write to the company formally asking them to address your complaint. If they do not do so, they will step in and make a decision on the rights and wrongs of the case.

 

Hope this helps,

 

Lex

 

F.O.S.

our complaints procedure and how to complain

[Sali]

This is very similar to my situation. My mum had been in hospital on and off over many months and I was due to go the States on holiday. My mum had never received a diagnosis for her illness, but just shortly before I went on holiday there was a breakthrough (doctor error on drug prescription) and it was thought she would fully recover. If I hadn't believed this was the case I would never have left her bedside. As it was, one week into the holiday I received news that my mum had died. Completely distressed by this information I phoned the AA helpline only to be told that it would be best to book the flights home myself. I tried my mobile/internet but could get no flights. I had to phone the AA back and they said I should call Global Excel (their US business?) to sort out the flights. I wasted time and money trying to get through (phone line kept going dead after minutes of automated nonsense) and eventually I had to call back the AA several times before they put me through to Global Excel. On their request I gave my card details and they booked my flights home. When I got back I asked the AA to provide the invoices for the flights so that I could provide them to my co-travellers so that they could make their own insurance claim. I was told I had to contact Global Excel myself. When I got the invoices I found that not only am I charged for the flights but also for 'professional services'. I phoned the AA and they have said that this 'wasn't right', but would not follow it up with Global Excel. They insisted I had to do this for myself. I have mailed Global Excel twice now for an explanation, but no response. I have today written to the FSA, the AA and the insurer behind the scenes, The National Insurance & Guarantee Corp. What a disgraceful service. Like t88mme, I had never heard of a clause which effected relatives not travelling. My mum actually died of a condition that the doctors had not even known about.

[littleladyellz]

Globel Excel are not highly thought of - we do not use them but i have come across cases which i have reviewed for other claims agents and they are not the best.

Sali you have been treated unfairling. AA need to pay the case fee. All assistance companies charge case fees to the insurer for when they assist a client. This fee is for the insurance company to pay not you. The fees vary from £75 to £275.

Unfortunatly most travel policies will have clauses regarding non travelling relatives. Depending on the policy and the destination depends on what you need to declare.

Travel insurance is complicated and a minefield if you dont work with it.

If either of you need a hand give me a shout x

[LemonTwist]

hi not sure on the cover think it was just a standard one as thay did not ask just said do you need travel insurance and said yes and booked it as a famliy for 3 and paid £40 for it

i dont have nout as most of the info was sent off to the cliams department??

 

From looking at their website, Thomas Cook seem to do 3 levels of policies: Economy, Traveller and Traveller Gold. It should say on your policy documents which level you've got (and on the front of the actual policy booklet). All their policies seem to be underwritten by AXA Insurance UK plc.

[t88mme]

so do you no what on each policies and what it covers ? do i contact axa insurance uk on any think?

From looking at their website, Thomas Cook seem to do 3 levels of policies: Economy, Traveller and Traveller Gold. It should say on your policy documents which level you've got (and on the front of the actual policy booklet). All their policies seem to be underwritten by AXA Insurance UK plc.

[t88mme]

thanks for this lex i will put it on to writing ,but not sure how to word it as never had to do anythink like this before can you help ? and whos f.0.s and how do i contact them if the letter i send to the insurance company still dont change there decision? and do i say the my mums policy with the post office paid her out as she had a standand one 2?

thanks

tammie

I spoke to the F.O.S. this morning over another insurance problem, this is how it works :-

 

1st, Complain to the insurance company in writing over their handling of the case. They have eight weeks to give you a final decision.

 

2nd, Contact the F.O.S, they will take all your details and issue a complaint pack.

 

3rd, The F.O.S will then write to the company formally asking them to address your complaint. If they do not do so, they will step in and make a decision on the rights and wrongs of the case.

 

Hope this helps,

 

Lex

 

F.O.S.

our complaints procedure and how to complain

[t88mme]

really sorry to hear about your mum sali,

you think thay would be understanding about close members of the family dieding just before you go on holiday or while your out there, we pay this money to have a break and go for a good time thats what holidays are all about but how can you really hand on heart you can do this and go if some thing like this has happened to us and not even get no money back at all it bad that we lose someone but paying for it to because thay have died its shocking!! plus pay for your own way back if you need to get back because of our loss!! i no if yourself hurts yourself on hoilday you can get over it but when you lose someone as close as your family you never get over it !!

