Travel insurance claim. Urgent advice needed

irishboy

Hi

I wonder if anyone can help with this. Ill try and keep it to the point.

My mum and her partner were due to go on holiday. Whilst waiting for a taxi to take them to the airport he collapsed and died.

They both had different insurance companies.

My mum had paid the holiday in full using her credit card.

The holiday wasnt that expensive (approx £450 in total)

She was insured through Virgin and made a claim.

However her claim was denied quoting general exclusion 1 -

a. The claim relates to a medical condition or an illness related to a medical condition which you or any person who your trip depends on (this would include a relative or a close business associate) knew about before you bought this insurance. You must make sure you tell us about any change in the state of health of yourself, anyone travelling with you, a relative or close business associate occurring after you have bought this policy but before you travel. Please refer to the Health conditions section on page 2 of this policy wording for further details.

I admit she probably didnt read all the T&C's but she thought that this only related to her as her partner had his own policy.
I've had a look at the virgin website and at the T&C's.
There is a section with regards to cancellation of the holiday that states she can make a claim in the case of -

2. The death, serious illness or injury of a relative, close business associate, a person who you have booked to travel with or a relative or friend living abroad who you had planned to stay with. The incident giving rise to the claim must have been unexpected and not something you were aware of when you took out this insurance. Please see General exclusion number 1d and 1e for further details


Exclusions 1d & 1e state -

d. You, a relative, business associate, a person who you have booked to travel with or a relative or friend living abroad who you had planned to stay with, are receiving or waiting for hospital investigation or treatment for any undiagnosed condition or set of symptoms at the time of purchasing this insurance and/or at the time of commencing travel.

e. You, a relative, business associate, a person who you have booked to travel with or a relative or friend living abroad who you had planned to stay with, have been given a terminal prognosis at the time of purchasing this insurance and/or before commencing travel.


Admittedly her partner did have medical problems. He was diabetic, suffered with angina and had a heart bypass 12 years ago. He had two previous heart attacks hence the reason for the bypass but had none in the last 12 years.
He was not teminally ill and he died suddenly. It was certailnly not expected as they were waiting for the taxi to take them to the airport.
He was not undergoing any hospital treatment at the time.

What doe she do now? I cant believe that if you take out insurance for yourself you have to provide details of the party you are travelling with.

PLEASE HELP.

Many Thanks

Neil

mayfair1985

Sorry for the morbid question, but what was the cause of death? If it was deemed to be related to a pre-existing medical condition (no matter how long ago these occurred) then there is a distinct possibility that the policy will not pay out, regardless of how superfluous you believe the information required is. Unfortunately for your Mother, it's stated quite clearly that the event in question would not be covered.

Sorry for your loss at this time.

irishboy

Hi

The cause of death was a sudden cardiac arrest.
I understand what you are saying however lets say someone suffers with high blood pressure. They have had it for years without any problems.

Lets say that this person then has a cardiac arrest 30 years since finding out they have this condition. The cardiac arrest may or may not have been related to the existing condition.

Can she claim under the cancellation cover? This death was sudden and unexpected.

comeandgo

I think the insurance company would have to have been aware of the high blood presure - they would use it as a get out clause as they have not been informed of a pre-existing medical condition.

InsideInsurance

comeandgo wrote: »

I think the insurance company would have to have been aware of the high blood presure - they would use it as a get out clause as they have not been informed of a pre-existing medical condition.

An insurer would never use the fact they have a declared fact as a way to get out of paying a claim. They will typically give you two options, either have cover for it for an additional premium or have it excluded under the pre-existing conditions clause.

If you dont tell them about it then it is excluded under the pre-existing clause by default.


The wording of the policy does look unusual because of the lack of the term pre-existing or anything else similar to it as a word/ phrase in bold.

Were they receiving any treatments for any of their conditions? When was the last time they had an angina attack or any other heart related issues?

irishboy

He had his own insurance and they were fully aware of all of his existing medical conditions. My mother had her own policy and did not think that she had to inform them of someone elses medical problems as they had their own policy.
He last had an MI approx 12 years ago. This was the reason he had the bypass and had not experienced any problems since.
He also suffered from AF and had a cardioversion performed in February this year.

InsideInsurance

irishboy wrote: »

My mother had her own policy and did not think that she had to inform them of someone elses medical problems as they had their own policy.

In most cases travel insurance doesnt have the ability to inform of the pre-existing conditions of those that the trip is dependent on and they are simply excluded from cover. The wording on this policy would suggest that there is potentially the ability to inform them and get cover but evidently this wasnt done.

If he had a heart irregularity looked at in February this year (I assume that is what you mean by AF rather than an Anal Fissure) then you'd be hard pushed to claim not to have a pre-existing condition but again a review of the full wording and special terms would be necessary.

irishboy

LOL. yes I mean atrial fibrillation. He had had it for years. After his treatment in February he was discharged and did nit have to reattend the hospital.

Can you advise as to what my next step should be.

Again, he had declared all his pre existing conditions on his own insurance. I find it strange that my mum would have to declare his conditions on hers.

There was no determination that any of his pre existing conditions caused his cardiac arrest.

Had this happened a few hours later when they were actually on holiday then Im quite sure there would not have been any problems.

Under the cancellation part of the T&C's (see original post) parts 1d & 1e do not apply.

Many Thanks

Neil

rs65

irishboy wrote: »

I find it strange that my mum would have to declare his conditions on hers.

Insurers want to know anything that may cause a claim - his medical history (as is clearly known now) was likely to cause a claim by her on her policy.

I think you need to find out exactly what declarations she made when she took out the policy. What is asked (or assumed) when going through the quote?

mayfair1985

Just out of interest, when did she purchase the policy?

mayfair1985

irishboy wrote: »

Had this happened a few hours later when they were actually on holiday then Im quite sure there would not have been any problems.

The claim still wouldn't have been paid, it would just be curtailment rather than cancellation, so possibly a higher amount.