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Travel insurance won't pay out - say condition was pre-existing

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Hi All,

 

Semi long story - please bear with me.

 

Booked a holiday this year for August.

went away.

 

 

4 days later we found out that my FIL had been rushed to hospital!

my husband frantically got his stuff together and he booked the first available flight home,

 

 

(could not afford to bring us all back early

- we had called the travel insurance co and they said it was quicker to book it oursleves rather than make the claim then as they would need medical certs etc)

approx an hour after booking the flight we found out that he had passed away.

 

His death cert states he died from (a) Respiratory Failure (b) Chronic Obstructive Pulmonary Disease.

 

husband goes home and begins organising the funeral.

 

I return with children 19 days later.

funeral was shortly after that and we did not complete the forms straight away as we had a lot on.

 

we finally complete the form

send it to the doctors to complete their section.

 

 

they took 2 weeks to do that

return to me

I attached all the proof of cost of the holiday and cost of the flight back etc.

 

I called the travel insurance comapny approx 2 weeks later

they say that they have had to send another doctors form to the doctors as they had missed a section

(they hadn't actually missed it completely

they had put lines through it

- saying that it was N/A)

 

 

when I looked it over I thought that it was completed ok.

 

 

there was no diagnosis of any Chronic Obstructive Pulmonary Disease,

we would not have gone away if we had known he was serously ill.

 

The question in full was this.............

 

Has the patient EVER suffered from the follwing medical conditions?

if yes please provide details and dates

 

Any Cardiac or circulatory conditions?

Any respiratroy condtions?

Any type of diabetes?

Hypertension?

Stroke?

Any type of Cancer?

 

........................................

 

He had been a smoker all his life and had a classic smokers cough but we put that down to him being a heavy smoker.

 

We declared that My MIL who came with us on the trip had had cancer before so we have not lied or wthheld any information from them.

 

As far as we were concerned there was problem apart from a bit of a bad cough!

 

This was the travel insurance company decsion ............................

 

We note from the claims information submitted that the reason provided for curtailment was due to your Father who was critically ill in Hospital who unfortunately passed away.

 

 

We note from the death certificate that he unfortunately passed away due to pre-existing conditions which are shown on the Medical Certificate. (there was nothing on the first one the doctor filled out!)

 

Please be aware that the policy purchased is unable to provide for claims that are caused by a known pre-existing condition of a close relative who is not insured by us.

 

 

The policy defines pre-existing medical condition as any serious or recurring medical condition which has been previously diagnosed or been investigated or treated in any way at any time prior to travel, even if this conditio0n is currently considered to be stable and under control.

 

We must follow the terms of the Policy and therefore we are unable to consider any payment on your claim.

 

We appreciate this is not the outcome you would have hoped and we are sorry that we cannot assist you with a more positive response.

..............................................

 

I never saw the second form that was completed by the doctor

I don't know if they have put something else in the above section now,

 

 

I feel its wrong that they re-sent it,

I don't know

the holiday was not cheap and I feel this is very unfair.

he missed the whole holiday and we were honest.

 

Any advise

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Write back and ask for your insurance money back stating that clearly the terms and conditions were impossible for you to claim on and therefore it was mis-sold.

 

I would use their own wording back at them - especially the phrase 'this is not the outcome you hoped for...' use that as your opening line and go from there.

 

They clearly are trying it on, as most insurance companies like to do.

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Hi Sillygirl,

premium was about £48 I think

so not really covering what we';ve lost

- holiday was over £5,000 (all inclusive 5 people!)

I had calculated about £800 or so was what we should have got back :-(

 

Like I said

we had no idea he had any kind of illness! -

we had declared that his mum had cancer approx 8-9 years ago

- so we were completely honest.

 

I wonder if I can see both medical certs from the doctor, I feel like I'm being done here!

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Write back and ask for your insurance money back stating that clearly the terms and conditions were impossible for you to claim on and therefore it was mis-sold.

 

I would use their own wording back at them - especially the phrase 'this is not the outcome you hoped for...' use that as your opening line and go from there.

 

They clearly are trying it on, as most insurance companies like to do.

 

You never ask for a premium back where you have a dispute like this. They won't do it anyway.

