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

[martin2006]

Agree that you will need a FR before going to FOS.

 

I still think the policy provides for the scenario at B3 as the condition was not known to the insured so would have no reason to disclose it when the policy was bought.

 

I am not saying UB is wrong at all, far from it, it does however provide another perspective on the issue which is what this forum is for.

[Myfamily]

I did it through a comparison site, (can't remember which one) but I then selected this company and completed the rest of the details.

 

Going to their website now, I enter all details , dob's and how long th trip is, whee to etc it then asks "Do any of the travellers have a pre-existing medical condition?" to which I say NO, next to the question it has a small i button (obvisouly mans information) if I press it now it says

 

"Pre-existing Medical Conditions

 

If you or anyone travelling on this policy have any pre-existing medical conditions then you must declare them or your policy could be invalid. If you answer 'YES' to this question then we'll ask you some more details about the conditions on the next page (this process is known as "medical screening"). If you're unsure if you need to declare any conditions, then you should go through the medical screening processes anyway to ensure your policy is valid, minor conditions are unlikely to effect your insurance premium.

 

If you are declaring conditions on behalf of a child or another person on this policy, you must have their consent and full knowledge of their condition. If you are unsure of an answer in respect of another person on this policy, please check with them before proceeding. Failure to disclose full medical details including all medications taken may result in a claim being denied.

 

 

We do not provide cover for other people not insured with us on whom a trip may depend, such as relatives or business associates."

 

Obviously the last line is the key, but it's pretty vague don't you think!? what does this mean? as I said we had no idea he had a serious illness!

 

I think hiding it in the little i button is a bit sneaky!

 

In the FAQ it says this!

 

"Am I covered for cancellation if a family member becomes ill?

 

You will be covered for cancellation on the policy if a family member becomes ill if this is due to a new or unforeseen medical condition. If family member is one of the travelers insured on the policy and the medical condition has been approved (with the correct additional premium being paid) then you will be covered. If a non-travelling family member becomes ill due to a pre-existing medical condition you will not be covered. See policy documents for full details."

 

To me the first line seems to suggest that we're covered but then the last line doesn't - all so confiusing !

[unclebulgaria67]

Agree that you will need a FR before going to FOS.

 

I still think the policy provides for the scenario at B3 as the condition was not known to the insured so would have no reason to disclose it when the policy was bought.

 

I am not saying UB is wrong at all, far from it, it does however provide another perspective on the issue which is what this forum is for.

 

Not my personal opinion on what is fair, but i have seen this rationale before. Pretty sure there are FOS cases where Travel Insurers have settled as they have in this case and the FOS have agreed.

 

It is a complicated area for people to understand. The Insurers take the view that there was a pre existing medical issue, whether the policyholder was aware or not. When dealing with the claim issue, they then try to backdate their underwriting criteria to the time the policy was bought.

 

The situation is not like a policyholder having an unknown heart condition, having never seen a Doctor, who falls ill on holiday. That is a new issue that starts from the point of falling ill. No need to go back to underwrite the policy, because it was not a pre existing condition that was known to someone.

 

It is an arguable issue.

[martin2006]

Its seems to be all centered around whether or not you knew he had a pre existing condition and in their response so far, they concede that you did not know.

 

I would certainly be therefore arguing that B3 applies and that you should be 100% covered, not 50%.

[unclebulgaria67]

"We do not provide cover for other people not insured with us on whom a trip may depend, such as relatives or business associates."

 

 

This is standard wording. They mean that if a trip depends on health of close relatives, then they won't cover costs of cancellation or curtailment. Sounds like an attempt to exclude automatically any claim for trips affected by a relative, even if you did not know about it.

 

I wonder whether the Insurers have updated their online information and it is different to when you took out the policy ?

[martin2006]

B3

If you have to come home early

Pro-rata refund of your pre-paid unused trip costs from the day you come home, if you or your travel companion have to return early because you, the person you are travelling with, a close relative or business associate in your home country, unexpectedly suffer injury, illness or

death.

 

 

It looks crystal clear to me, B3 states "unexpectedly", which indicates that an unknown condition is covered.

 

The trip did not depend on the FiL much in the same way it did not depend on anbody else who didnt travel.

[Myfamily]

the thing is part of section B3 says

 

*you are not claiming due to an existing condition of you, a non-travelling relative or travelling companion, unless declared and accepted by us in writing.

