Travel Insurance decline to pay out....advice please

dickydonkin

Pollycat wrote: »

Why would a GP filling in an insurance report say that a patient had an illness that had never been diagnosed?

I would suspect the GP had been asked for a targeted report specifically for a travel insurance claim.

It is also possible that a document was supplied by AXA for the GP complete which could have asked if the condition that activated the claim was 'pre-existing', however, having never claimed on a travel policy, I am not familiar with the documentation required.

It would be a reasonable to assume that if the GP had not stated that there was no pre-existing condition - irrespective of the format of the report - you can bet that AXA would have contacted the GP to confirm the fact anyway.

This seems a sensible and time saving approach to me.

Voyager2002

The insurer has done nothing wrong.

Documentation was provided stating that the claimant fell ill because of a pre-existing condition. They were right to decline.

The issue, of course, is that the OP believes that the illness was something new, and not pre-existing at the time the insurance was taken out and the holiday booked. It is possible that the GP was careless in completing the forms from the insurance company, but it is also possible that the OP's mother was confused, or that the GP had noted problems but failed to tell her about them.

I suggest a meeting with the GP (book a double appointment) to explain what has happened and the serious consequences of the way s/he responded to the insurance company, and ask whether s/he could write again to put things right. And note that all patients now have the right to a print-out of their complete medical records: it might help to ask for this, although doing so might feel confrontational to the doctor and mke him/her less willing to help.

dickydonkin

Voyager2002 wrote: »

The insurer has done nothing wrong.

Documentation was provided stating that the claimant fell ill because of a pre-existing condition. They were right to decline.

The issue, of course, is that the OP believes that the illness was something new, and not pre-existing at the time the insurance was taken out and the holiday booked. It is possible that the GP was careless in completing the forms from the insurance company, but it is also possible that the OP's mother was confused, or that the GP had noted problems but failed to tell her about them.

I suggest a meeting with the GP (book a double appointment) to explain what has happened and the serious consequences of the way s/he responded to the insurance company, and ask whether s/he could write again to put things right. And note that all patients now have the right to a print-out of their complete medical records: it might help to ask for this, although doing so might feel confrontational to the doctor and mke him/her less willing to help.

I think some people are missing the point her.

The OP's mother did not actually travel and at the time of booking the trip - there was no indication of a pre-existing condition - once the trip was booked - then she was covered.

The condition became apparent after the booking - but before depature and the insurers were informed when the condition was diagnosed.

Obviously if she travelled when she was fit to do so but failed to declare the episodes the OP referred to and subsequently took ill while abroad - then that would be a totally different situation altogether.

Based on the OP's account, it seems that AXA are once again attempting to wriggle out of paying on a seemingly genuine claim - something AXA are notorious for.

As an aside - I wonder if the OP's mother was asked at the time of taking out the insurance if there were any PEC's - however, I also wonder if the TA was more interested in the commision from the insurer!

I would suggest the Ombudsman would be the right option to resolve this.

travellerboy

dickydonkin wrote: »

Fortis apparently have a good reputation.

Totally agree with dicky, Fortis were excellent.

They have been taken over by Ageas Insurance Ltd. and not too sure of their status / history towards claims.

Missterious

But did her mother or the op tell the insurance company that she was being treated for an illness with antibiotics and they hadn't diagnosed anything yet?
If they did this the insurer would have then excluded this undiagnosed condition, leaving her in the same situation or at best able to make a claim cos there is no cover.

dickydonkin

Missterious wrote: »

But did her mother or the op tell the insurance company that she was being treated for an illness with antibiotics and they hadn't diagnosed anything yet?
If they did this the insurer would have then excluded this undiagnosed condition, leaving her in the same situation or at best able to make a claim cos there is no cover.

What the OP needs to clarify is when she refers to the anti-biotic treatment was if this occurred after the insurance was paid or prior to it.

Is 'running up to the holiday' AFTER the insurance was paid?

If so, I cannot see where a pre-existing condition was required to be notified to the insurer if the illness occurred after booking - unless of course the trip went ahead - which in this case, it didn't.

Underlined added to clarify.

Pollycat

dickydonkin wrote: »

What the OP needs to clarify is when she refers to the anti-biotic treatment was if this occurred after the insurance was paid or prior to it.

Is 'running up to the holiday' AFTER the insurance was paid?

If so, I cannot see where a pre-existing condition was required to be notified to the insurer if the illness occurred after booking.

I agree with this - it's pretty much what I said earlier.

Pollycat wrote: »

I agree that the timeline is important.

From the OP's post, it does sound like the holiday was booked and then her Mum started having these specific health problems.

Whether she had been treated for that previously and AXA are treating it as a pre-existing condition reamins to be confirmed.

I think (one of) the OP's Mum's doctor may have caused some of this:

Why would a GP filling in an insurance report say that a patient had an illness that had never been diagnosed?

It's quite confusing as the OP refers to a number of medical people.

Hopefully, the OP will be back to answer some of the questions, unless she's already got AXA to agree to pay out.

dickydonkin

Pollycat wrote: »

Hopefully, the OP will be back to answer some of the questions, unless she's already got AXA to agree to pay out.

Hopefully - but I suspect many insurers will try to wriggle out of paying if they think they can find something that could potentially breach their T&C's - but it is wise in many situations not to accept a refusal to pay and persevere until you get some satisfaction.

roadatlas

I'm not sure the OP has the medical facts correct as Antibiotics are not prescribed for a viral infections. Antibiotics are only prescribed for bacterial infections.

notanewuser

mallissaann wrote: »

Running up to our holiday my mum was a bit poorly but kept being prescribed antibiotics over the phone by her doctor saying it was a viral infection....no problem there.
!

For future reference antibiotics do not, can not and will never work on viral infections. She may as well have taken smarties. And she's put some antibiotics into the water supply for nothing too.