Insurance co. wont pay for medical claim

[out of pocket]

Hi,

 

I'm hoping that someone out there will be able to shed some light on something for me and tell me if the insurance company are right with what they are saying.

 

I had 2 flights booked for January, which had been booked for a few months, then in December I had IVF treatment, (which I didn't know I would be having when I booked the flights) which was all done prior to my flight date. The flight date was only 2 days after the treatment and I was in no way fit to fly or go on holiday, so I cancelled my flights.

 

I contacted my insurance company, completed a form and my GP sent a letter (which cost me £25), the response I got from the insurance company is:

 

We very much regret to advise you that your claim cannot proceed as your insurance policy excludes claims as follows:

 

"any claim directly or indirectly arising out of any medical condition which, at the time this insurance is arranged and each time you make arrangements for a trip or extend the original period of your insurance, affects you or any of your travelling companions, or as far as you are aware, anyone else on whom your travel-plans may depend and you are aware is likely to result in a claim unde this insurance"

 

from the information provided it would appear that you would have been aware for the need for treatment that led to cancellation as you would have been on a waiting list. We are therefore unable to recommend you claim for settlement.

 

Do you think this response is justified? I have accepted the fact that I've lost my money, I just hope I've done the right thing.

 

I have been with this insurance comapny, which is done through work, for 10 years, I have never claimed. It is an annual worldwide policy.

 

Thanks!

[Bookworm]

Do you think this response is justified? I have accepted the fact that I've lost my money, I just hope I've done the right thing.

 

Which response? Have you replied to them?

 

To expect anyone to declare that they have fertility problems is nothing short of absurd. Unless you were on a waiting list for IVF, that is. If you were, and knew you could be given an appointment at any given time, then yes, they have cause to refuse payment as they state.

 

Did you see what the letter from your GP said? I think a lot will hinge on how the dates work out. For example, if you had booked before your GP referred you for IVF, then you should be covered, and should fight it.

 

If you didn't see the letter, I suggest you contact your surgery in the 1st instance to find what it said.

[buzby]

I agree to disclose fertility problems would be absurd, however it still remains an elected medical treatment that resulted in you not being able to complete your holiday. Was the policy with Employee Advantage by any chance? They refused a claim by me after my mother took a panic attack and I had to cancel the day before my departure. They eventually paid out, but they did try to say thay as a depndant person I should have delcared her condition!

 

It's not the fact you had treatment, but that you scheduled it so close to an 'insurable event', like your holiday. If you had the treatment after you came back, it wouldn't have been an issue.

[MrMatteh]

It will depend on what information you were aware of at the time of purchasing the policy or booking the trip (whichever is later).

 

Obviously I cannot speak for your specific policy as I do not know the company. But our policies clearly state (normally in the Medical Warranty section) that "If you are aware of any medical condition at the time of buying this insurance or booking your holiday (whichever is later) then this must be declared to our Medical Assessment Department" - It also says "If at the time of buying this insurance or booking your holiday (whichever is later) you have received any advice, treatment, on medication for any medical condition within the 12 months prior to this date than this must also be declared." ..

 

It will completely rest on what the GP says. Ie. If your GP said that you first consulted him on 1st January 2007 with regard to your condition and you went ahead and booked a holiday on 2nd January 2007 - at the time of booking your holiday (2nd January 2007) you shouldve advised the medical assessment team.

 

I know it seems absurd and unfair - but from the insurance point of view - its all about risk. And by accepting the terms in the policy you have accepted to do this.

 

IF you PM me and tell me what company it is, then if it one that I deal with I can look into it and give you a bit further information.

 

Regards,

 

 

 

Matt.