Travel Insurance won't payout

andresmi

Hello All - Interested in your thoughts as to whether the insurance company are acting fairly here or not and if there is any recourse.

I recently travelled as a family of four to Mexico.  We took out a platinum insurance policy with COVID cover for us all.  Whilst in Mexico my partner contracted COVID. As such we had to stay longer than planned and therefore incurring unplanned accommodation and airfare costs (~£4,000).  The insurance company have said that since it was my partner alone that contracted covid, the rest of us (myself and two young kids) should have travelled home as planned.  As such they will only pay out 1/4 of the accommodation costs and only her return airfare.

This seems unfair because for the rest of us to return was completely impractical.  My partner was sick but not unwell enough to be hospitalised.  She needed care and had to isolate, meaning she could not go shopping for herself for food.  We took the cheapest Air BNB possible and cheapest economy return flights.  My question is do we think that it is reasonable to expect that we abandon one of our party?  I didn't even contemplate leaving her on her own.

Interested in your thoughts.  I've complained to the insurance company and am awaiting their formal response which if it is not in my favour I'll go to the insurance ombudsman.

Sandtree

What do the terms of your policy state? Most will consider an additional one person staying where the illness of the passenger requires it at the sole discretion of the insurer and normally requires prior approval. At what point did you contact the insurers?

Walmart, Chedraui and the other supermarkets all do home delivery... delivery charge is normally 30 pessos and so cheaper than a taxi to them. Similarly Rappi (the equivalent of Deliveroo) and Uber Eats offer fast turn around delivery which can include shopping from supermarkets and convenience stores including medication (many of which in the UK would need a prescription but not in Mexico). Naturally they also deliver from restaurants if you want hot/ready to eat food.

I personally struggle to see that on the grounds of getting shopping that it required the three of you to stay with her.  We spend a lot of time in Mexico, in different areas, and have actually found getting things delivered online easier than in London during Covid with same day delivery available most the time whereas UK you're booking supermarkets a week or more out during Covid.

There certainly is potential grounds to argue on the 25% of the accommodation as the cost of a place for 1 person doesnt cost a quarter the cost of a place for 4. 

SaverRate

Who was your insurer and what do the terms and conditions state 

andresmi

HarryDavies01 said:

Who was your insurer and what do the terms and conditions state 

It was Puffin Insurance who outsource to AXA.  The Policy wording doesn't cover this.  It simply states, "Medical claims due to COVID-19 while travelling so long as you are not travelling against Foreign, Commonwealth and Development Office advice".  It has no detail and no further detail was shared with me.  

andresmi

Sandtree said:

What do the terms of your policy state? Most will consider an additional one person staying where the illness of the passenger requires it at the sole discretion of the insurer and normally requires prior approval. At what point did you contact the insurers?

Walmart, Chedraui and the other supermarkets all do home delivery... delivery charge is normally 30 pessos and so cheaper than a taxi to them. Similarly Rappi (the equivalent of Deliveroo) and Uber Eats offer fast turn around delivery which can include shopping from supermarkets and convenience stores including medication (many of which in the UK would need a prescription but not in Mexico). Naturally they also deliver from restaurants if you want hot/ready to eat food.

I personally struggle to see that on the grounds of getting shopping that it required the three of you to stay with her.  We spend a lot of time in Mexico, in different areas, and have actually found getting things delivered online easier than in London during Covid with same day delivery available most the time whereas UK you're booking supermarkets a week or more out during Covid.

There certainly is potential grounds to argue on the 25% of the accommodation as the cost of a place for 1 person doesnt cost a quarter the cost of a place for 4. 

We didn't tell the insurers verbally until after our flights had left because despite spending 3 hours on the phone once we knew she couldn't fly we could not get through to their call centre.  We sent an email instead saying we couldn't get through and asking what to do and never received a reply...

We also could not have just 1 person remain as we are a family with a 8 year old and a 6 year old.  They have to stay with me as they can't fly back as unaccompanied minors.  If I left the 8 year old with mum she's no old enough to take responsibility.  The point is that mum was ill with Covid.  She wasn't asymptomatic.  As such she needed care and wasn't in a position to be calling supermarkets or takeaway.  She's ill, doesn't speak Spanish, is alone in a foreign country, is in a cheap Air BNB out of any metropolitan areas to save money and therefore not near public transport.  Perhaps I could have hired a private nurse or admitted her to hospital in which event that would prove much more expensive that having me remain as carer.  So I hear you, but still believe the insurance company are acting unreasonably.

lisyloo

In this situation you should have spoken to your insurer.