 

That last sentence seems to suggest to me that if I had told them of his condition (if I had even known!) that they could have still provided cover? whereas their letter says that it is exlcuded, so again which is it??!

[Myfamily]

B3

If you have to come home early

Pro-rata refund of your pre-paid unused trip costs from the day you come home, if you or your travel companion have to return early because you, the person you are travelling with, a close relative or business associate in your home country, unexpectedly suffer injury, illness or

death.

 

 

It looks crystal clear to me, B3 states "unexpectedly", which indicates that an unknown condition is covered.

 

The trip did not depend on the FiL much in the same way it did not depend on anbody else who didnt travel.

 

Exactly Martin, I honestly hate insurance companies, you pay so much money, car home, travel and when something goes wrong they are determined not to pay out!

[martin2006]

Claims handlers are there to mitigate the companies losses, which any insurance claim is to them.

They will always try to settle for the least amount they can get away with.

 

As you have not yet received a Final Response, i would personally reject the offer based on the wording at B3 and the concession that they accept you did not know about your FiL condition and therefore could not have foreseen what happened.

Within your letter i would request their Final Response on the matter.

 

You have seen that both mine and UB's opinions are different but we wont be falling out over it, its simply difference of opinion which is always welcome.

[Myfamily]

Claims handlers are there to mitigate the companies losses, which any insurance claim is to them.

They will always try to settle for the least amount they can get away with.

 

As you have not yet received a Final Response, i would personally reject the offer based on the wording at B3 and the concession that they accept you did not know about your FiL condition and therefore could not have foreseen what happened.

Within your letter i would request their Final Response on the matter.

 

You have seen that both mine and UB's opinions are different but we wont be falling out over it, its simply difference of opinion which is always welcome.

 

 

No I understand that there can be a difference of opinion here sometimes

 

Do you think you might be able to give me a hand with a professional bit of wording to reject this?

[unclebulgaria67]

No I understand that there can be a difference of opinion here sometimes

 

Do you think you might be able to give me a hand with a professional bit of wording to reject this?

 

Sometimes trying to understand why an Insurers has reached a decision can be helpful. It is not a difference of opinion, but simply an excercise in discussing an issue, looking at it from both sides.

 

I think you need to simply put it to the Insurers, that they have accepted that when buying the policy and also buying the holiday, you had no knowledge of your Father pre existing health condition. That simply looking at the policy terms B3, the reasons for curtailment, critical health and subsequent death of father, was an unexpected event and therefore you are not sure why they are not covering the claim under the policy. Trying to underwrite the policy from inception based on confidential patient information that was unknown to the Policyholders does appear to be a correct way of proceeding, as it is unfair.

 

However, please do read their letter. They normally exclude cover for pre existing health of relatives, so it makes no odds whether you were aware or not. If you argue that the policy terms should apply, there is no claim. The payment they are making is discretionary outside of the policy terms.

[unclebulgaria67]

Provided you are not claiming for

coming home due to an existing medical condition of you, a non- travelling close relative or travelling companion, unless declared and accepted by us in writing.

 

So being that you did not know about your FIL and could not have disclosed any pre existing health issue, it was not declared and accepted by Insurers in writing. Therefore they are saying any pre existing health issue of a relative that is unknown is something that is automatically excluded.

 

I wonder whether the argument needs to be that the policy terms are unfair contract terms. Not something i know much about, but others such as Bankfodder might have some input on this.

[martin2006]

No I understand that there can be a difference of opinion here sometimes

 

Do you think you might be able to give me a hand with a professional bit of wording to reject this?

 

Have a go at writing one and post for comments, encompass the relevant points regarding why you are rejecting the offer and ask fir a Final Response.

 

We can review it tomorrow and make any amendments

[Myfamily]

Hi All,

 

Well I discussed with hubby ast night and we decided to accept their offer, I think he just wants it over a done with, nt had a very good year and hey bit of extra chirstmas money doens't hurt, it could take months with the FOS and it's not rally worth it. but thank you everyone for all your advise - at least I will be MUCH more careful in the future when choosing travel insurance!

[unclebulgaria67]

Buying Travel Insurance via comparison sites is not recommended. The companies who are cheapest have reduced the cover applying loads of exclusions, so they are top of the price charts. Most people buy on price and just look at the headline cover, without reading the policy.

 

The silly thing is that often a much better policy without as many exclusions, is not that much more expensive. The amount of loss that you can suffer on holiday can be life changing and therefore trying to save say £20 on Insurance can end up biting ones *ss.