Thanks Steve. I am going to find out who the correct people are to send the letter to. There is also another Ltd. company that deals with the claims.

Ok. I will have a think about those 3 arguments. Yes I think the broker is the underwriters agent, well its says they are on the ins.certificate.

I think best argument is that the previous years policy was still in force so as you say, covered the period of the cause. It's just how to word it.

But maybe also mention how broker were of little help when we called them?

if you are sure the broker is the underwriter's agent then pile it on! But be wary of arguing anything that was said rather than written down, it will end in a "he said, she said" standoff.

The company that deals with the claims isn't really part of the argument, as far as you are concerned they are a part of the underwriters which is contracted out, they are just paid to handle the paperwork.

Ok, here's version 2, I've tweaked it slightly... any suggestions/improvements very welcome. TIA.

I need to get this sent off ASAP. I've now got the correct contact address and I can also do it via email.

Dear Sirs,

Please treat this letter as a formal complaint against your department, for not settling my mother's (xxxxx) travel insurance claim, bearing reference number xxxx.

Her policy was renewed and paid in full on 4th April 2011, at which time she was in good health with no pre-existing medical conditions. Her initial consultation on 14th April 2011 where she was subsequently referred for further tests.

Shortly after her cancer diagnosis and surgery date was given on 28th April, we informed the agent/broker (Leisure & Lifestyle Insurance) about it and enquired as to the procedure.

The broker was of little help and did not advise that we contact the Tokio Marine Medical Referral Helpline. They simply instructed us to download and submit the correct claim form. Having renewed her insurance policy in good time, we believe she therefore had continuous cover and feel that your decision to decline her claim is overly harsh and unfair considering all the circumstances.

Regardless of the disputed validity of the renewed policy, the cause/onset of the illness occurred during the previous policy which was still valid until 26th April.

We have acted at all times in good faith and with the best intentions to the best of our knowledge.

If the issue has not been resolved to my satisfaction after 8 weeks have elapsed, I will refer the matter to the Financial Ombudsman Service.

Sincerely,

xxxxx (on behalf of xxxxx)

Sorry but it will not do anything to resolve your problem. The reply will be along the lines.

We regret but due to the Data Protection Act we are unable to discuss this matter with a third party.

I suggest you tweak it so that it comes from your mother. I again suggest inserting something along the lines of "Due to my medical condition/treatment I have asked my son to act on my behalf on this matter.I hereby authorise him to act on my behalf in this matter"

Not quite right but I think you will understand where I am coming from.

fwh

Yes I was going to include a separate signed statement from my mum giving me authorization to act on her behalf.

Though, I think will re-write it as from my mum, and include the bit you mention. Thanks fwh

Big mistake in this!

the diagnosis was not made on 28th, it was made, in a laboratory, on a date shortly after the 14th and before the 26th during the validity of the previous year. But due to natural delays in the notification process it was not received until 28th. You must not say that anything happened after 26th other than notification of things that had happened before.

Cheers Steve, good points.
Ok here is version 3, now written as if from my mum. I think I'm getting there....

-------------------------------------------
Dear Sirs,

Please treat this letter as a formal complaint against your department, for not settling my travel insurance claim, bearing reference number xxxxx.

My policy was renewed and paid in full on 4th April 2011, at which time I was in good health with no pre-existing medical conditions.

My initial consultation was on 14th April 2011 and I was diagnosed with cancer soon after this but wasn't given the news until 28th April due to natural delays in the notification process.

After receiving the bad news, I informed the agent/broker (Leisure & Lifestyle Insurance) about it and enquired as to the procedure.

The broker was of little help and did not advise that I should contact the Tokio Marine Medical Referral Helpline. They simply instructed me to download and submit the correct claim form.

Having renewed my insurance policy in good time, I believed I therefore had continuous cover and feel that your decision to decline my claim is overly harsh and unfair considering all the circumstances.

Regardless of the disputed validity of my renewed policy, the cause/onset of my illness occurred during the previous policy which was still valid until 26th April.

I have acted at all times in good faith and with the best intentions to the best of my knowledge.

If the issue has not been resolved to my satisfaction after 8 weeks have elapsed, I will refer the matter to the Financial Ombudsman Service.

Finally, due to my medical condition/treatment I have asked my son (Mr.xxxxx) to act on my behalf in this matter, and I hereby authorise him to do.

