Travel insurance refusing to cover costs

crystyl

Please excuse me if this is not in the right place.

I am hoping for some advice and guidance on how to proceed with the above (title). And please bear with if this is a little long!

My daughter (19) went on her first girls holiday last year, she went to Majorca. The day after she arrived she felt she has a cold and a couple of the other girls were experiencing similar symptoms. On the third day, she went to the local chemist to be checked over and to get some antibiotics for a chest infection - which is what she felt she had, the other girls had started to recover.

The doctor at the chemist said she was very unwell and needed to go to the hospital. At this point, she told the doctor and showed him her EHIC card and travel insurance documents. The doctor arranged an ambulance, in the ambulance her friend showed the 'crew' my daughters' EHIC card again. She was taken to a private hospital!

Now, obviously, her travel insurance did not cover her for private treatment! My daughter was very unwell and struggling to breathe. It was only the next day, she was admitted the previous evening, that I realised that she was in a private hospital.

Phoning her insurance company, they told me that she needed to be transferred to a public hospital. I relayed this information to the hospital to be told she was too unwell to be transferred. I then contacted the British consulate - very helpful, they acted as an interpreter for me! However, the private hospital would not realise her to the public hospital. She remained in the private hospital for 2 days. She was treated for asthma, a mild pre-existing condition undeclared by her on her insurance - she had never received treatment for an asthma attack prior to this event!

Her condition didn't improve significantly and the private hospital was at a loss as to what was wrong. On the third day, she was transferred via ambulance to the public hospital. The following day she received a diagnosis of an underlying condition which had been present from birth - this had caused her to be symptomatic brought on by a chest infection and the pressure from flying. She was diagnosed with a hole in the heart.

I was told by the hospital that I needed to get to the hospital asap as she was now severely unwell.

I was in contact daily, multiple times a day, with her insurance company - they advised me to fly out, that my costs would be covered. We have now received an invoice from the private hospital for 3,500 for her stay and the insurance company has declined the claim. They state that it was due to the pre-existing condition not being declared and as there was a state hospital she should have been sent there! Nor will they honour my claim (money borrowed from family members).

I am at a loss, what can I do? I have contacted the ombudsman but they have said due to the timescale it is now outside their jurisdiction (longer than six months ago), even though we only received the invoice in May.

Please can anyone help?

Thank you

Quentin

Apart from appealing the FOS decision your only other option is to take legal action.

Though do get proper legal advice on your chances before embarking on that.

Your daughter's undisclosed pre existing conditions do look to mean the insurer is correct.

When advising you to travel out and costs would be covered they were under the impression that the condition was covered when in fact it wasn't

dacouch

Which month did your Travel Insurer decline to pay your claim?

Who is your Insurer?

crystyl

Thank you for the replies. The condition which kept my daughter in the hospital was not previously diagnosed (it should have been picked up at birth), hence why she wasn't improving and is (?) therefore not connected to undisclosed asthma. The lack of blood flow through the heart was causing the breathlessness and hypoxia.

The travel insurer declined the claim in December. She was insured with On The Beach - Travel Insurance Facilities Plc. I also should have said that we had received no communication from the hospital until 2 weeks ago - when an invoice was received. I am not bothered about recovering my own costs, it's the costs from the hospital. She is a full-time student.


Thank you again for any help

dacouch

Did you make any form of complaint shortly after they declined the claim?

Note a complaint does not need to clearly point out it is a complaint, it can be simly a communication eg call, email or letter etc querying the Insurers position on declining the claim

crystyl

Yes I did, I telephoned them and asked for it to be looked at again.

dacouch

crystyl wrote: »

Yes I did, I telephoned them and asked for it to be looked at again.

That would normally count as you making a complaint for the purposes of the Ombudsman.

Do you know when the Travel Insurer responded to your "Complaint"

and also when they responded to your "Complaint" did they point out to you about making a complaint to the Ombudsman and any time limits about making a complaint to the Ombudsman?

When you spoke to the Ombudsman, did you tell them about the abobe?

crystyl

I don't appear to have a response to my 'complaint'. Nor was I told about the ombudsman or a timescale.

I'm sorry but I don't know what abobe means.

Thank you again

Quentin

As #2 - appeal to the FOS over their decision not to investigate your complaint

(Abobe in #7 is a typo and should read "above")

crystyl

Thank you, I will.

Do you think I should also instruct a solicitor?

Quentin

Not until you have exhausted the FOS complaints procedure which is at no cost to you, and their decision is binding only on the insurer, and not you. (Which means you can still then take further legal action against the insurer if you want to - though at your cost)