i just wish thay have a heart

This is very similar to my situation. My mum had been in hospital on and off over many months and I was due to go the States on holiday. My mum had never received a diagnosis for her illness, but just shortly before I went on holiday there was a breakthrough (doctor error on drug prescription) and it was thought she would fully recover. If I hadn't believed this was the case I would never have left her bedside. As it was, one week into the holiday I received news that my mum had died. Completely distressed by this information I phoned the AA helpline only to be told that it would be best to book the flights home myself. I tried my mobile/internet but could get no flights. I had to phone the AA back and they said I should call Global Excel (their US business?) to sort out the flights. I wasted time and money trying to get through (phone line kept going dead after minutes of automated nonsense) and eventually I had to call back the AA several times before they put me through to Global Excel. On their request I gave my card details and they booked my flights home. When I got back I asked the AA to provide the invoices for the flights so that I could provide them to my co-travellers so that they could make their own insurance claim. I was told I had to contact Global Excel myself. When I got the invoices I found that not only am I charged for the flights but also for 'professional services'. I phoned the AA and they have said that this 'wasn't right', but would not follow it up with Global Excel. They insisted I had to do this for myself. I have mailed Global Excel twice now for an explanation, but no response. I have today written to the FSA, the AA and the insurer behind the scenes, The National Insurance & Guarantee Corp. What a disgraceful service. Like t88mme, I had never heard of a clause which effected relatives not travelling. My mum actually died of a condition that the doctors had not even known about.

[ScarletPimpernel]

I have had a look at the current Thomas Cook/AXA policy wording.

 

I suspect that the repudiation of the claim is based upon one or both of these exclusions under the Cancellation and Curtailment section:

 

3. Any claims arising directly or indirectly from:

...

b) Circumstances known to You prior to the date this insurance is purchased by You or the time of booking any Trip (whichever is the earlier) which could reasonably have been expected to give rise to cancellation or

Curtailment of the Trip.

...

5. Your disinclination to travel for any reason

 

It seems to me that the claims handlers have based their decision on the assumption that the insured person should have known that 'heart problems' could have resulted in sudden and unexpected death. This is patently absurd, especially if the condition was one which the deceased had suffered from for an extended period. Significantly, is it reasonable to expect a lay person to have a clear understanding of the effects and potential outcomes of cardiac conditions? 'Heart problems' is a massive generalisation - it could cover anything from minor (and entirely harmless) arrythmias, to major conditions.

 

Thomas Cook sold the policy (and took the commission); AXA is the underwriter; Global Excel are a company whose function is to control medical costs - they may also provide the claims handling service.

 

In terms of what can be done now, you should write to AXA - the details will be on the insurance wording. Stick to the pertinent facts - name changes after booking, and other people's insurance is irrelevant, as is (harsh as it may seem), the emotional and compassionate aspect - this is a business contract, and nothing more.

 

Can you tell us exactly what the letter from the claims handlers said about why they were declining the claim? This will be helpful in determining how best to word a complaint.

[Sali]

Why can't travel (or any other) insurance documents be straight forward, plain English, short, no small print and standardised across the industry? Anything above the standard - say extreme sports cover for holiday - could be requested by the individual. It seems that whether it's compulsory (car) or advised (holiday) we are paying our money to brokers who could not give a damn what happens after the cheque is cashed. Insurers seem to spend their energies getting out of compensating or even providing a basic level of service to the customer and are truly exploiting the fact that most people do not tend to read pages and pages of smallprint. Why is there this multi-layered system? I have hated the fact that the broker, the helpline and the insurance people have all been separate companies, who have refused to liaise with each other on my behalf or take any responsibility.

 

I'll let you know what response I get from my complaint. Still, lessons, however painful, have been learned. Good luck with yours too t88mme. I think we've both realised that it's a cruel world.

[ScarletPimpernel]

Policy wordings are significantly clearer now than they were even 10 years ago; there are some that are actually understandable at first reading, but these are rare. However, these days most will have at least a summary of cover and exclusions.

 

Unfortunately caveat emptor applies as much to insurance as it does to so many other purchases. Insurance poilicies are boring; we want to think of our holiday, not what might happen if something goes wrong, and so we don't read the paperwork before we go to make sure it's suitable. In some ways it's like buying clothes without looking at them, and just hoping that they'll fit and are the right colour.

 

In some ways it's a good thing that the system is often multi-layered, in that underwriters are more likely to uphold a complaint against a third party claims handler than their in-house team, because they can do it without a corporate loss of face, and so retain customers. The medical assistance companies can be a mixed bag (I used to work in this area, both on the 'frontline' of repatriations, and as an ops manager liaising with policyholders, claims handlers and underwriters. Again, as a third party we were better placed to give unbiased medical advice to underwriters; the insurers who have inhouse teams generally have much more rigid guidelines. I do think that the increasing involvement of offshore companies, particularly in 'managing' medical expenses and repats, is worrying, as they often use aggressive US business models that are very much focussed on saving money rather than providing service - it's a situation that has arisen out of competition.

