Issue with travel insurance

Yba

Hello, my son who is 17 has had a serious accident whilst on holiday abroad. There was a rescue operation with police involvement.we have travel insurance with HSBC, which I believe is provided by Aviva. They’re not agreeing to authorise the claim on the basis that they have not being provided with the police report, therefore have insufficient information about the circumstances that led to the incident. In the meantime, my son has been in a public hospital in Spain where he is receiving urgent medical care. Due to the level of fractures, we would need a medicalised transfer to repatriate him back to UK. I’m very disappointed and upset at the reluctant response from Aviva and feel we have been left stranded with little options. I’m wondering if anyone has knowledge or expertise on travel insurance claims relating to minors and whether I should pursue an Ombudsman complaint. Any advice would be greatly appreciated 

Sandtree

Ombudsman is about 6 months wait at the moment for someone to start working a file and even then you can only go to them when you've had a final response from the insurer (or 8 weeks have passed). How long until a decision is made depends on the complexity of the complaint and the speed at which information is provided.

Have the doctors stated he is fit to be repatriated yet?

I'd assume Aviva are wanting to confirm if alcohol was involved in the accident or if he was on a motorbike more powerful than allowed by the policy (or any other of the exclusions for high risk activities)

MattMattMattUK

Yba said:

Hello, my son who is 17 has had a serious accident whilst on holiday abroad. There was a rescue operation with police involvement.we have travel insurance with HSBC, which I believe is provided by Aviva. They’re not agreeing to authorise the claim on the basis that they have not being provided with the police report, therefore have insufficient information about the circumstances that led to the incident. In the meantime, my son has been in a public hospital in Spain where he is receiving urgent medical care. Due to the level of fractures, we would need a medicalised transfer to repatriate him back to UK. I’m very disappointed and upset at the reluctant response from Aviva and feel we have been left stranded with little options.

The insurer will never had out money and cover costs without supporting evidence so that they can establish that he was insured (being insured is more than having a policy, you also have to be in compliance with it, eg. if he was injured sky-diving but that was excluded by the policy then he is not covered), that is the nature of insurance. The best thing you can do is to supply them with the evidence they have asked for, that will get the matter resolved quickly.

Yba said:

I’m wondering if anyone has knowledge or expertise on travel insurance claims relating to minors and whether I should pursue an Ombudsman complaint. Any advice would be greatly appreciated 

To go to the ombudsman you first need to exhaust the provider's complains procedure, you can then take that to the ombudsman if you do not think the decision is correct from a legal standpoint. Going through the insurers complains procedure will take weeks and the ombudsman will take from several weeks to several months to make a decision, realistically the ombudsman would be unlikely to give a final decision this year. If you have been asked for evidence by the insurer and refused to provide this then the ombudsman will find in favour of the insurer. 

Is there any reason you do not want to provide HSBC/Aviva with the police report?

born_again

I would say you are wasting your time with the Ombudsman at the moment.
As 1st you need to exhaust Aviva's complaints procedure (max 8 weeks) Then as Sandtree has said you are looking at a wait with the Ombudsman.

 As you have been asked for a police report. They will say that is required to confirm the details & if he is covered.
So you really need to chase the police for the report.
This maybe best done in person.

Best wishes to your son. 

Aylesbury_Duck

I don't think it's a case of them adhering to a conclusion without any evidence.  It's entirely reasonable for them to withhold payment until they've established they're obliged to pay out.  In the meantime, your son is being cared for, so the lack of insurance payout isn't harming his recovery.  If it takes time to establish whether there's an eligible claim, he'll hopefully recover sufficiently to be able to travel home as a normal passenger if he wishes to.

Andy_L

Yba said:

Thank you all for your contributions. The police report is not something the Spanish police releases to individuals involved in incidents, they actually file it with the Courts who then decide on whether any further action is needed. What is complicated in our situation is that my son fell off a cliff and he was on his own, with no witnesses. What transpires is that Aviva is suspicious that he wanted to end his life and therefore will not authorize the claim. This is very difficult for all of us, my son has no precedent in mental health or previous suicide attempts. What I find horrific is that Aviva will adhere to this conclusion without any evidence. I also wondered if because he is minor and there is no previous incident or psychiatric history, they would need to err on the side of caution before declining cover. My common sense tells me is that because he has no age to make decisions as an adult then the exclusion on intent to self harm/suicide would not apply. I realise this is a very tricky situation but wondered if anyone had any suggestions as to how I could take this further. In the meantime, my son continues to be well cared for in a public hospital but not sure for how long and how we would be able to take him back due to the complexities of his fractures. Thank you again to everyone who has contributed to this discussion, very much appreciated.

What have Aviva said when you told them that?

user1977

Andy_L said:

Yba said:

Thank you all for your contributions. The police report is not something the Spanish police releases to individuals involved in incidents, they actually file it with the Courts who then decide on whether any further action is needed. What is complicated in our situation is that my son fell off a cliff and he was on his own, with no witnesses. What transpires is that Aviva is suspicious that he wanted to end his life and therefore will not authorize the claim. This is very difficult for all of us, my son has no precedent in mental health or previous suicide attempts. What I find horrific is that Aviva will adhere to this conclusion without any evidence. I also wondered if because he is minor and there is no previous incident or psychiatric history, they would need to err on the side of caution before declining cover. My common sense tells me is that because he has no age to make decisions as an adult then the exclusion on intent to self harm/suicide would not apply. I realise this is a very tricky situation but wondered if anyone had any suggestions as to how I could take this further. In the meantime, my son continues to be well cared for in a public hospital but not sure for how long and how we would be able to take him back due to the complexities of his fractures. Thank you again to everyone who has contributed to this discussion, very much appreciated.

What have Aviva said when you told them that?

And surely (since Spain is hardly an obscure jurisdiction for them to be dealing with) they already know what normal Spanish practice is anyway?

born_again

Try  contacting The British Consulate they maybe able to assist in getting a report to provide to Aviva. Or the court that the report is sent too. They must be used to these requests given how many Brits go to Spain and end up in hospital.

Are you out there with him?

Yba

Yes I’m here with him, the British consulate suggests hiring a lawyer to resolve dispute but I’m afraid this venue would be lengthy, expensive and not provide us with a short term solution which ultimately is medicalised repatriation 

Aylesbury_Duck

I know it's not ideal to be overseas, but what's the rush to repatriate him?  Surely it's more important that he remains under hospital care, even if that means hotel and travel costs for you in the short term?  If the insurer eventually deems it a valid claim, does the policy permit you to claim those costs?  If so, keep the costs minimised and with receipts.

user1977

Aylesbury_Duck said:

If the insurer eventually deems it a valid claim, does the policy permit you to claim those costs?  If so, keep the costs minimised and with receipts.

They can claim the costs if the policy covers it, whether or not the insurer agrees that it's a valid claim...it's just harder work.