Help!!! I'm being ripped off £10K by AXA!!!

mkoprulu

Hi all moneysavers. I'm after some big time consumer revenge this time... Here's the "brief" story:

Prologue:

My wife was misdiagnosed by a consultant gyneacologist in UK with Polycystic Ovaries Syndrome back in November 2005. Therefore the medicine she was diagnosed not only caused no improvements, it caused some bad side effects as well.

Anyway, she was having symptoms like extra hair growing on her arms and face area, also she was lethargic.

April 2006, we went to Turkey for holiday. While there, she went to her gyneacologist who did some additional tests and found out that her cortisol levels were higher than expected and referred her to an endocrynologist to look at.

The endocrynologist measured her blood pressure as 180/120 which was dangerous and told her to stay there until she was diagnosed properly. Therefore her return ticket on 30th April was not used.

On 7th May 2006, she was taken to hospital as an emergency due to hypertension and tachycardia which was about the time our story begins.

Story:

I called AXA Travel Insurance and let them know of the situation when she was admitted to the hospital. They started up a claim and some documentation traffic started.

She stayed in the hospital for a week and during her stay, her diagnose was made as Cushings Syndrome related to a pituitary adenoma (tumor).

We shopped around for a good surgeon for a week, and on 22nd May, she had an operation.

Afterwards, a common post-operation side effect occured called diabetes insipidus. This condition required a certain treatment period. She stayed in Turkey during this period undertaking more tests and finally returned back to UK on June 2006.

After her return, the insurance claim was transferred to AXA Insurance, which is the company that deals with UK side of things (whereas the previous AXA Travel Claims was for people still abroad).

They requested loads of documents, which we meticulously prepared and sent back. Then they requested some more, which we also sent.

First hit from them was few weeks ago when they called up and said they wouldnt cover the claim. The reason they said was because she stayed abroad longer than a month and travel insurance was only for a month's stay.

I told them the condition occured within a month of her travel to Turkey as she went there on 14th April and admitted to hospital as emergency on the 7th May, and there was no way she could have returned back as she was under treatment from then onwards.

Then i heard nothing for a long while, until i recently called to ask what's going on with the claim, only to learn that they have refused to cover it!!! Without even bothering to let me know.

When i asked the reason, they first gave me the same reason stating the 30 day limit. I gave them the same reply and then they said it was AXA Travel Claims that told them that she won't be covered.

I asked to speak to their manager, who first called me back without even going through my file, and gave me a generic reply. When i explained the whole situation, she said she would read through the file and call me back.

When she eventually did call me, she said i should call AXA Travel Claims and ask why they refused it because it wasn't her company's decision (AXA insurance) and they had no idea why AXA Travel Claims refused it.

When i didn't like that answer, she decided she could pick up on another statement on our report stating that her symptoms started 2 months ago prior to the claim date. She said that we should have disclosed her situation to them...

I tried to explain her that those symptoms were things such as hair increase on body, lethargic and tired moods, which at that time we had thought to be related to Polycystic Ovaries Syndrome as we had not heard of a possibility of Cushing's Syndrome yet. When i was filling in the form though, i already knew she had Cushing's, as she was diagnosed, therefore i stated the symptoms started 2 months ago because i knew only THEN! that those symptoms were related to Cushings, and not PCOS.

Obviously she didn't listen much and told me to call AXA Travel Claims and if still not satisfied, write to their complaints dept...

Here comes the fun part!

I then called AXA Travel Claims and asked them why they decided to refuse this claim. Their reply was that it was because they haven't received the medical report from our GP.

I told them that I did get my GP write the medical report, i paid for it, and i sent it to AXA Insurance. I told them i'm not supposed to chase after both of the companies one by one, and they should establish a communication themselves. I told them I confirmed with AXA insurance that they had the medical report and asked AXA Travel Claims to call them and ask for it to be sent to them...

They asked for a couple of days to do that, which i highly doubt that they will do within that time.


The fact is, i'm not rich. I borrowed lots of money to pay for this. All the evidence is here. My wife was REALLY sick. She REALLY got treated and i REALLY paid for all of it.

I would appreciate all help i can get on this. What i want to do is first of all complain about all this poor treatment from AXA. I also want to complain to my bank, who provides the travel insurance.

Finally, i want to speak to a lawyer about this and possibly sue them to hell.

Any advices anyone?

Wyndham

First of all, you've had a tough time - it's awful being ill anyway, let alone when you are abroad. So, I do sympathise! However, you want answers, so I'll put on my 'used-to-work-for-an-insurer' hat and try to help - which means that I may not sound sympathetic, which is why I wanted to state it up front.

