AXA insurance refusing to pay claim

spendalotgottostop

Hi all, I'm a long time lurker on here and love the site. This is though the first time I've posted and woul appreciate any advice.

AXA are refusing to pay on the accidental death element of a travel insurance.

In short they say there is a clause in the insurance that means if a person had consumed alcohol, the claim is invalid. The insurance with a bank account and although we were provided with a record of the insurance benefits, we have it at any time received the full terms and conditions. At the time of making the claim we asked AXA for a copy of the full terms etc so we could check them. They haven't sent them to us even after we asked again. So we made a claim.

When they told us they were refusing to settle because of the clause we challenged them on a number of points and because of the above. They have been really poor in their communications we have had to chase and phone them, they have not replied or made contact when they said they would. We are now waiting for another response from them because of our challenge but we fear the worst. Has anyone any advice about the next steps we can take please? Would the FSO be the first step?



We Would be happy to hear from anyone thank you.

BJV

Sorry probably me miss-reading your post but what type of insurance claim are you trying to make?


For example it if is car insurance then yes they would refuse to settle if the driver was drunk behind the wheel.


I think before you get any really useful advice you will need to give more information.


What type of claim?
When did you buy the insurance?
Was there an exclusion period on the policy or did cover start straight away?
What are the circumstances that made you need to make a claim?

spendalotgottostop

Hi, thanks for the reply the insurance was travel insurance, the claim was for accidental death.

There was no driving involved. Does that help to clarify?.?

InsideInsurance

spendalotgottostop wrote: »

Hi, thanks for the reply the insurance was travel insurance, the claim was for accidental death.

There was no driving involved. Does that help to clarify?.?

Unfortunately not as it doesnt cover the most critical point which was the circumstances of the claim.

Which bank did the insurance come from so that we can see the wording?

Ultimately irrespective if anyone here thinks you have a case or not then your ultimate choice is to first register a formal complaint with Axa and if you arent happy with their response or they dont respond within 8 weeks you then have the choice of going to the ombudsman.

If you want peoples opinion on if you have a case or not then its the details of the circumstances, why you think its wrong the claim is declined etc that is more important than how long its taken them to assess the case or how poor their comms have been etc.

magpiecottage

As a general rule, the Financial Ombudsman Service will look at how much alcohol was consumed and whether it contributed to the accident.

If the person was drunk then they tend to side with the insurer. If not then with the complainant. However, the rules are not hard and fast.

Driving is not relevant save that if the person is over the drink drive limit at the time of the accident, that may indicate that alcohol played a part in the accident and entitle the insurer to refuse the claim.

They have eight weeks from when they first receive a complaint to make a final response.

You then have six months from when the final response from them is sent by them (not received by you) to get the complaint to the Financial Ombudsman Service).

Silk

Can't say about AXA but it's a common clause in travel insurance.

Quentin

spendalotgottostop wrote: »

.... Has anyone any advice about the next steps we can take please? Would the FSO be the first step?......

You need to first exhaust their formal complaints procedure before being able to escalate to the FOS (which should be your next step).


If your "challenges" have not been "complaints" then put in a complaint now.


However if they have actually been complaints and you are unhappy with their response then now is the time to involve the FOS

spendalotgottostop

Thank you for your responses appreciated.

Inside insurance, thanks for the guidance. The insurance was through the Cooperative bank, when the account was opened the insurance was automatically provided.

We are obviously unhappy that they have refused the claim, because of the alcohol clause but we wanted to take it further through the formal complaints process or any other options because of the failure to provide the terms and conditions of the policy when asked to and also about the way they handled the claim. That is why I think we thought the FSO was the most appropriate route, because as I understand it they investigate if the insurer has failed to follow proper procedure rather than if they have made the correct assessment of a claim. Or am I mistaken?

Thanks Magpie Cottage that's helpful I didn't know about the timescales, that is something else AXA have failed to advise us off.

Thanks Silk, it's been a harsh lesson.

Thanks Quentin, we initially 'challenged' verbally and in writing, but we have now complained.

Some great advice xx

InsideInsurance

The FOS can deal with both complaints - how the claim was handled and the decision they reached.

It will be critical in your letter to both the insurer and if needs be on the complaints form to the FOS that there are these two separate elements, if not the chances are it'll get rolled into one and it'll focus on the decision and not the process.

stator

Do you think alcohol contributed to the accident?

rs65

spendalotgottostop wrote: »

Has anyone any advice about the next steps we can take please? Would the FSO be the first step?

As mentioned, complaints procedure first then FOS if still not happy.

Have a read here to see if these help

http://www.financial-ombudsman.org.uk/publications/ombudsman-news/120/120-alcohol-exclusions.html