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Holiday Complaints

Hi guys,

I was advised there is some smart people on this forum.

I'm going to write back to the insurer and complain but I thought I'd seek some advice before I put together a letter.

Basically this is the timeline of events of what happened with my 70 year old mum...

4th April - Mum's insurance is renewed & paid (no medical condition known at this point)
14th April - First doctor consultation, referred for tests
26th April - Renewed insurance policy cover starts
28th April - Mum diagnosed with cancer and needs operation

The whole family was in a state of shock during this time of course and paperwork/insurance etc was last thing on the mind. We just assumed we renewed it in time so we had continuous cover and could put a claim in if we had to.

Just after her diagnosis, we phoned the broker/agent Leisure & Lifestyle about her illness and need to cancel her holiday, and asked them the procedure.

They just advised her to download and fill out a claim form which we did.

The reason they are now declining the claim is that we did not inform the underwriters (Tokio Marine Ins.) about her change in medical circumstances between 1st consultation and getting the diagnosis. What were we supposed to do during this difficult time, call them and say "oh, by the way I *might* have cancer, just thought Id let you know"

She did what she thought was right. Also, I dont understand this because had we done what they wanted and informed them of the change, what would they have done? Denied her insurance or asked for more money, so how can you win? Isn't this the sort of thing you get travel insurance for, so what's the point when they won't pay out. Grrrr.

Any advice or opinions on how to fight this would be most appreciated?

Darren.
  • Edited by airbag 2011-08-15 14:02:38
ouch!!!
while you have my sympathies i think we need a bit more information.
when was the holiday booked
who was going on the holiday
what was the date of the holiday
when did you cancel the holiday
when, exactly, did you first tell your insurers about the new medical condition
were there any pre-existing conditions that had already been advised to the insurers, or was she in good health before this

are you 100% certain that the very first appointment with the doctor about the problems leading up to the cancer diagnosis was after you had paid the renewal your policy, and that the first confirmation of the diagnosis was after the actual renewal date.this is one of the things that the insurers will check directly with the doctor/hospital, along with any other medical conditions.

this looks like they are trying to wriggle out of paying by claiming that the cancer was an un-notified "pre-existing condition".
there will have been something hidden in the small print of the renewal notification about informing them of any changes;there will also be something in the main policy.
you need to check what exactly it says in both documents.
assuming that all the facts line up, i would expect that you would get paid out, although it may be a while.
if they refuse the claim again, then you should be able to take this to the Financial Ombudsman.
i would suggest you check the dates i have asked for, and produce a new timeline and resubmit your claim.
Thanks for the quick reply Jim :)
Holiday was booked October 2010. A party of 10 friends were going.

The holiday was scheduled for departure on 12th May 2011.

Mum's holiday was cancelled with Thomson on 30th April by letter.

Well, my mum thought Leisure and Lifestyle who she purchased travel insurance from was the insurer (she didn't realise they were just the agent) but she told them by phone in early May I think, shortly after her diagnosis, when we knew she could no longer go on her holiday.

As I said, she told them about her illness and enquired as to the correct procedure but they never told her she had to inform these Tokio Marine people. Just to download/print a claim form.

Yes, she was in good health before this and there were no pre-existing conditions when we paid the renewal on 4th April.

And yes I am 100% certain that the very first appointment with doctor was 14th April (as we have a doctors declaration form thing, which cost £25 and took 2 weeks!) and I paid the renewal with my card on 4th April.

Again yes, the diagnosis was 28th April as per doctors form they wanted us to get to go with the claim form.

I will scan in the rejection letter for you to see exactly how they are trying to wriggle out of paying.
it wont let me post links yet. but the rejection letter can be viewed at betfinder.co.uk then put forward slash and ins-rejection.jpg
fwh
I agree with Jim on this. It would appear they are trying to get out of paying. It also makes a bit of a mockery of the so called "Pre Existing Condition" requirement they are claiming. To be correct most major illnesses are Pre Existing, it is only that we do now know about them.
A couple of years ago I went for a medical as part of a research programme. Until then I was fine but a blood test revealed I had type 2 Diabetes. I must have had it before the medical but did not know. We often visit the doctor because we feel unwell. That is what we have doctors for. It does not follow that we have a life threatening illness.

