Travel insurance and smoking

scouselad1974

Thanks everyone for your comments, I have been told that this is a provisional decision by the Ombudsman, I think the decision could still be over turned but that rarely happens. He has 4 weeks to supply his final points.
Apparantley the adjudicator who was dealing with the case for over 12 months sided with my friend and asked the insurance company to make payment, the insurance company then refused and the case went to the Ombudsman, the Ombudsman then over turned the adjudicators decision.

Does anybody know if a provisional decision can be over turned or is it basiaclly not going to happen.

huckster

What explanation did the ombudsman provide for reaching their provisional decision?

The ombudsman must have reasons for going against the adjudicator.

What was the claim for?

scouselad1974

The claim was for medical expenses.

The adjudicator agreed that my friends medical emergency was caused by a condition he had declared and paid a premium for, a letter from the Dr at the hospital also backed this up.

The Ombudsman said that the adjudicator did not take into account that the wrong information was supplied regarding my friends smoking history therefore the insurance company had the right to refuse the claim even though the condition that caused the medical emergency had been declared.

huckster

Did smoking 30 years ago and not declaring this, have any affect on the claim for medical expenses? If not, the ombudsman in my opinion has got this wrong.

Your friend should ask the ombudsman, whether an independent medical opinion would help decide this. The opinion would be whether smoking 30 years ago had any relevance to the medical claim.

scouselad1974

Hi

Thanks for your help, I will pass this information on.

FH_Brit

Huckster - You can take the insurers to court, but remember the court considers the ombudsman an expert and you may have an almighty fight winning. The cost of the claim may be smaller than the legal costs!

A thought - in the UK there is "The Rehabilitation of Offenders Act" under which a criminal can legally say he has a "clean record". Whereas smoking, being a LEGAL activity carries a much longer sentance than an illegal act!

You know the particular Ombudsman may have been an anti-smoking "nut" and ruled against you. That may be discrimination or applying personal standards where professionalism should have applied.

huckster

FH_Brit wrote: »

Huckster - You can take the insurers to court, but remember the court considers the ombudsman an expert and you may have an almighty fight winning. The cost of the claim may be smaller than the legal costs!

I am not sure how judges take into account any ombudsmans ruling.

If this went to court, I am not sure what angle would be used to make the argument. But I agree it would depend on the value of the claim, as to whether this would be worthwhile.

FH_Brit

The reason they are considered "experts' (and in cases the courts look at experts for their advice) is because they are independent and should give an unbiased opinion. They are impartial and government appointed.

It's more of a case of pricipal, and principal has cost many people a lot of money in the past. Sometimes we just have to live and learn although we are totally in the right!

Sorry to be the downer!