 

This type of situation is unfortunately very common.

You might not have known about your FIL suffering from any pre existing medical condition at the time of booking the holiday or taking out Insurance and you are not likely to go around asking close family not travelling with you whether they have a life threatening condition, before you bought Travel Insurance.

 

The death certificate issue that Insurers have raised is a bit odd.

Of course when someone dies they carry out tests to find out how they died and they might find out issues that the deceased was not aware of.

 

Suggest a written compliaint to Insurers head of claims threatening to involve the FOS.

You were not aware that your FIL had any pre existing health issues, as they had never said anything or been into Hospital suffering ill health as far as you are aware, that would have meant cancelling or curtailing your holiday.

 

Hi Sillygirl, premsium was about £48 I think so not really covering what we';ve lost - holiday was over £5,000 (all inclusive 5 people!) I had calculated about £800 or so was what we should have got back :-(

 

Like I said we had no idea he had any kind of illness!

-we had declared that his mum had cancer approx 8-9 years ago

- so we were completely honest.

 

I wonder if I can see both medical certs from the doctor, I feel like I'm being done here!

 

Your husband should be able to get hold of the info from his Fathers Doctor.


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Hi Uncle,

 

well they're saying that the medical cert states that not the death cert but I never saw the second medical cert, but the first one was crossed out which would indicate to me that there was no diagnosis!

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Your FIL might never have told your Husband, if he had been to the Doctor previously.

I know my Dad would mostly not said anything to Family unless he had to.


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exactly!

he was in supported accomodation too,

 

 

when he moved in i remember shortly after that we registered him to the doctors closer to his flat

- and the carers said that they had a few other residents registered there so it was easier for them to walk them round to the doctros when needed.

 

How do I reposnd to them

- how can I prove that we knew nothing?

 

 

should I mention the first med cert whcih staed that was no diagnosis?

 

 

its just so un fair

-my husband was so looking forward to that holiday as well as his father dying

- he was totally gutted!

 

 

we would never have even thought about booking such an expansive holiday if we thought that we might have to cancel!

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You MUST write a "Formal Complaint" to the Head of claims as suggested and include that you will forward the complaint to FOS if no satisfactory resoultion is reached within 8 weeks which is a standard timeframe.

 

Include an assessment of your losses which you wish to claim for witha as much proof as possible. If you have already sent receipts for the original claim, state so.


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ok I will see if i can contact the doctor again and get a copy of what they sent, i sent them absolutely everything i could think of - they don't even give me any option to appeal on their letter which I thought a bit strange?

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Makes no odds whether they have ir havent, doesnt stop you sending a formal complaint


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Read very carefully how the Insurer word the declaration about existing medical conditions and pay particular attention to whether it just relates to those who are travelling or asks about non travelling members of family (It will typically refer to non travelling persons on who the trip would depend or words to that effect).

 

Most companies have a tight wording that asks about non travelling persons, but most companies did not include this until recently and there are still companies that don't ask about non travelling family members.

 

The law of the land specifcally states that Insurers have to ask clearly worded questions that ask specific questions, if they don't ask a clear & specific question then they cannot rely on it. You are legally not obliged to volunteer any information that they have not asked clear and specific questions about

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Hi,

 

It does mention non travelling relatives

but we had no idea that he would pass away,

he was not diagnosed with any illness or disease as such.

 

 

Like I said he did have a typical smokers cough

typical of someone who has smoked for a good 50 years.

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If you look through FOS decisions, it is odd why Insurers have refused the claim, unless they are trying to see whether you come back to complain. They might think that in some cases those that don't complain are those who were aware of relatives health condition. When they then receive complaints, they look at the claim again.

 

See FOS example case

 

http://www.financial-ombudsman.org.uk/publications/ombudsman-news/105/105-travel-insurance.html


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Thanks Unclebulgaria,

 

I am struggling with how to begin with this, obvioulsy I will start with - I wish to appeal againest your decision not to make payment on my claim. but then not sure where to start! any advise please.

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Why not just say something like.

 

I wish to register a formal complain for FOS purposes as you have unfairly rejected a claim under the Travel Insurance policy terms. I have taken advice and also researched FOS case history, which indicate that the FOS are likely to view any complaint as reasonable in the circumstances.