Personally I would contact the Insurance Ombudsman - http://financial-ombudsman.org.uk/ - without delay. It is obviously a stressful time and arguing the toss with the insurance company will not help. Get the experts on it now and so save yourself some.

fwh
I shall move this to our Complaints forum where it may attract the attention of other members who may have some input.

luci :wave
I have offered to get this letter on the board by sending a Pm to Darren with my e-mail addy enclosed....although because it has the words spam on the end, he probably thinks it is.
Personally I would take the good advice from FWH and get some professional advice ASAP..... and it goes without saying that I send my warmest wishes during this difficult and very stressful time.

IMO: When we have someone complaining about a trivial thing on this board and we get something like this.....it puts things into perspective.( well it does for me)

Sanji
I agree with fwh. Check the Complaints Procedure for the insurance company and carry it through, asking for a final decision letter. Then take it to the Insurance Ombudsman.

It would really be appreciated if you could keep us updated as we like to find the outcome of queries posted on the site.

luci :wave
Thanks guys. I got your PM sanji and will email you the rejection letter tomorrow. (well today)

My mum would be well chuffed if I could get her holiday money back.

With all thats happening right now, we really dont need this hassle.
Very,very sorry to hear of your Mum's medical problem.
However,the problem as I see it, is that the referral for tests occurred
before the new policy became live
.
Most Insurance Cos. include a question re awaiting hospital tests in initial application & usually ask for any changes in personal circumstances before renewal so since you didn't inform them they can claim that the policy was null and void because of incomplete /incorrect information. The fact that you renewed so far in advance doesn't help.
Well what about her previous policy then with was still in force during this time. Wouldn't she have had continuous coverage ?

You'd think we could claim on that policy as it was still valid until 26th April when new one started.
Can't claim under the "old" policy as it had expired before you made the claim and the
actual
diagnosis that caused the cancellation.
Morally and ethically you deserve to get the money back on your Mum's behalf from the insurer but legally not sure that you have a case.... the best of luck anyway in this difficult time.
fwh
However,the problem as I see it, is that the referral for tests occurred before the new policy became live.
Most Insurance Cos. include a question re awaiting hospital tests in initial application & usually ask for any changes in personal circumstances before renewal so since you didn't inform them they can claim that the policy was null and void because of incomplete /incorrect information. The fact that you renewed so far in advance doesn't help.



Whilst the question about awaiting hospital tests question is valid the way I read the OPs information suggests that did not apply. The way in which I read it is that her mother renewed the insurance and at that time declared there was no problems. Following the renewal she felt unwell so visited the doctor who then referred her for tests. If that is the case then she could not have known there was anything wrong with her.

fwh
Whilst the question about awaiting hospital tests question is valid the way I read the OPs information suggests that did not apply. The way in which I read it is that her mother renewed the insurance and at that time declared there was no problems. Following the renewal she felt unwell so visited the doctor who then referred her for tests. If that is the case then she could not have known there was anything wrong with her.


But the policy renewal date was actually after the date of referral - they just paid in ~ 3 weeks in advance - the policy wasn't "live" until 26th April - any health declaration must be @ actual policy start date.
SMa
Well what about her previous policy then with was still in force during this time. Wouldn't she have had continuous coverage ?

You'd think we could claim on that policy as it was still valid until 26th April when new one started.


Can't claim under the "old" policy as it had expired before you made the claim and the actual diagnosis that caused the cancellation.


Firstly, I do hope that your Mum makes a good recovery and that this insurance problem can be sorted for her.

But re the above comments I wondered whether both policies were with the same underwriter/insurance company or not? Given that you're dealing were with/via a broker rather direct to the insurer I wondered if this is a factor. If the policy was with the same provider then I think that it would be hard for them to argue that this wasn't a case of continuous cover. On the otherhand if the brokers had arranged for her to renew her cover with a different company then this is probably why they are arguing that she isn't covered.

