Travel insurance claim - not lived with partner for 6 months

lisyloo

I usually book travel insurance a few days before the trip.

For future reference this is a BAD plan.
The risk starts when you book e.g.you could be struck down by the lurgy and unable to go after walking out the travel agents, so you should book as quickly as possible after booking.

My own opinion is that someone in a call center cannot be expected to check every single qualifying feature before giving you a yes/no answer.
They gave you an answer on the assumption you were eligible (THEIR assumption, not yours).

Technically they should have given a disclaimer
e.g. said something along the lines of "In principle yes you can claim, but I have not at this stage checked your claim for eligibility, fraud etc, and you could later be turned down on the basis of something not apparent to me now".

But I think the above would be fairly obvious to most people.

schnide

Regardless of whether that's a bad plan or not, it doesn't change the circumstances in this case - but thank you for the acknowledgement of the technicality.

I'm still waiting for someone to give me an answer as to how

"Yes"

..also means exactly the same as..

"Yes, as long as your claim meets all other areas of the policy which we have not discussed and you therefore need to read the entirety of the policy"

..given that I'd already detailed the nature of the case on the phone, that the operative had asked me relevant questions which I'd answered, and I then made a £2.5k decision based on the answers that were given to me in what I believe is a legally binding conversation.

He asked me if my girlfriend had been given an NHS helpline reference number, in which case he told me the claim would be valid. He did not ask me if my girlfriend had been living with me at the same address for six months, and did not say this would invalidate the claim.

If you do not see the importance of both these distinctions, why wouldn't any AXA operative just answer "yes, you can claim" to anyone who phones up with anything they dream to claim for?

gordikin

It should also be obvious to most people that you don't leave it until a few days before the trip before booking travel insurance.

cogito

Chances are that your original call to Axa was recorded in which case you need to ask them to review the transcript. If the situation is as you describe, it seems to me that Axa have no option but to pay up.

Quentin

schnide wrote: »

, why wouldn't any AXA operative just answer "yes, you can claim" to anyone who phones up with anything they dream to claim for?

Anyone can make a claim!

The claim is then assessed by the insurer. If the claim is valid it is processed. If not, it is rejected!

schnide

cogito wrote: »

Chances are that your original call to Axa was recorded in which case you need to ask them to review the transcript. If the situation is as you describe, it seems to me that Axa have no option but to pay up.

Thanks for that. As of 9.30am this morning, that is exactly what an Axa representative is doing. Do I have a right to see the transcript of that conversation?

*MF*

@OP

I fully appreciate that your "complaint" relates to the conversation that took place when you phoned the Insurer about your circumstances, and fully understand that you feel what you were told, or perhaps more accurately what you were not told, was inadequate.

Ultimately, you may wish to take that complaint to the Financial Ombudsman Service. (FOS).

Using the link below, you will find how the FOS reacted to a Travel Claim, with similarities to your own - it is the last item (76/12 if I remember):

http://www.financial-ombudsman.org.uk/publications/ombudsman-news/76/76-travel-insurance.html

I genuinely do NOT know - but experience tells me that the FOS may well have expected you to read the insurance contract, and I suspect if you make a formal complaint - that issue will arise, just as it has in many of the replies you have got on this forum.

I make this post, so that you have some prior knowledge of this FOS case as you go forward.

schnide

Quentin wrote: »

Anyone can make a claim!

The claim is then assessed by the insurer. If the claim is valid it is processed. If not, it is rejected!

By your logic, if I call up Axa and ask them if I can make a claim on being unable to travel to Saturn because I forgot where I put my left foot last Hogglesday, they will not say:

1) "No."

2) "Yes you can make a claim, but it will be rejected."

3) "Yes you can make a claim, but check your policy to see if it is likely to be valid."

4) or even "Only if you were journeying to one of Saturn's moons."

..but they will just in fact say:

5) "Yes."

..in exactly the same way they did to me. Correct?

lisyloo

Regardless of whether that's a bad plan or not, it doesn't change the circumstances in this case - but thank you for the acknowledgement of the technicality.

I was trying to offer you (and others reading) some helpful advice for the future, not score points on technicalities.

and I then made a £2.5k decision based on the answers that were given to me in what I believe is a legally binding conversation.

I don't believe you are legally correct, however I would suggest you write a formal complaint following the formal complaint procedure and send the letter recorded delivery and keep the receipt.

For future reference (and others reading) I woudl stringly suggest getting such decisions in writing where thre is a lot of money depending on such a decision.
You probably won't be able to get a full commitement to pay in writing, which demonstrates that there are disclaimers that apply.

If you do not see the importance of both these distinctions, why wouldn't any AXA operative just answer "yes, you can claim" to anyone who phones up with anything they dream to claim for?

They can never say 100% without fullly validating the claim.
For example you could be a fraudster with a fake tamiflu box.
They won't know that until the box is chcked.
Are you proposing they withdraw all phoen services and give no information until they have investigated the evidence.

Sorry if you don't like the answer but to most of us it's blatantly obvvious that the answer is "in principle" until they have berified the claim, including things they can't do over the phone (like checking the box).

lisyloo

Do I have a right to see the transcript of that conversation?

You could also ask for a SAR (subject access request) under the data protection act.
I've done this before and got a huge package with phone call transcripts in.
Max charge is £10

I don't think there is a guarantee that all calls are recorded and kept, but it's certainly worth a try.
You can then check whether there was any disclaimer stated e.g. "all information is indicative and is not binding until backed up by a proper claim".