Holiday Insurance Claim Problem

Geoffrey_Bobbles_Bonbon

This concerns a holiday my partner and I booked in November 2011. It was booked through Thomas Cook in England.

Due to an illness I suffered on the plane before it took off we had to leave the plane and were unable to take the holiday. I understand we are covered for a refund since we took out additional insurance with White Horse Insurance Ireland Ltd., as suggested to us by Thomas Cook, the reason being my partner suffers from two forms of epilepsy and we were concerned that she might have a seizure on the plane. In the end it was not her who had the illness. I thought I was having a heart attack, but my GP said it was probably a severe panic attack. I am not a good traveler on a plane but I did not expect to suffer quite like this.

White Horse advised over the telephone that we should indeed be covered for a refund of the cost of the holiday and a refund would be given since I provided the necessary documentation from my GP, confirming that I had suffered an illness from which I had not previously suffered.

White Horse later refused to issue a refund as this was not an “existing illness”. I challenged this via a telephone conversation with them and they said, once again, that we most definitely would be covered and apologized, saying that my claim would be presented again. Once again the refund was refused on the original grounds.

I was then advised to take my case to the Financial Services Ombudsman in Ireland as it did not come under the jurisdiction of a British Ombudsman service.

I then received a letter from the Irish Financial Services Ombudsman which stated the following:

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I refer to your dispute with White Horse Insurance Ireland Ltd.

Having obtained your policy document I note that the clause in the contract documentation between two parties of this dispute confirms that the policy is governed by and construed in accordance with the laws of England. Therefore, in these circumstances the Financial Services Ombudsman would not be the appropriate forum to adjudicate the complaint and this office would decline jurisdiction on that grounds.

However, should Irish law govern the contract, the circumstances would be otherwise, I would be grateful if you could let me have confirmation from you in writing from you that:

the applicable laws pursuant to which the complaint will be examined and adjudicated upon, will be the laws of Ireland.

An appropriate note in that regard is attached for your attention.

Upon receipt of the said confirmation in writing from you the investigation on this matter can proceed.

I look forward to hearing from you within the next ten days.

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I really don't know how to proceed with this. Is it a good idea to let this go through the Irish system? Or is there a better alternative?

I am afraid to admit that I am lost with this and have found the whole procedure extremely stressful. I have already exceeded the 10 day reply limit just worrying about this.

Slapped wrists for taking so long trying to sort this out, but I need advice on what to do next.

Thanks

John

dazzadub

Any system is better then none. English law or Irish law. As long as your policy covers you in there terms either ombudsman will support your claim. Just get a move on with it

mkknrtn

I'm not sure on aspects of english and irish law BUT what was the actual reason they have declined your claim? I noticed you mentioned the cancellation was due to the fact you had a panic attack on the plane, it's worth looking in your policy for the following exclusions:

Cancellation due to medical conditions (which, is what has happened in your case)
Any claims related to stress, anxiety or depression unless admitted as an inpatient.

If a panic attack was the reason, if this was confirmed by your doctor and your policy had the above exclusion in (perhaps worded kind of differently) then... unfortunately they won't pay out.

Let me know, I'm a claims assessor and so I'm happy to help.

Quentin

Geoffrey_Bobbles_Bonbon wrote: »

.....Due to an illness I suffered on the plane before it took off we had to leave the plane and were unable to take the holiday......I thought I was having a heart attack, but my GP said it was probably a severe panic attack. I am not a good traveler on a plane but I did not expect to suffer quite like this. ......

Maybe your GP has reported your previous episodes (you say you have previously had problems travelling)?

In which case it is a pre existing condition.

Geoffrey_Bobbles_Bonbon

Thanks all.

The panic attack was the first one I am aware of. I don't have a history of these. It's true enough that I don't like flying, but it's not a fear as such and it's never stopped me from getting on a plane before.

The insurance company seemed helpful and couldn't understand why my claim had not been accepted. It seemed odd that the claim form stated that I could only claim against illness if it was one I was already suffering from. I challenged this and also argued the point that I could not possibly know where and when I was going to take ill, as the claim form seemed to suggest.

I explained to her that, surely you take out an insurance policy to cover you against the unforseen. You couldn't possibly make a claim for something you knew was going to happen. That would be fraudulent. She agreed. She also agreed that this was ridiculous and checked with her colleagues, phoning back an hour or so later to confirm that she couldn't see why my claim was rejected and that my claim would go before another hearing and they would be in touch a week or so later. The result was the same though.

I really thought I was having a heart attack. Of course there is no way of knowing with 100% certainty as I never had a medical assessment at the time of getting off the plane.

I have no history of panic attacks and there was no exclusion of these in the terms and conditions, as far as I can remember. I don't have them anymore as they were sent to White Horse Insurance. The Ombudsman had to obtain a copy of these on my behalf. Nothing was stated that my claim was invalid.

Thanks again everybody. I am hopeless when it comes to filling in lengthy forms and I have let this drag on, believing that I don't stand a chance - which is what the insurance would like me to believe I expect.

I will phone the Ombudsman tomorrow to see if I can proceed with this, despite exceeding the ten day reply limit.

Cheers

John

jonesMUFCforever

Not having a medical assessment after getting off the plane IMO will be a massive negative effect on your claim.
You might just have changed your mind - how do you prove otherwise?

Sorry to be negative.

Geoffrey_Bobbles_Bonbon

That's a very good point and I expect this could be a consideration in the proceedings. Hopefully the doctor's certificate will add some weight.

mkknrtn

Ahh, the Part about having a medical examine at the time of cancellation could be problematic. However saying that, if a doctor has confirmed retrospectively that you were unfit to travel due to medical reasons which aren't pre existing or excluded specifically in the cover, then I can't see why not. The best thing to do would be to go through the companies own complaints procedure and ask for a final decision letter in wiring, outlining the reason why your claim has not been successful and ask them to how you what part of the policy wording states the exclusion (because copy and paste isn't hard!). Ask ask for it without jargon! The best that can come From that is that it'll be re-reviewed from scratch, usually by someone a lot more senior and with better technical ability. The worst is they put it in plain terms why it's not covered. Follwing that, if you feel you could potentially overturn the decision by providing more evidence then you can give that a try.

Good luck!

Geoffrey_Bobbles_Bonbon

That's excellent. I will do exactly that mkknrtn. Thanks very much for this.

Cheers again.

Geoffrey_Bobbles_Bonbon

Sorry for being slow on getting back on this. This whole thing fills me with dread and I have taken far too long over it.

I did exactly as you suggested mkknrtn and asked White Horse Insurance for a Final Decision Letter, which I now have.

Links to the two pages here:

Page 1 Page 2

I have deleted personal info of course.

The conclusion is that they will not pay up because it was my GP who made the diagnosis and not a specialist. Why on earth should a specialist be necessary? Why won't my own GP's certificate suffice? This is what is so unfair.

I know I have been slow on this whole matter, but that is irrelevant. I have up to six years to go through with this. I didn't get a doctor's letter originally because I didn't know I needed one, hence the four months waiting.

It looks like I have lost this one.

Geoffrey_Bobbles_Bonbon

By the way, the two images are hosted at !!!!!!!!. It's safe and you don't have to download anything. You'll see the pages and you can zoom in easily to see the text.