But if that was the case then I think I think that you might be able to proceed with a claim against the broker - they should have advised her of this and made sure that she realised that a fresh medical declaration would be needed.

SM
Sorry to hear about your mum. I know who hard it is at times such as this.

When I 'renew' my annual policy every year with the same company, I have to make a new medical declaration every time.
I agree with brewerdave on this. The time between being referred for tests and the new policy coming into force, is IMO, the problem. The referral for tests should have been declared. Had the referral been done before the renewal had been made, it may have made a difference to the renewal policy and premium. The new policy came into force without full medical disclosure.
Yes, it was just an annual travel insurance policy that she was simply renewing with the same broker and I *think* the same insurer for both years but I would have to check that.

So it could be argued it's continuous cover but you do get a different policy number.

It's quite a complicated one with all the payment, renewal dates, doctors dates etc all so close together.

Thanks for the replies.
I think I'm going to agree with Sunaddict, but I think it would have been worse.

The money for the premium was sent in advance but the actual premium contract only started on 26th April.

If you had told them about the consulation and tests on 26th April I think they would have refused cover and not taken the money. This is a situation we've had before, someone was caught in limbo without insurance after a company refused to renew annual cover when a medical condition occured after the holiday was paid for but before it was taken. They would have left you with no cover before the test results were received. But they ought to refund the premium since they are saying the contract isn't going to be accepted - after all she has paid for a year and they say they aren't going to cover her.

However, there may be a tiny glimmer of hope here concerning the timing of the "diagnosis". When you say diagnosed, is that when the medical people made their decision or was it an appointment with a doctor when the news was given. If the actual event of diagnosis occured before April 26th but your mum wasn't made aware until 28th then there may be grounds for claiming on the
old
policy. If for instance, they had made the diagnosis of the 25th and phoned her immediately she could have called the insurers during the old policy. But they never phone people so there's bound to be a delay. It would be unfair to say she didn't inform them in time if she hadn't been informed herself. Proving the actual date of diagnosis ought to be simple, presumably there is some paperwork at the doctors. It might still be a job for the Ombudsman but in that situation I think the claim would go against the old policy and their refusal to accept the new policy contract is a smokescreen.
there does not seem to be any way of claiming under the old policy as the holiday was not cancelled while it was in operation, nor did she have a problem then that she was aware off.
the date the hospital became aware of the results are a red herring. the test results could have been available to someone in the hospital on the day of the test, but if the patient is not informed they have nothing to declare.
what was the date of the test?
they were not given a diagnosis until after they had renewed the policy.
the policy holder was not aware of a problem until after renewal, and that is the important bit, UNLESS when her doctor sent her for tests they informed her that she seemed to have cancer and was being sent for tests to confirm a diagnosis.
the policy was renewed(although i believe that a new yearly policy was issued) and there would be something in the renewal invitation about reporting any medical issues -that is the important bit that needs to be clarified.there will be some small print about what the insurers expected the policy holder to provide in the way of a medical update, and this could be anything from a simple declaration of being in good health to providing details of any doctors/hospital visit in the last year.this will be the clause they are using to get out of paying.
the effect on the renewal premium is now a matter of hindsight, but depending on what the doctor had actually told the patient at the first appointment -whether he was sending her for a test to confirm cancer or just a routine test -the policy may well have been refused or issued as normal.we will never know.
if she was supposed to notify the insurers of any tests outstanding before renewal, then there will be problems with the claim and so it may be worth getting some free advice from Simpson Millar whose details are here
so, it comes down to what was asked for in the renewal notice.
One of the standard questions when renewing insurance is 'Have you or your travelling companion during the last year:

had, or are waiting for, any medical or blood tests

(or similar wording) Although the renewal premium had been paid, the policy wasn't effective until the 26th - 12 days after the referral for tests was made. During this time the insurance company should have been informed that she had been referred. If the renewal had taken place after the 14th it would have had to have been declared.

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