First of all, travel insurance policies either ask, or assume and mention in the small print, that you are in good health. If you have any medical conditions, especially ones for which you are receiving treatment, you need to declare them. Unfortunately, this can often mean that you are not covered by standard insurance, and need to take out a specalist policy, usually with a hefty premium. So you should have declared the Polycystic Ovaries Syndrome and the medication. I'm not sure if you did or not.

However, when in Turkey you say you saw a " gyneacologist who did some additional tests" which isn't normal holiday behaviour, and the insurer will think this is at least slightly odd.

I'm not sure about the claim date, but I think the date of the original claim needs to be within the policy, so I'm slightly puzzled that they are querying treatment she had after this, assuming it arose out of the original condition. There is a rule of 'proximate cause' which is about what the actual insured event is, and actually I think it is difficult to be sure in this case, but they may argue that it was the surgery on 7th May.

As for a way forward.... well, it sounds as if you have provided everything they have asked for, and you haven't received good customer service at the very least. I would suggest that you write a letter to the CEO of AXA, stating the case and why you feel they should review the claim again. At the bottom of the letter put a sentance like 'if you are still unable to honour the claim please could you give me a 'notice of stalemate' so I can go to the insurance ombundsman'.

And if they do not agree to it, insist on the notice, then go to the ombundsman who is independent. Their ruling is not binding on you, but is binding on the insurance company. However, they tend to only find for the customer in about a third of cases, mostly because by asking for a notice of stalemate, it puts the wind up them and they look VERY carefully at the claim again.

I would also go to your bank and ask for their support, and don't be fobbed off by 'we only sell someone elses policy so can't help you' - they are acting as a agent and you can ask them for help in the same way that when you buy a washing machine, it is the retailer with whom you have a contract, not the washing machine supplier.

If you want to sue, that is up to you, but to restate, I'm not sure it is clear cut, and would suggest the ombundsman first.

Finally, good luck, and I hope your wife is better now.

Astaroth

As per the post above, certainly the FOS is the place to go once you have received a final written response from AXA as this doesnt prevent you from court action and is of no cost to you.

I am a little confused by your statement:

While there, she went to her gyneacologist

Why does she have a gyneacologist in Turkey? Clearly she has had regular appointments with them given her other medical condition... has she been flying out there each time to the them?

mkoprulu

Wyndham,

Thank you very much for the quick and detailed response. It's actually better to hear from a person who worked for an insurance company, regardless of it being sympathetic or not.

The fact is, we had no idea she was going to be hospitalized and we would end up having to pay for hefty bills, therefore claiming it from the insurance. We didn't "take" the insurance out before arranging for our holiday. Like you stated, AXA insurance comes with LloydsTsb card automatically.

Her treatment for PCOS was back in November 2005. We stopped her treatment (taking the prescribed medicine) months before we took the holiday. When we stopped it, we had informed her gynecologist that the medicine was causing bad side effects, so he told us to stop it. He suspected something else (not Cushing's) and wanted to see her again, but by that time we were quite disappointed with him anyway due to the fact that he used my wife as if she was a guinea pig and just prescribed her with a medicine without proper diagnosis and tests. Therefore we indicated we don't want to make any more appointments with him. (Actually, this is another topic by itself, as we are planning to take legal action against him as well What a life!) At that time, we went back to our GP and asked for a referral to an Endocrynologist for further diagnosis, but our kind! and knowledgeable!!! GP refused it saying we should continue our treatment with the misdiagnosing gynecologist!!!



Anyway, this is the background information. As a summary, the PCOS was not mentioned in the beginning because it's treatment was stopped ages ago, and her Cushing's Syndrome was not related to PCOS in any way.

The reason we saw a doctor in Turkey was because she wanted to see someone she could trust. She didn't have major symptoms even then, but as the diagnosis progressed and she was referred to an endocrynologist, that was when her serious symptoms (tachycardia, high blood pressure) started to occur.

Can i ask what is a "notice of stalemate" and where can i find the insurance ombundsman?

Finally, I have written a mail to them, which i'm planning to copy to Lloydstsb as well like you adviced. I just am not sure yet if i should send it now or wait for them to formally refuse it. Because at the moment, the refusal reason according to AXA Travel Insurance seems to be the medical report missing. There is still a possibility for them to accept it once they manage to receive it from AXA insurance, if they ever can...

If you want, i can post that letter too, but it's 4 pages on ms word, so it will clutter up the already huge thread...

mkoprulu

Astaroth wrote:

As per the post above, certainly the FOS is the place to go once you have received a final written response from AXA as this doesnt prevent you from court action and is of no cost to you.

I am a little confused by your statement:

Why does she have a gyneacologist in Turkey? Clearly she has had regular appointments with them given her other medical condition... has she been flying out there each time to the them?

Astaroth, when you say the court action will not cost me, could you explain how i can get free court representation? I really am not in the mood / situation to spend more than i already have.