 

Incidentally, anyone care to guess how much of the premium you pay to a travel agent for insurance is paid back to them as commission? Anything from 40% to 80%, so you can see how much is put towards providing a service.

[ScarletPimpernel]

Sali

 

I agree that your case was very badly managed indeed, in various ways. It will be interesting to see what the response to your complaint is.

[Sali]

Well, to my surprise the assistant that I spoke to at Global Excel when I was in the US has just 'phoned me, in response to my email. She was unaware that I had not been able to claim back by costs and was aghast about the insurance clause relating to the health of non-travelling relatives. (Bet she'll be double-checking her policy next time though). The professional charges were apparently because she had to use a travel agent to book my flights as it was a holiday in the US and Canada and the in-house people who would normally do this (and not charge) were absent. Unfortunately she didn't think to explain this to me at the time as it is normal practice and assumed I would know. The AA helpline mustn't realise this either or they wouldn't have sent me on a wild goose chase to contact Global Excel.

 

So ScarletPimpernel how much does the broker pick up when I use them? Same percentage as the travel agent? I'd still like the layers to be flattened. I'd rather deal with one company and raise any issues with an ombudsman if necessary, rather than doing, as I am now, running around like a headless chicken.

[ScarletPimpernel]

Sali

 

The company that arranges a travel policy is not, strictly speaking, a broker - they are an intermediary that brings together the component parts of the policy (underwriter, claims handler and assistance service), for the principal (e.g. a tour operator or travel agent). Most of the premium that's left after the seller's premium goes to the underwriter, who uses it to pay claims and hopes there's enough left at the end to make a profit - although travel is very often not a very profitable line. Big underwriters can absorb a bad claims experience (when the amount paid out in claims exceeds the amount of premium taken), but small underwriters will often take a very hard line on claims because of the potential loss. The claims handlers will get a few pence per policy, as will the assistance service, and finally the intermediary.

 

Looking at your case, you should now be initiating the formal complaint procedure that will be part of the policy. Details will be on the policy document - it's likely to be the AA in the first instance. I'd suggest that everything is in writing - as with DCAs, there's room for misunderstanding with phone conversations.

 

The complaint procedure will typically start with the intermediary or claims handler; if you aren't satisfied with their response, you can then usually go to the underwriter. It's important to note that FOS will only consider a complaint if you have already exhausted the insurer's complaint procedure.

 

Stick to one point of contact at a time, and follow the procedure - if you do have to go to FOS it is always useful to show that you have always acted in good faith. It also makes for a clearer paper trail - useful if you ultimately decide to go to court.

 

From your description of what happened, it seems to me that your complaint should revolve around these points:

 

- You acted in good faith throughout

- You followed the policy procedures (I'm assuming there's some blurb on the policy about what to do in the event of a problem)

- The AA Helpline failed to provide appropriate assistance

- After following the AA's advice you had to call them back and they referred you to Global Excel

- Global Excel failed to provide appropriate assistance

- Global Excel charged you fees that should not have been incurred because some of their staff were on holiday

 

In my view, a reasonable insurer would have:

- Taken full details of the circumstances

- Investigated to confirm that the death had occurred (a phone call to the hospital or GP)

- Assisted you to arrange to return home and paid any reasonably incurred expenses (where this is covered by the policy - most do)

 

What they actually did was left you, in difficult situation, to sort yourself out and then make a claim - which they then mishandled. Consequently, you have been left out of pocket because of their breach of contract.

[t88mme]

on the letter i received from them said:

 

standard policies, such as the one covering your agreementmant have standard term and conditions and exclusions,

not all claims can be paid . under the pre-existing medical conditions section of your poilcy it states that " if you are aware that you or any other person (including relative, travelling companion or close business associes) have:

 

a pre-existing condition that can force you to cancel or cut short your trip:

been admitted as a inpatient in hospital in the last 24 months:

suffered for heart or circulatory related condition ( angina,stroke):

any cancerous condition:

any lung related disorder

then you must contacted the medical pre-screening company in order to arrange for that condition failure to advise them of the medical condition will result in those undisclosed condition not being paid*

 

( know one at the travel agency ask me if anyone have any medical conditions , just do you need a family travel insurance and i said yes thats it !! i have been on a few holiday over 10 years and never been asked about medical conditions and allways booked my insurance thougth the agency)

 

the medical evidence presented to us confirms that my late granmother suffered from chronic heart disease.

