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

[unclebulgaria67]

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.

 

Perhaps change to, Had we been aware of my Father having any illness or medical condition that might have affected any holiday plans, we would not have booked it.

 

Apart from that, it is good.

 

The only other question Insurers might have is why your Husbands Mother would not have told you about this. Not that it is any of their business, but if they no longer live together it might also answer this point. The point is that you had no information about illness at the time of booking a holiday and taking out insurance,

[Myfamily]

Hi Unclebulgaria,

 

ok will change that part too .

 

The reason My husband mother didn't tell us as because she didn't know either, she left him when my husband was about 4, took the kids and left (various reasons I thnk) but anyway my husband had only been back in touch with his dad for the last 6-7 years, during which they'd got quite close. His dad was suffering from early dementia which is why he was in supported accomodation at only 65 he was in a flat with a flat mate before who was actually using him for his DLA money, the flat was a mess and so was he - so my husband and I got him moved into supported accomodation as it was clear he couldn't look after himself really, bit of a sad situation really.

 

So my husbands mother had been divorced from him for approx 40 years.

 

Do you think I should mention his mother's relationship to him at all. all she ever did was have him over for xmas a couple of times because she felt sorry for him.

[honeybee13]

UB is the expert, but I would have thought it was enough explanation to say that your husband's parents divorced 40 years ago. It's not a rare situation, sadly, so the insurers must have seen this before.

 

HB

[unclebulgaria67]

It might be worth saying something along the lines of.

 

Just for your information, so you may understand family dynamics. My Mother and Father divorced about 40 years ago, with me only having had contact with my Father during the last 6 or so years. So, i have not had a long history of knowing my Father.

 

That is all i would say. But it answers the question about why you may not know.

 

My family is closer than that. But i would never have been told by my Mum or Dad about their private conversations with Doctors. It was a case of whether it was relevant for us to know or not.

[Myfamily]

thanks HB

 

Hi UB, yes that sounds good but I worry that they might say that he wasn't that close if he's only got close within the last 6 or 7 years, or even that he shouldn't have curtailed his trip - I don't know, just trying to cover all bases I suppose!

 

My family is very close but my mother didn't tell any of us when she had abnormal cells appear on her cervical test, I happened to see a letter when I was at her house inviting her for further tests, but I never let on to her that I had seen it - I thought that if it was serious she would let us know.

[unclebulgaria67]

Or just amend to , Just for your information, so you may understand family dynamics. My Mother and Father divorced about 40 years ago so i have not had the amount of contact that i might have wished for.

[Myfamily]

Thank UB,

 

I have added that and have now sent - so fingers crossed - thanks for all your help

[Myfamily]

Hi All,

 

Well I received their decision but I don't like it!

 

They have offered 50% settlement of the full amount and have also not included the cost of my husbands return flight £96 and the cost of the taxi to the airport 180 turkish lira (approx £90).

 

I don't see why we should be penalised in any way.

 

Any thoughts?

 

Thanks

travel insurance decision.zip

[martin2006]

Cannot read a zip file myfamily

 

Please could you upload a redacted pdf?

 

180 Turkish Lira equates to around £40/41 not £90, can you clarify

Edited December 12, 2016 by martin2006

[Myfamily]

Cannot read a zip file myfamily

 

Please could you upload a redacted pdf?

 

I'll try!

[martin2006]

Just hit the upload link for instructions

[Myfamily]

How's this?

travel insurance decision.pdf

[martin2006]

Ok thats better.

Some if what they say regarding the additional return expenses may be correct, it depends whats written into the policy you took out.

There are differing levels of cover with any insurer and this may or may not have been covered. You would need to check the policy wirding for the relevant level of cover you have.

 

Turning to the 50% offer. You can either accept or reject.

If you reject, the claim can be passed to the FOS within 6 months from the date of their offer.

 

Check your policy to confirm what was actually covered with regards to return fares etc in the event of curtailment. It might help if you could scan that section and post to thread and any other general provisions of the policy.

[havinastella]

Take it all the way. They just want to to accept half. If it's not about the money let the FOS decide.

[Myfamily]

Hi Martin,

 

I have attached the policy, I see a part about a refund of pre-paid unused trip but not much re extra costs incurred - so not sure it's all that clear - but you may disagree.

 

Regarding the 50% offer I feel what thay have written is a bit contradictory, they say that they will permit the policy exclusion to be waived with means of upholding my complaint - yet only pay out 50% - that makes no sense! if you're waiving the exclusion and upholding my complaint then surely the full amount is due??

Puffin Silver Medical v4.pdf

PolicySummaryMedical.pdf

[martin2006]

I am assuming you bought silver?

[Myfamily]

Yes I did

[martin2006]

At B3 pg 8 of 28 of the silver medical

 

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.