As for the confusion, please refer to my previous reply to Wyndham.

Wyndham

mkoprulu wrote:

The fact is, we had no idea she was going to be hospitalized and we would end up having to pay for hefty bills, therefore claiming it from the insurance. We didn't "take" the insurance out before arranging for our holiday. Like you stated, AXA insurance comes with LloydsTsb card automatically.

But treatment/medical conditions will still be covered in the terms and conditions. Check them out and you'll find it I think. You have a duty to check that the policy is suitable for you and your circumstances, and it is your duty, not theirs to read it all before you sign. Yes, I know it is a pain but that is how the world works!

mkoprulu wrote:

The reason we saw a doctor in Turkey was because she wanted to see someone she could trust. She didn't have major symptoms even then, but as the diagnosis progressed and she was referred to an endocrynologist, that was when her serious symptoms (tachycardia, high blood pressure) started to occur.

So, you knew this was going to happen when you went out there? If so, then you are on very dodgy ground for not declaring it to the insurer. Again, their terms and conditions will say something about this. They assume you are travelling for a holiday, and actually it sounds as if you travelled to see the doctor which is a very different matter.

A notice of stalemate is to basically say that you and the company have done as much as you can and cannot agree on this. If you go to the ombudsman without it, they will point you straight back at the insurer and tell you to get one. It may have a different name, but this is what I know it as, and it basically comes from the company to say 'we can't resolve this with the customer and we've tried as hard as we can' (though obviously in more formal language.

The ombudsman can be found here:

http://www.financial-ombudsman.org.uk/

I was out of date, the financial ombudsman took over insurance and other areas a few years ago. Told you a USED to work for an insurer (haven't for about 6 years now and you may want to bear that in mind with any advice I give you).

mkoprulu

Wyndham,

Of course we didn't know what was to happen. We wouldn't have travelled knowing that it would present her life a risk... Our travel arrangement was for 2 weeks. If we were going for treatment, we would have taken a one way ticket in the first place.

As i said, all she was complaining about were insignificant things such as hair growth, weight gain and tiredness, not serious things like hypertension. We were made aware of such more serious symptoms after we went to the doctor there. I find it quite normal to visit a doctor that you can trust for a checkup while you are on holiday.

If you look from a different angle, if we hadn't visited her gynecologist there, we probably would have finished our holiday and returned back, which would either have compromised her health during the flight back or after she returned. We couldn't have guessed that she was going to have a hypertensive attack, so to arrange for a cover holiday to claim for it... We are both covered under AXA (yes again...) here in UK anyway. Why bother risking a travel claim and go abroad when you already are covered here?

If they are going to look at the matter from all these angles, they might as well take this into consideration as well...

The decision to extend the diagnosis and the fact that her gynecologist suspected of some other reason for her symptoms show how much the doctors here in UK are to be trusted, if anything. However, it doesn't show that we planned for this drama action.

EdInvestor

I find it quite normal to visit a doctor that you can trust for a checkup while you are on holiday..... If you look from a different angle, if we hadn't visited her gynecologist there....

Is your wife perhaps a Turkish national? Or were you based in Turkey as expats in the recent past?

That's the only basis on which I could imagine a person living in the UK would have her gynecologist that she trusted based in an overseas country to which she then went on holiday.

Astaroth

mkoprulu wrote:

Astaroth, when you say the court action will not cost me, could you explain how i can get free court representation? I really am not in the mood / situation to spend more than i already have.

As for the confusion, please refer to my previous reply to Wyndham.

The FOS is free, which is why I would recommended it above going to court - you may be able to get legal representation for court through no win, no fee or if you have legal expenses insurance on another policy but this will only be if they feel you have a reasonable chance of success.

To be honest I am having difficulty in following the sequence of events or knowing why you would have gone to a gyni in Turkey etc - as EdInvestor says, I assume you or your wife must have deep roots over there as most people in the UK probably would trust a turkish doctor less.

Presumably you contacted your insurers as soon as the consultant over there requested that tests be done - normal practice would have been for the insurers to confirm cover then and there and then handle the case (taking expert opinion on if a medical evacuation is suitable/ what treatment to have and where etc). What did they state to do when you first reported it? Or did you not report it until after you had incured costs?

Wyndham

EdInvestor wrote:

Is your wife perhaps a Turkish national? Or were you based in Turkey as expats in the recent past?

That's the only basis on which I could imagine a person living in the UK would have her gynecologist that she trusted based in an overseas country to which she then went on holiday.

This is still puzzling me too....!

mkoprulu

Astaroth wrote:

The FOS is free, which is why I would recommended it above going to court - you may be able to get legal representation for court through no win, no fee or if you have legal expenses insurance on another policy but this will only be if they feel you have a reasonable chance of success.