Sincerely,

Mrs.xxxxx

--------------------------------------

HI, I've been following this thread with interest but haven't been able to offer any better advice than you've been getting here already

I think that last version of you letter is precise and to the point, whils setting out all the main issues. Good luck with the claim, I hope you get a result. Best wishes to your mum, hopefully she will get treatment that will perk her up soon.

Please keep us informed of all the replies you receive from the insurance company.

I think that does it, send it recorded delivery. Hope it works out for your mum.

I do not offer advice on this forum in a legal capacity as I do it all day at work! However I can't help but say something here. Date of diagnosis is irrelevant. It is date of knowledge. Sometimes they can be the same date, however the date of knowledge tends to be before ie when did she start feeling ill and when would the reasonable man have connected it etc. That is the relevant date in legal terms.

I do hope you resolve this matter. My mother was diagnosed last year. I sorted her insurance and luckily (did not feel like it at the time) she had renewed her policy approx. 6 months before. If your insurance is still refusing to pay out, request a note from your mother's consultant advising when he would be of the opinion that date of knowledged happened.

Good point, my case was trying to show a latest date still within the original policy but anything that pushes it even further back would be good.

People tend to become fixated on date of diagnosis and it really isn't relevant in legal terms unless that was the date of the wrong doing ie a crime or an accident. With anything medical it is always date of knowledge.

Apologies, my last post did not make much sense (by a Thursday I am far too sleepy at this time!) but I am just trying to say, forget date of diagnosis legally.

Well that's good as the date of diagnosis falls within the new policy which they are trying to say isn't valid due to not being informed of a pre-existing condition.

Claiming under the original (old) policy seems to be the strongest case then.

Letter now sent so now we're just waiting to see what comes back.

I've now had a response from insurance people on this.(pasted below) Basically the symptoms she presented on 13 April was she found lump in her breast and they referred her to hospital for mammagram/biopsy a week later. So at this stage, we were very worried of course but didn't know whether it was a cancerous tumour or benign or what.

They are asking why we didn't call the medical referrals helpline and to be honest we didn't know there was such a thing , but also we didn't know until the results until 28th April either. Insurance wasn't really on our minds and none of us knew that we were expected to tell them at this point. As I said before, we had renewed it at start of April so just assumed we had cover in place and could put a claim in if need be. Naive maybe, but did not foresee the pitfalls ahead.

Any ideas on what they are angling at and any advice on how to respond ? Appreciate any help as always Thanks.

-------------------------------------------
Dear xxxx,

We have received your Mother's letter of complaint regarding the above, and she asked us to correspond with you.
In our letter to her of 1 September we promised to reply within 4 weeks.
I write at this stage to advise that we have not completed our investigations, but that we aim to do so, and provide a final decision by 27 October.

To assist us in resolving this matter, please ask your Mother to advise what symptoms she presented to her GP on 13 April, and what she was told by the GP about the nature of the further investigations to be carried out, and what she was advised about the specialism of the consultant/hospital department to whom she was referred.
The fact that your Mother was to undergo tests should have been referred to the medical referrals helpline at that stage, and we would like to know why she did not call the referrals line.

Yours sincerely,

xxxxx
Claims Supervisor

----------------------------------------------

They are obviously "angling" for an admission that your Mum was told by the GP. that something might be seriously wrong at the very first consultation ,which was ~ 12 days before the new policy came into force - they can then use non disclosure to rule that the policy renewal was invalid.

To assist us in resolving this matter, please ask your Mother to advise what symptoms she presented to her GP on 13 April, and what she was told by the GP about the nature of the further investigations to be carried out, and what she was advised about the specialism of the consultant/hospital department to whom she was referred.

Strange that they are going to take the word of your mother. you'd think they'd be in touch with her GP to see what was what. Obviously I don't know what your mother was told by her GP or how serious the GP thought it might be but I do know that the majority of lumps do not turn out to be cancerous and there are a number of reasons why lumps present themselves. I think the best chance you've got is if the GP said that he thought they more than likely were some sort of benign cyst (had them myself) but he just wanted to check to be sure.

Sorry if my post isn't very helpful. I think it's despicable the way they are trying to get out of paying!

A breast cancer specialist told me that only 10% of people who present with lumps in their breast turn out to have cancer.

luci

Thanks guys. Actually now I remember the GP initially said it could well be just a cyst.

So I guess I should just reply to them saying this then? .. i.e. that she found a lump and was just referred for a biopsy on it a week later. Not much else to say really.

However, I do need to answer their question about why we didn't call their medical referrals helpline.