 

Then set out your case in more details.

 

I arranged the policy for a family holiday on x date and was not aware of any reason why the holiday might be cancelled or curtailed. My Husbands Father who was not travelling with us, was living in supported accommodation as a person aged xx and we had no information about any illness or general medical condition at the time of booking the holiday or arranging Insurance. Had we been aware of any serious illness or medical condition that posed a threat to his life, we would not have booked the holiday.

 

Then about what happened when on holiday. While on holiday, we were advised that my Husbands Father had been rushed to Hospital and my Husband got the first flight home with the rest of the family having to stay. If you phoned any claim helpline, say what you were told.

 

When you write a letter it is best to be personal and polite, without being too technical about the Insurance declaration etc. It is quite a simple case that you would not have been aware of the health of Husbands Father , as it was a sudden change in health, with no prior warnings. I would not mention a cough. Unless you were aware of Doctors visits, hospital tests or a life threatening condition, it is not relevant.


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Read very carefully how the Insurer word the declaration about existing medical conditions and pay particular attention to whether it just relates to those who are travelling or asks about non travelling members of family (It will typically refer to non travelling persons on who the trip would depend or words to that effect).

 

Most companies have a tight wording that asks about non travelling persons, but most companies did not include this until recently and there are still companies that don't ask about non travelling family members.

 

The law of the land specifcally states that Insurers have to ask clearly worded questions that ask specific questions, if they don't ask a clear & specific question then they cannot rely on it. You are legally not obliged to volunteer any information that they have not asked clear and specific questions about

 

Just quickly coming back to Dacoucs comment above.

 

I have looked at the policy summary again and the questions are laid out like this , in a flow chart.

 

* Have you, or anyone tarvelling with you EVER had treatment for

. Any heart or circulatory condition?

. A stroke or high blod pressure?

. A breathing condition (incluing asthma)?

. Any type of Cancer?

. Any type of Diabetes?

. Has your doctor altered your regular priscribed medication in the last 3 months

 

If you answer NO to any of these questions it move on to the next questions one of which being

 

* Do any close relative, business associates or friends who are not travelling with you or who are not insured with us have an existing medical condition (even if considered ads "stable", under control or in remission)?

 

but it does not list all the conditions as it does in the first question - is this what you meant Dacouc??

 

it seems totally crazy - am I supposed to ask everyone i know including work colleagues whether they are ill or not? crazy!!

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Just quickly coming back to Dacoucs comment above.

 

I have looked at the policy summary again and the questions are laid out like this , in a flow chart.

 

* Have you, or anyone tarvelling with you EVER had treatment for

. Any heart or circulatory condition?

. A stroke or high blod pressure?

. A breathing condition (incluing asthma)?

. Any type of Cancer?

. Any type of Diabetes?

. Has your doctor altered your regular priscribed medication in the last 3 months

 

If you answer NO to any of these questions it move on to the next questions one of which being

 

* Do any close relative, business associates or friends who are not travelling with you or who are not insured with us have an existing medical condition (even if considered ads "stable", under control or in remission)?

 

but it does not list all the conditions as it does in the first question - is this what you meant Dacouc??

 

it seems totally crazy - am I supposed to ask everyone i know including work colleagues whether they are ill or not? crazy!!

 

Yes, imagine that!

Frank who works in finance suffers of bunions! 😂😂😂

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Yes, imagine that!

Frank who works in finance suffers of bunions!

 

exactly King! it's crazy.

 

I'm annoyed - it was not cheap, hubby looked forward to it as he's never been all inclusive before - he was having a lovely time, really enjoying it and was totally relaxed then out of the blue I got a whatsapp message saying his dad had gone to hospital! I was so upset for hubby - he works so hard and deserved a break, and only got to enjoy 4 days! And now we're out of pocket by nearly £1,000!

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exactly King! it's crazy.

 

I'm annoyed - it was not cheap, hubby looked forward to it as he's never been all inclusive before - he was having a lovely time, really enjoying it and was totally relaxed then out of the blue I got a whatsapp message saying his dad had gone to hospital! I was so upset for hubby - he works so hard and deserved a break, and only got to enjoy 4 days! And now we're out of pocket by nearly £1,000!