 

 

Now the exclusion for this is "if" you were a aware if a pre existing medical condition and as they have made an offer, it is my understanding that they accept that you did not know.

 

With regard to the return fares.

 

In a claim i had a few yrs back where i and 2 of my kids could not travel back on the due return date due to chicken pox, we arranged all the extra travelling, taxis etc through the insurers.

If you did this off your own back then you will probably not be reimbursed as you didnt obtain prior approval.

 

I would forward what you have to FOS, include everything and also the additional travel expenses and let FOS decide.

I am confident that you will get a favourable result re the full 100% of the the curtailment element and they may also order reimbursement for the additional expenses but on that side, i wouldnt hold my breath.

[Myfamily]

Take it all the way. They just want to to accept half. If it's not about the money let the FOS decide.

 

Hi Havinastella.

Thanks for your comment.

Not sure what you mean by " if it's not about the money" it kind of is as I feel that a half offer is not good enough if they're saying they've waived the exclusion then i should be entitled to the full payment.

 

To me it's not about the money right now as in I'm not desperate for it now, I just don#t feel that what they're offering is fair. Or maybe I've misunderstood what you meant

[Myfamily]

At B3 pg 8 of 28 of the silver medical

 

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.

 

 

Now the exclusion for this is "if" you were a aware if a pre existing medical condition and as they have made an offer, it is my understanding that they accept that you did not know.

 

With regard to the return fares.

 

In a claim i had a few yrs back where i and 2 of my kids could not travel back on the due return date due to chicken pox, we arranged all the extra travelling, taxis etc through the insurers.

If you did this off your own back then you will probably not be reimbursed as you didnt obtain prior approval.

 

I would forward what you have to FOS, include everything and also the additional travel expenses and let FOS decide.

I am confident that you will get a favourable result re the full 100% of the the curtailment element and they may also order reimbursement for the additional expenses but on that side, i wouldnt hold my breath.

 

Hi Martin,

 

That's interesting because when we found out that he was in hospital, we called the insurance company on the number provided on the sumary docs and we were told that it would be quicker for us to arrange the return fare ourselves rather than waiting for the insurance company to do it, the lady advised to purchase his return ticket and make the claim for it when we got back!

[martin2006]

It would have been helpful if you had recorded that converstion but nonetheless you can add that into the compkaint to FOS, the insurers shoukd record all calls so if it was said, maybe time to SAR the insurers specifically for recorded calls.

Did you call the insurer or an agent of the insurer?

If unsure, ring the number again to find out and ask for the recording of the call on the date you made it.

[Myfamily]

It would have been helpful if you had recorded that converstion but nonetheless you can add that into the compkaint to FOS, the insurers shoukd record all calls so if it was said, maybe time to SAR the insurers specifically for recorded calls.

Did you call the insurer or an agent of the insurer?

If unsure, ring the number again to find out and ask for the recording of the call on the date you made it.

 

Yes, I just believed her, we were both in total shock, in the phone call I am in tears at one point, I just didn't eve think about recording it (even though I know that insurers will try anything to get out of it!)

 

I will add it to my complaint, I did mention it in my last complaint that I was advised to purchase the flight back etc.

 

Thanks Martin, I will give them a call and check.

[martin2006]

FOS will want everything documented so well worth trying to get that call recording, via a SAR if necessary

[unclebulgaria67]

Whilst going to the FOS is correct, you are adding months before the claim would be settled more favourably?

 

The Insurers offer won't be their final response unless they have said so. You could see if you can phone the person or department dealing with the complaint ( record call if you can) and just say that you are not happy. You believe that following advise that the FOS would look at your complaint favourably. Ask them to have a think about this again, as you are sure they would want to avoid time and cost of an FOS complaint. If they won't budge, ask for them to note the records and issue final response letter.

 

You might get a quick decision from the Insurers and save yourself having to wait for the FOS to deal with it.

[unclebulgaria67]

Might have helped to have looked at your uploaded documents.

 

Having just had a look at their response, i can see what they are saying and have come across this before. The FOS might not uphold your complaint for a higher payment.

 

What they are saying is that the policy was not underwritten to include cover for non travelling close family member with medical condition, because it was not a known issue. But the fact is that your FIL did have a pre existing health issue at the time of buying the Insurance. It was not a heart attack or stroke etc totally our of the blue with no previous health issue.

 

So the Insurers are then faced with going back to when the policy was bought to see whether they would have provided cover or not. If they provided cover what the extra premium would be and whether any conditions would be applied. The Insurers would normally have asked questions about your FIL's condition, but they were denied this opportunity. They therefore would consider that no cover would have been offered for curtailment costs, without knowing all information. This is why they are offering a 50% ex gratia payment outside the policy terms.

 

Up to you whether you complain to the FOS, but if you understand my explanation, you might see why the Insurers offer will be accepted by the FOS as being fair.