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

AXA_Insurance

mallissaann wrote: »

I wonder if anyone can advise me on this one, my mum booked us a holiday with Thomson online and had to take out travel insurance which turned out to be with Axa before she could confirm the booking. 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.
Anyway the week we were due to fly she made an appointment as she was still having problems with her chest and saw a different doctor who sent her for a chest xray immediately which resulted in her being rushed to hospital with a spontaneous pneumothorax.......her consultant at the hospital admitted her straight away and told her to forget the holiday. In her words 'if you had got on that plane you'd be dead' quite simple as that. She had to remain in hospital for just over 2 weeks being treated hence I immediately contact Thomson who told me not to panic it's covered under the insurance and advised me to cancel and claim...this I did.
After sending the medical certificate signed by her doctor and all the paperwork they required AXA have now declined (claim went in mid August they declined the claim in November) to make any refund as her doctor had said that 'Chronic Asthmsa' (which she has never been diagnosed with and 'possible COPD' again never diagnosed or even investigated could have contributed to her spontaneous pneumothorax and she had not declared any 'pre existing medical conditions'.
Obviously my first question is how can she declare conditions she's never been diagnosed with?????
Her doctor has clearly stated that this was a New Problem and that the date of onset was just 10 days before we were due to fly. Incidently I should mention this doctor had been the one prescribing her drugs over the phone and completely misdiagnosed her in the first place, thank god she did get a second opinion. The consultant at the hospital is an expert in her field of respiratory problems and she had clearly stated that they don't know what causes this particular problem and that it could of happened to anyone.
Following the conversation that Axa had with my mum today obviously we are at a loss as to what to do, they won't accept anything from the consultant and keep banging on about pre existing medical conditions that my mother has never had diagnosed. I am going to investigate myself when these conditions were apparently diagnosed, but after reading several reviews see that any appeal or complaint we put in is going to be ignored. Here's the good bit the advisor on the phone said 'of course if you had at least gone to the airport or got on the plane it would be different'!!!!! Oh so if my mother had got on the plane and died after being explicitly told it would kill her they'd pay out would they???
Yes I'm stunned at that but Thomson also said something very similar to me on the phone.
What should I do? Should I bother complaining directly to AXA or the Financial Ombudsman or even just go to watchdog with it?
Any advice would be really welcome, if this was just a couple of hundred pounds I'd leave it but this cost myself and mum £1500 each, and that's without the excursions.
Help Please!

Hi there,
I am an AXA rep. We're very sorry to hear about your story - and we hope things have improved since! Having read your message, we'd like to look at this again and try and sort it out as soon as possible. If you wouldn't mind sharing the policy number and claim number with us by emailing pressoffice.ins@axainsurance.com, we will do so straight away.
Many thanks and we'll keep an eye out for your email.
Regards, the AXA team.

dickydonkin

roadatlas wrote: »

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.

Could Antibiotics have been prescribed as a preventative measure to reduce the risk of additional complications?

loulou123

My hubby had 2 spontaneous collapsed lungs (1 at a time, not both together!) And both times there were literally NO symptoms before they occurred, so maybe the insurance is arguing that as there were symptoms of a chest infection or similar before, that the collapsed lungs were as a result of that pre existing disorder ie the illness she was already being treated for caused her lung to collapse.

callum9999

roadatlas wrote: »

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.

They shouldn't be, but they often are.

At least from the patients perspective, the doctor may have another reason for prescribing it but I know many people who have been told they have a viral infection/bad cold/flu etc. and given antibiotics specifically for it.

dickydonkin

loulou123 wrote: »

My hubby had 2 spontaneous collapsed lungs (1 at a time, not both together!) And both times there were literally NO symptoms before they occurred, so maybe the insurance is arguing that as there were symptoms of a chest infection or similar before, that the collapsed lungs were as a result of that pre existing disorder ie the illness she was already being treated for caused her lung to collapse.

But totally irrelevant if all of these ailments occurred AFTER the insurance was paid.

dacouch

travellerboy wrote: »

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.

It was just a name change

dacouch

"undiagnosed symptoms

Problems can arise where the consumer's medical records indicate that, prior to the start of the policy, they (or their relative or pet, if relevant) were displaying symptoms that are subsequently known (or thought to be) related to the medical condition that gave rise to the claim.

In these circumstances, no diagnosis may have been made at the time the policy was taken out – and so the consumer argues that they were not aware they had the condition.

This could be the case where the consumer has been displaying symptoms that might be an indictor of a serious condition but which, equally, might be minor.

For example, a consumer suffering from headaches is not necessarily “ill” – and may not consider themselves to have a “condition” that needs to be declared. Yet if the consumer subsequently has a brain tumour diagnosed – which gives rise to an insurance claim – the headaches may well be related to this in some way.

Many insurers include wording in their policies to exclude pre-existing conditions that existed at the start of the policy but were not yet diagnosed. Even if this wording is included, we generally take the view that claims should not be excluded where the consumer had suffered only from some undiagnosed or minor generalised symptoms at the start of the policy.

However, when we decide whether a condition was “pre-existing” within the meaning of a policy, we take into account the following considerations:

the intensity of the symptoms;
the seriousness with which they were regarded;
whether the consumer was undergoing tests or had been referred to a consultant;
the eventual diagnosis;
any treatment given;
the extent of the connection between the pre-existing condition and the condition that gave rise to the claim – and the foreseeability of this; and
whether the consumer could reasonably be expected to have been aware that they might have to make a claim as a result of the symptoms.
The insurance sector accepts that ordinary consumers are not expected to have expert knowledge about the state of their health (or the health of others on whom cover depends).

We normally take the view that it is not reasonable for insurers to exclude claims – if they would have accepted the risk at proposal, had a full underwriting procedure been carried out."

http://www.financial-ombudsman.org.uk/publications/technical_notes/medical-conditions.htm

Brownedoff_3

Three years ago I had dvt following an operation on my right knee. I underwent treatment (warfarin) for 6 months before being discharged by a specialist. I was advised to take one 75mg aspirin per day as a precautionary measure and have never received any other treatment. I was told it was in all probability a one off as I was 48 years old at the time. I am currently in Cyprus and have unfortunately got dvt in my left leg which lead to 4 days in hospital. AXA insurance have today declined to pay my medical expenses, flight home etc. I have had a policy with them for approximately 7 years sold as part of my LLOYDS BANK PLATINUM ACCOUNT. I have never previously made a claim. They are arguing that aspirin is a prescribed drug even though I buy it from my local Poundland store and that I should have declared that I was taking it. They are also arguing that I have an ongoing medical condition which may well be the case (with the benefit of hindsight) but was never diagnosed previously.
I would strongly urge anyone with a LLOYDS BANK AXA policy to be very, very wary. It would appear these policies are not be worth the paper they're written on.