 

Sooner you send the letter, the nearer you will be to getting the claim paid.

 

If you think about it, the Insurers have no proof you were aware of FIL having a medical condition. They are making presumptions based on what they have received that you would know about it.

 

The Insurers refusal is just standard gate keeping, where they decline the claims and then review them on receiving the complaint. If people don't complain, they don't get paid out.


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Sooner you send the letter, the nearer you will be to getting the claim paid.

 

If you think about it, the Insurers have no proof you were aware of FIL having a medical condition. They are making presumptions based on what they have received that you would know about it.

 

The Insurers refusal is just standard gate keeping, where they decline the claims and then review them on receiving the complaint. If people don't complain, they don't get paid out.

 

I've just had anice conversation with the secratary of the doctors, I called her to ask what the insurers had asked for and what was sent to them. she expained that the doctor had confirmed tothem that my FIL had been disgnosed with COPD in 2009! We had no idea that there was any diagnosis!.

 

I explained to her that they have refused my claim - she was shocked and said that we could never have known unless my FIL told us, they would not have disclosed that to us themselves, so it was not our fault! she was a nice lady and said make sure you appeal!!! she said it was not a life limiting illness that anyone could have put an end date on(like Cancer where they can says thae person has 6 monthsor something!) so were they expecting us to not go away on holiday for the last 7 years!!??

 

I am just writing the letter now, I will post here first for approval if you don't mind?

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OK.

 

With COPD, unless he told you, how were you to know. As i said before, you can't go around your immediate family who are not travelling with you, before booking holidays asking them about medical conditions. They might not tell you anyway.


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Hows this look?

 

************

I wish to register a formal complaint for FOS purposes as you have unfairly rejected a claim under the Travel Insurance policy terms. I have taken advice and also researched FOS case history, which indicate that the FOS is likely to view any complaint as reasonable in the circumstances.

 

I arranged the policy for a family holiday on 15 July 2016 and was not aware of any reason why the holiday might be cancelled or curtailed. My Father, who was not travelling with us, was living in supported accommodation as a person aged 65 and we had no information about any illness or general medical condition at the time of booking the holiday or arranging Insurance. Had we been aware of any serious illness or medical condition that posed a threat to his life, we would not have booked the holiday.

 

While on holiday, we were informed that my Father had been rushed to Hospital, he was still alive at that time and so my wife called the helpline number of the insurance company and was told that it would be quicker to book a flight home ourselves rather than make a claim now and go through the insurance route as she stated that they would need medical documents before they could arrange to get me home, so we were told to book the flight home and make a claim when we returned. I note that you record calls so you can listen to the advice given to my wife in that call.

 

My mother in law booked a flight for me (as my internet access was very poor) and the rest of my family had to stay as the cost to bring us all back early was too much (would have been close to £500) and I didn’t feel that my children should miss out on their holiday. I found out shortly after booking my flight that my father had passed away, so I returned to begin the process or organising the funeral.

 

I was not aware that my father had been diagnosed with any illness, You will note that I declared to you that Ms **** **** (my mother – who was travelling with us) had breast cancer a few years ago, we declared everything that we were aware of at the time. I could not have been expected to know of any health condition of my father as he had not informed me of any health condition; this was a sudden change in health, with no prior warning.

 

I fail to see how it is practical for someone taking their family on holiday to go around asking all their family and friends and even business associates (as I note it is written in the policy summary) whether they have a serious illness or not. I have today called his doctors surgery and spoken to the secretary, she read the letter to me that had been sent to you, in this letter the doctor states that my father had been diagnosed with COPD in 2009! She also advised that this was not a time limited diagnosis so there was no way that anyone could tell how long he would have lived with this condition, were we expected not to go on holiday for the last 7 years? She also stated that the doctors would not have disclosed this to me while my father was alive due to patient confidentiality.

 

I respectfully request that you re-consider your decision

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Letter good, but thinking about the paragraph re supported living, it might raise questions as to why a person aged 65 needed supported living accommodation, if they had no medical problems. I think i would leave this out, as it just begs questions. Perhaps just say that he was not living with you and was a private person who would not discuss anything about his state of health.