To be honest I am having difficulty in following the sequence of events or knowing why you would have gone to a gyni in Turkey etc - as EdInvestor says, I assume you or your wife must have deep roots over there as most people in the UK probably would trust a turkish doctor less.

Presumably you contacted your insurers as soon as the consultant over there requested that tests be done - normal practice would have been for the insurers to confirm cover then and there and then handle the case (taking expert opinion on if a medical evacuation is suitable/ what treatment to have and where etc). What did they state to do when you first reported it? Or did you not report it until after you had incured costs?

You mean Financial Ombudsman when you say FOS right? I'll certainly give it a try. As for your confusion, both my wife and I are Turkish Nationals. But that is not the reason for us to trust Turkish doctors. If we were that much patriotic, we would have stayed there and not moved to UK. Doctors, and the health system is the only thing that is better in Turkey than in UK. You said people in UK wouldn't trust a Turkish doctor as much as a British one. Yes, if they can find any... 90% of doctors in UK are not British anyway. And having a degree in UK doesn't make them any better than any other doctor in another country either.

Proof? Here are some examples from own experience: (I'm going to mask the countries of doctors apart from the UK doctors just because it's so easy to charge people with racism, not because i care)

"private" gynecologist (From country X) charging £200/session misdiagnosed my wife. He only did an ultrasound scan and facial observation before he said she had PCOS and if she doesn't get cured, she not only would destroy her chance of having babies in the future, but she also is a candidate for diabetes.

Ok, it's fair for a doctor to state the truths, but if they are this much shocking, he'd better be CERTAIN that he's made the right diagnosis. What he didn't bother doing was to ask for hormone tests, 24 hour urine tests, measuring her cortisol levels, ACTH levels, etc before deciding that my wife had PCOS.

Giving my wife and me hell for months after that statement doesn't bother him, does it?

Prescribing the medicine used for PCOS doesn't bother him either until she gets serious side effects (cold urine, extreme lethargy, cold hands/feet, dizzyness) and i call him up saying she's not gonna take that damn medicine again.

People in UK trust those doctors? Well, i'd say even the "Proper" doctors in UK don't trust that.

She's under post-op treatment at the moment from a "British" professor from central london right now. When he heard about the misdiagnosis, he tried hard to keep himself from bursting out disagreement over the incident just because he didn't want to blame someone from his own profession. You could say he was quite shocked though, from his expressions such as "1500mg a day??? Are you sure? Did he not do blood and urine tests?"

More examples? Take the useless GP's for instance. Our "thankfully" previous GP was a total joke.

When she felt the side effects of the medicine, my wife asked our GP to refer her to an Endocrynologist. And what did our "Country Y" GP say? He said we should continue our treatment with the respected Gynecologist... Right...

Here's generic one,

Regardless of what doctor or GP we went to, we are yet to observe even half of the cleanliness of what Turkish doctors have. No sense of disinfection whatsoever!

Our previous and current GP, when first registering asked us to give urine samples in tiny bottles. She then took those from us with her bare hands, not bothering to think if we might have missed the bottle or not, and then went onto her routine, typing on her keyboard with those hands, touching files, maybe after us, touching a visitor's baby's face, commenting how cute he/she is!

Trust that? No thanks...

Oh almost forgot, that urine samples we gave... A normal person would expect the reason for collecting urine would be to send it away to a lab to be tested. Oh no, she just held the tube and a color chart next to each other, and looked if the color matched the one that said "normal"... WoW!!! What a technology...

It's all coming back to me in a rage now... Our old GP needed blood samples from my wife. If they had bothered to look at her records, they would have seen she had problems with blood glucose levels, which means that taking 3 tubes of blood out from her would have been dangerous! But oh no, they are sooo PERFECT that they wouldn't need to look at those insignificant records. They took her blood out until she was pale white, at which point i said it was probably enough...

Here's another one, she was stung by a big bee (don't know what they are called exactly) once and it was the first time in her life, therefore she didn't know if she was allergic to bee sting or not. (you swell up and may die if you are) I was at work, so i told her to go to GP asap. She went there only to be told by the nurse to go back home, put some ice or cream on and she'll be fine. My wife insisting on saying she didn't know if she was allergic or not didn't make any changes to that treatment either.

On top of all that, what really pisses me off is the fact that doctors are so used to just tell a patient to take a medicine, or do smth, and not explain why. And when you challenge them into explaining the reasons why they came into that conclusion, they suddenly take a defensive position and act like you question their diploma.

It's not only the doctors who should be blamed for this though. It's patients as well, who behave like sheeps and just go towards where they pointed, whether it be a green field or a cliff...

This is only our own experiences. Whoever we speak about the health system in UK have loads more stories to tell. Not all are as lucky as ours either.

So you want to trust to doctors in UK more? Be my guest. I've lost that trust 4 years ago.