Pre-existing nightmare

nco41

I had a holiday booked to take my two children and i to Egypt costing £2500.
I booked holiday Insurance over the telephone . I booked the insurance a week before we were due to go(i always do this).I was asked the usual medical questions about my children and i .
The following day my mother dies suddenly and most unexpectly. Obvioiusly the children and i could not go on the holiday.I contacted the travel agents to try and postpone the holiday.I was advised that as i was leaving in under eight days i could not do this .So i would have to cancel and claim on the insurance.I was slightly miffed but i had little choice.
I contacted my insurance company who sent me out a claim form. I duly completed the form and sent it back enclosing my mothers death certificate. My mothers cause of death was listed as heart failure.On the claim form i stated that my mother has a heart attack some twenty years previously but was in excellent health.I also go my mothers GP to write a letter stating that mum had been in excellent all round health for many years and her death was not only untimely but premature.
A few weeks later i received a letter telling me my claim had been turned down due to my mothers pre existing medical condition that i had failed to disclose!. I contacted the IC to protest as i was not taking my mother on holiday with us. They claim that i would of been asked about family members health when i took out the insurance.I maintained that i was never asked.Why would i as they were not coming on holiday with us. I mentioned if they had asked i would i told them about my Fathers health first and formost . I asked them to listen to the recorded telephone conversation i had with them when i took out the policy,but apparently they do not record every message.Convient. They claim that i would of been told of the pre-existing rule for parents as all their staff say it,but they cant prove it.
The IC also told me i would of been advised of this rule in writing with the written policy. I explained that i had not received the written policy.
They are adament they will not pay out as i did not advise them about mum.I still maintain i was never asked ,told or advised of the pre-existing parent rule.
What can i do????
I would be greatfull for any advise.

dianasnan

Very sorry about your situation. How about contacting the relevant ombudsman if you get nowhere with the Insurance firm.

How many people think they are covered but aren't because of 'undisclosed 'pre-existing family health issues that they never knew that they had to list , must be thousands and thousands.

this is precisely the reason that we haven't been on holiday abroad for 3 years as we haven't discovered an insurer yet who will cover us for 3 elderly relatives in appalling state of health.

stephenni1971

The first thing you must do is contact the insurance firm and inform them that you want to make an official complaint.

They will have a set rules of procedures that they must follow and they must give you a written reply to your complaint and the reason they are upholding it.

Only when you have done this with the insurer can you go to the Ombudsman.

There are others more familiar with travel insurance than myself, who may give you a more detailed answer, but I can certainly understand your frustration.

Get your complaint lodged asap...

nco41

Thanks for the advise.
I have already been through the IC's complaints proceedures and got nowhere that is why i am on here.They are maintaining that they will not pay out as i did not tell them mum had a heart attack twenty years before!!! I maintain they never asked me.Stale mate.
My next next move would be the Ombudsman.I did not know if i have any chance of winning? It is all very stressful and wearing me down.
Loosing my mum like this is hard enough to deal with but having to fight for my holiday refund is getting me down.
Once again thanks.
I will keep you posted.
Nco

nco41

Thanks for the advise.
I think i dont have any choice but to go to the Ombudsman. I just cannot beleive that you have to tell a insurance company about the health of non travellers!! What would happen if you did not know?
Insurance companies are as bad as the banks.They take your money quick enough but then try ever and anything to get out of paying you.
I will keep you posted.
Nco

pedro123456

nco...............it looks like you are on the right track, the Ombudsman sounds your best bet now, make sure you have the "final response " from the IC as the FOS will be reluctant to get involved if you haven't attempted to sort it yourself before hand, you can e-mail and or phone them for advice.

And you are right IC are as bad if not worse than banks, it’s about time they were brought into line like the thieving banks.

All IC,s could limbo dance under a grass snakes belly.

Good luck………..

Pete

Mikeyorks

nco41 wrote: »

I just cannot beleive that you have to tell a insurance company about the health of non travellers!! What would happen if you did not know?

Increasingly you do. You have to tell them about the health of anyone upon whom your trip relies. If you dont know then you either find out ... or they can't be 'close' enough that you would cancel because of them? I got very close to a similar issue with the death of my Mother last year. Some policies also exclude cancellation if you take out the insurance after the holiday confirmation is issued!

If you booked the insurance by phone ..... they must have sent the policy to you. This is an extract from my current Travel policy ... and covers the aspect you're concerned about :


What you are not covered for (Cancellation & Curtailment) :
The insurer will not pay for the following
• claims arising directly or indirectly as a result of a pre-existing medical condition relating to you, your travelling companion, a relative or close business associateof yours, or the person with whom you have arranged to stay whilst on the trip, relating to:
a) any pre-existing medical condition which would require you to answer yes to the Medical ScreeningQuestions, unless declared to and accepted by us



The Ombudsman may be sympathetic in the light of the 20 elapsed years .... but I'm afraid it's far from clear cut.

dunstonh

The Ombudsman may be sympathetic in the light of the 20 elapsed years

I think it will depend on how old you were when it happened and if it is something you would know about. e.g. if you were aged 3 at the time and it was never mentioned then why would you know? It is inadvertant non-disclosure.

However, if you were 20 at the time and knew then its not the sort of thing you will forget and is more likely to be classed as intentional non-disclosure.

Non-discosure is fairly well covered by FOS guidelines now and companies do tend to respond in line with those guidelines. However, it is very hard sometimes to tell whether non-disclosure was actually on purpose or not. I wouldnt want to be an adjudicator having to make those sort of decisions with cases.

dacouch

I agree with Dunstonh, I have been reading the Ombudsmans rulings on these types of cases and he seems to deal with each case indivually. It seems to hinge on how clearly the Insurer pointed out the importance of declaring the PEMC. How aware the OP would have been of the PEMC and how relevant the PEMC was to the actual claim.

So the simple answer is to go through the executive complaint route with First Assist and then going to the Ombudsman. Bear in mind the ombudsman can take a long time to deal with claims.

The other option would be to go to one of the newspaper financial problem solving columns such as Jessica at the Telegraph, they can be very successful as when the media are involved companies often back down (Note these tend not to get involved if the case is being looked into by the Ombudsman)

What may help your case is doing a test quote with First Assist for a similar holiday and then declare the heart attack 20 years ago to find out if First Assist would offer cover and under what terms. Keep records of this as it might be helpful to the ombudsman.

scouselad1974

Hi

First of all I am so sorry for the loss of your Mum and I understand exactley what you are going through.
18 months ago my Dad suffered a brain haemmorage while on holiday in Spain and I had to travel out to be with him as it was touch and go, anyway he pulled through and I brought him home two weeks later.
After 2 weeks of admission to a private hospital my Dads insurance company decided to not validate the policy, due to him ticking the wrong box on an online application, he ticked a box to say he was a non smoker when he should of ticked the box that said he was a non smoker who had given up over 20 years ago, he also did not declare another pre exsisting condition as there was confusion at the time as his GP had told him he no longer had the condition and had stopped all treatment for it, my Dad didn't realise he still had to declare it.
We are currently awaiting the decision of the Ombudsman but to be honest I dont think we will get a favourable result.
I would deffinatley advise you to go down the Ombudsman route even If you don't think you can win the case, otherwise the isurance companies can get away with murder.
People who make genuine mistakes should not be treated like criminals, especially if they have been a regular customer in the past.

b3nton

Sorry to hear of your mother.
This is shocking behaviour from the insurer, but does not surprise me unfortunately.

Make sure you keep a written record of all correspondence with them.