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It's a good complaint letter, concise and devoid of emotional blackmail.

 

Just to add to Uncle's comments.

 

I would remove the words"Serious Illness" from the penultimate paragraph, their flow chart does not ask for serious illnesses but simply medical conditions. It's a much wider term encompassing minor ailments including as others have noted bunions.

 

Using "Medical Conditions" might be helpful if it goes to the Ombudsman, they tend to look at how the Insurers word questions / statements, how Joe Public may interpret this and whether it's overall fair.

 

I would also reference the relevant Ombudsman case number 105/1, it shows you've thoroughly researched your situation and it would not be unusual for the person handling your complaint to not be aware of that case.

 

The Ombudsman will certainly take into account that they specifically provide a list of certain medical conditions (Including Breathing / Heart conditions) when asking about the health of travelling persons. But they do not provide a list when asking about non travelling persons.

 

Feel free to refer to that when making your complaint, it may help swing the case, especially if the person handling it has any experience as to how the Ombudsman may view the case.

 

Bear in mind, the Ombudsman is not a cut and dry win as they will look at the whole case which we are not neccessarily aware of. But have no fear the Ombudsman does look at what's fair and expects a high standard from the Insurer who after all are the professionals.

 

If it does go to the FOS, they tend to move at a similar speed to continental drift, so don't expect a swift answer from the FOS

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Hi Guys, thanks for the input.

 

 

Have made the changes. Hows this?

(the ombudsman link is weird on the posting but is in full on the letter so don't worry :-))

 

I wish to register a formal complaint for FOS purposes as you have unfairly rejected a claim under the Travel Insurance policy terms.

 

 

I have taken advice and also researched FOS case history, which indicate that the FOS is likely to view any complaint as reasonable in the circumstances, I refer you to Ombudsman case number 105/1 which you can view at..

 

www.financial-ombudsman.org.uk/publications/Ombudsman-news/105/105-travel-insurance.html

 

I arranged the policy for a family holiday on 15 July 2016 and was not aware of any reason why the holiday might be cancelled or curtailed.

 

 

My Father, who was not travelling with us,

was a very private person and we had no information about any illness or general medical condition at the time of booking the holiday or arranging Insurance.

 

 

Had we been aware of any serious illness or medical condition that posed a threat to his life, we would not have booked the holiday.

 

While on holiday,

we were informed that my Father had been rushed to Hospital,

he was still alive at that time and so my wife called the helpline number of the insurance company and was told that it would be quicker to book a flight home ourselves rather than make a claim now and go through the insurance route as she stated that they would need medical documents before they could arrange to get me home,

 

 

we were told to book the flight home and make a claim when we returned.

 

 

I note that you record calls so you can listen to the advice given to my wife in that call.

 

My mother in law booked a flight for me (as my internet access was very poor) and the rest of my family had to stay as the cost to bring us all back early was too much (would have been close to £500)

 

 

I didn’t feel that my children should miss out on their holiday.

I found out shortly after booking my flight that my father had passed away,

so I returned to begin the process or organising the funeral.

 

I was not aware that my father had been diagnosed with any illness,

 

 

You will note that I declared to you that ** ***** ***** (my mother – who was travelling with us) had breast cancer a few years ago, we declared everything that we were aware of at the time.

 

 

I could not have been expected to know of any health condition of my father as he had not informed me of any health condition; this was a sudden change in health, with no prior warning.

 

I fail to see how it is practical for someone taking their family on holiday to go around asking all their family and friends and even business associates whether they have any medical conditions or not.

 

I have today called his doctors surgery and spoken to the secretary,

she read the letter to me that had been sent to you,

 

 

in this letter the doctor states that my father had been diagnosed with COPD in 2009!

 

 

She also advised that this was not a time limited diagnosis so there was no way that anyone could tell how long he would have lived with this condition, were we expected not to go on holiday for the last 7 years?

 

 

She also stated that the doctors would not have disclosed this to me while my father was alive due to patient confidentiality.

 

I respectfully request that you re-consider your decision

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