Travel insurance claim

Sago48

We recently took out insurance for a trip to Costa Rica and unfortunately both suffered quite a serious gastric (etc) episode. On returning we made a claim to our insurers - via Travelclaims Services.

Yesterday we got a letter asking for further details as follows.

1. Proof of dates of travel. This was provided on the VJV invoice we'd sent. I was put on hold for a while and when they came back they agreed the dates were there.

2. A response to the question did we have other private medical insurance. We'd already answered "no" to this on their form.

3. Proof of payment of the costs. The payment receipt given to us at the Medical Centre in Costa Rica where were treated included the word CANCELADO in the stamp. Travelclaims said this meant cancelled and won't accept the receipt. We had spare dollars so we paid cash ($500) so there's no paper trail. A quick google showed that in Central America cancelado means paid. I rang the Costa Rican Embassy and they have confirmed the meaning as "paid".

This is the first time either of us has made such a claim, and such a level of incompetence is hard to believe.

So w'd be grateful for any advice on these points:

1. From experience do you think are we dealing with incompetence or mischief?

2. If/when they refuse the claim, or offer perhaps a small part of it, what do we do?

3. Are there insurers who, again form your experience, are able and willing to process claims competently?

Thanks

Sparx

I think they are being vigilant and want to confirm the facts to see if you slip up and change the 'facts'. It's to try prevent fraudulent claims as it's becoming increasingly common these days unfortunately.

Your story seems legit to me, the insurers just want to be confident before paying out.

I would ask them to look up the definition of CANCELADO in Spanish. A quick Google myself and depending on the context, it can mean either "to cancel" or "to pay, to settle".

Is it worth ringing the Medical Centre you attended and asking them to scan, email or fax you a reprinted copy of the receipt/invoice with it clearly marked as paid? You could then forward this to your insurer as proof.

InsideInsurance

To be honest, the main issue is clearly cancelado. Their spanish is probably as good as mine and if you go to http://translate.google.co.uk/#es/en/CANCELADO as I always do when trying to read foreign documents then it simply says it means cancelled.

Ideally you need something in writing from an appropriate authority that Cancelado means "paid" in this context and not cancelled or something from the clinic to confirm the invoice was actually paid and not waived/cancelled.

Its a south american thing too that they say the invoice is cancelled meaning there the debt has been cancelled because its been paid

Sago48

Thanks for the helpful replies. I've now got an email from the Consul General of Costa Rica with links to websites that do give the "paid" meaning of cancelado, so I'll send that email with the links and see where it goes after that. What puzzles me as well is given that they offer world wide insurance, have they never seen a central and south american receipt with 'cancelado' on it before?

I quite understand that they want to detect fraud, and in their position I would in fact query 2 different technical aspects of our claim myself. These have not yet been mentioned, so I expect they will get to them once a suitable further period of time has passed. We shall see.

My other query was whether there are insurance companies who don't behave like this? I was thinking about this and although we've never made a health claim before we did make a claim for cash perhaps 18 years ago, and for a camera maybe 7 years ago. I recall that in both cases payment was relatively unproblematic, so perhaps there are indeed some companies better than others?

InsideInsurance

Sago48 wrote: »

What puzzles me as well is given that they offer world wide insurance, have they never seen a central and south american receipt with 'cancelado' on it before?

Whilst they as an organisation may have that doesnt necessarily mean the person who reviewed your case has nor that necessarily there is any peer or manager review involved in declined claims.

In my claims handling days (mainly TP motor and injury) it was only payments and complaints that were ever routinely reviewed by anyone. Outside of that it was just quarterly random sampling of a selection of closed cases.

Obviously if someone isnt sure of something they really should ask but there are plenty of people in this world that dont like asking, are arrogant and think they know everything etc. Likewise with peer/ manager review you can still get the same issues or a manager not being arrogant as much as thinking someone can do no wrong so rubber stamps all their decisions etc.


No insurer is impervious to errors, really the question is as much how they handle your complaint about the claim being rejected as anyone really should get it right after two bites of the cherry

Sago48

After another letter asking for more proofs - including confirming for the 3rd time that we had no other private medical insurance - they settled in full. We'd begun to wonder if they knew something we didn't - e.g. did we in fact have some other insurance we'd forgotten about? Not likely, but...

Anyway, no further mentions of cancelado, and definitely no apology for being so daft.

The problem of getting proper insurance still remains though. If anyone has any recommendations?

Thanks to all who helped.

PS. Our council is just about to start a residents' parking scheme in our street after 4 years of rearguard action by us residents. The website for applications was faulty in lots of ways but after emails to councillors etc. in the end it seemed to work and they confirmed we'd got the permit. Yesterday 2 permits arrived, with different accompanying letters, and slightly different details on the actual permit. I think I'll apologise to the Travel Insurers for these posts!!

InsideInsurance

Sago48 wrote: »

We'd begun to wonder if they knew something we didn't - e.g. did we in fact have some other insurance we'd forgotten about? Not likely, but...

If they had their own ways of checking there wouldnt be all the questions.

The problem is there are lots of places people get cover, free with their bank, some credit cards, home insurance, company schemes (travel or PMI) etc and people do forget/ not realise. I know multiple people who've had all these "free" insurances and still go out and buy a policy because they forget they got it bundled in elsewhere.

Without a way for an insurer to check they are reliant on you remembering what perks you get with all your other financial service products and employment etc.

As to recommendations, wont make any but have a look at Which? or Defaqto depending on if your priority is service or product quality.

The only travel insurer I ever made a claim against was Axa, the process was a little bit slow but reasonable considering it was a year of terrible snow storms so massive volumes of claims. Simply completed the form and sent it with evidence of the delay and got the money in my bank about 5 weeks later.

Unfortunately none of the HNW insurers write their own travel from what I know. Hiscox's isnt actually their own product. In theory you'd expect them to still have a good handle on the service their partner is providing but that doesnt always happen (in general, not explicitly hiscox)