( my gran had a heartatack about 20 years ago i dont even remember it as i was only a kid then )

 

unfortunately as you have not declared your late granmothers medical condition to the pre-sreening company, i regret to advise you, that i am unable to be financial assistance to you on this occasion. however, if you have any further questions in relation to the above , please do not hesitate to contact this no bla bla .....

[ScarletPimpernel]

T88mme

 

I still find it hard to see how you, as a non-medical person, could possibly be expected to have known (a) what type of condition your grandmother was suffering from and (b) whether it was serious enough to potentially affect your travel plans, not least because it had not done so for many years to date. I doubt that it was a daily topic of conversation.

 

What medical evidence was presented to them? Only if you were in possession of the evidence, and qualified to interpret and understand it, could they expect you to take note of it.

 

I's not unreasonable, however, for them to have a reasonable expectation that you would have read the policy conditions. However, the terms look to me to be sufficiently loose to be worthy of challenge.

 

I'd write them a letter asking them to deal with the matter under their complaint procedure. Explain that they appear to have incorrectly assumed that you had sufficient details of your grandmother's condition to enable you to determine that there was a risk of curtailment, but failed to contact the screening service. Because you were not in possession of sufficient facts (and in any case had no right to share your grandmother's data), and the policy wording did not state that contact should still be made if there were any doubt, you acted in good faith and did not contact the screening service because you did not think it necessary. Therefore, they should reconsider their decision.

[t88mme]

i had a medical form off the insurance so my granmother doctor could fill it in but some of the things thay where asking my granmother doctor said this is confidential and i can give this info out he could not even tell me never mind the insurance

i sent a copy of the death certificate as thay requested that too

i now she took tablets but she was 82 and a lot of people at that age take them

so you think i should say it in a letter on how you send about the complaints procedure?

im really greatfull for your help as i really dont understand this kind of stuff

 

T88mme

 

I still find it hard to see how you, as a non-medical person, could possibly be expected to have known (a) what type of condition your grandmother was suffering from and (b) whether it was serious enough to potentially affect your travel plans, not least because it had not done so for many years to date. I doubt that it was a daily topic of conversation.

 

What medical evidence was presented to them? Only if you were in possession of the evidence, and qualified to interpret and understand it, could they expect you to take note of it.

 

I's not unreasonable, however, for them to have a reasonable expectation that you would have read the policy conditions. However, the terms look to me to be sufficiently loose to be worthy of challenge.

 

I'd write them a letter asking them to deal with the matter under their complaint procedure. Explain that they appear to have incorrectly assumed that you had sufficient details of your grandmother's condition to enable you to determine that there was a risk of curtailment, but failed to contact the screening service. Because you were not in possession of sufficient facts (and in any case had no right to share your grandmother's data), and the policy wording did not state that contact should still be made if there were any doubt, you acted in good faith and did not contact the screening service because you did not think it necessary. Therefore, they should reconsider their decision.

[t88mme]

(the terms look to me to be sufficiently loose to be worthy of challenge.) what do you mean buy that ?

[Sali]

T88mme. My mum's GP completed the medical form for the insurance company without issue and gave it to me to send on to the insurers. They can make you pay £25 for it. Were you listed as next of kin?

[ScarletPimpernel]

I think you've seen the point I was making; the insurers have, after the event, obtained confidential clinical information from the GP, and assumed that you were in possession of essentially the same information before you travelled.

 

It is this assumption that should be challenged. The insurer does not and cannot know what you knew about your grandmother's condition. Family dynamics are different in every family; for example, I get on very well with my sister, but I have no idea if she has any medical conditions, takes any regular medication or is having any treatment. If I was booking a holiday, I would not interrogate her or the rest of the family, or expect them to volunteer any confidential information to me so I could pass it on to an insurer.

[t88mme]

(They can make you pay £25 for it. ) who can make you pay? my mom was the next of kin as she was my granmother 1st child

T88mme. My mum's GP completed the medical form They can make you pay £25 for it..for the insurance company without issue and gave it to me to send on to the insurers. They can make you pay £25 for it. Were you listed as next of kin?

[t88mme]

ok will sort a letter out to them on what advise you have gave me , im really greatfull for your help

will it take them upto 8 weeks to get back to me?

i will keep you posted on what thay say

I think you've seen the point I was making; the insurers have, after the event, obtained confidential clinical information from the GP, and assumed that you were in possession of essentially the same information before you travelled.

 

It is this assumption that should be challenged. The insurer does not and cannot know what you knew about your grandmother's condition. Family dynamics are different in every family; for example, I get on very well with my sister, but I have no idea if she has any medical conditions, takes any regular medication or is having any treatment. If I was booking a holiday, I would not interrogate her or the rest of the family, or expect them to volunteer any confidential information to me so I could pass it on to an insurer.