25% seems unfair and you should challenge it.
If you took 1 room and paid for accom only then they should pay for the room (100%)
if you took 2 rooms then I think they should pay 50%.

Aretnap

andresmi said:

HarryDavies01 said:

Who was your insurer and what do the terms and conditions state 

It was Puffin Insurance who outsource to AXA.  The Policy wording doesn't cover this.  It simply states, "Medical claims due to COVID-19 while travelling so long as you are not travelling against Foreign, Commonwealth and Development Office advice".  It has no detail and no further detail was shared with me.  

The important part won't be in a Covid specific section. The general section on illness should set out the terms on which they'll cover a family member or members to stay behind with a traveller who is unable to return due to illness. These will be no different for Covid than for any other illness. 

Sandtree

andresmi said:

HarryDavies01 said:

Who was your insurer and what do the terms and conditions state 

It was Puffin Insurance who outsource to AXA.  The Policy wording doesn't cover this.  It simply states, "Medical claims due to COVID-19 while travelling so long as you are not travelling against Foreign, Commonwealth and Development Office advice".  It has no detail and no further detail was shared with me.  

So Puffin are just a retailer, they dont outsource to Axa, Axa is the insurer. I assume your wording is the same as: Puffin - Direct - 2021.3.1.1 AR.pdf (windows.net) 

So the relevant wording is probably:

What is covered
We will pay you up to the amounts shown in the Table of Benefits for the following expenses which are necessarily incurred during a trip as a result of you suffering unforeseen injury due to an accident, illness, disease and/or compulsory quarantine:
1. Emergency medical, surgical, hospital, ambulance and medical fees and charges incurred outside of your home area.
2. Emergency dental treatment incurred outside of your home area for the immediate relief of pain and / or emergency repairs to dentures or artificial teeth if they are causing pain.
3. Up to the amount shown in the Table of Benefits for every complete 24 hour period you are in hospital or confined to your accommodation on the advice of a medical practitioner. This limit is increased if you are admitted to hospital because you have suffered an injured whilst being mugged.
4. Up to the amount shown in the Table of Benefits towards meal expenses for a nominated person who is staying or travelling with you.


It would therefore appear to offer no cover for the cost of someone staying with out with an ill person beyond some meal expenses, though the mentioned table has no value against this. 

TELLIT01

Did you inform the insurer that one of your party had Covid and would be unable to travel home.  If so, what advice did they give you?

daveyjp

Only paying for the injured party to stay longer is fairly typical.

This is often highlighted on cruise forums where someone is taken off ship to hospital.  They are covered, but whoever they are travelling with either stays on the cruise or has pay to stay with them and get home.

Sandtree

andresmi said:

Sandtree said:

What do the terms of your policy state? Most will consider an additional one person staying where the illness of the passenger requires it at the sole discretion of the insurer and normally requires prior approval. At what point did you contact the insurers?

Walmart, Chedraui and the other supermarkets all do home delivery... delivery charge is normally 30 pessos and so cheaper than a taxi to them. Similarly Rappi (the equivalent of Deliveroo) and Uber Eats offer fast turn around delivery which can include shopping from supermarkets and convenience stores including medication (many of which in the UK would need a prescription but not in Mexico). Naturally they also deliver from restaurants if you want hot/ready to eat food.

I personally struggle to see that on the grounds of getting shopping that it required the three of you to stay with her.  We spend a lot of time in Mexico, in different areas, and have actually found getting things delivered online easier than in London during Covid with same day delivery available most the time whereas UK you're booking supermarkets a week or more out during Covid.

There certainly is potential grounds to argue on the 25% of the accommodation as the cost of a place for 1 person doesnt cost a quarter the cost of a place for 4. 

We didn't tell the insurers verbally until after our flights had left because despite spending 3 hours on the phone once we knew she couldn't fly we could not get through to their call centre.  We sent an email instead saying we couldn't get through and asking what to do and never received a reply...

We also could not have just 1 person remain as we are a family with a 8 year old and a 6 year old.  They have to stay with me as they can't fly back as unaccompanied minors.  If I left the 8 year old with mum she's no old enough to take responsibility.  The point is that mum was ill with Covid.  She wasn't asymptomatic.  As such she needed care and wasn't in a position to be calling supermarkets or takeaway.  She's ill, doesn't speak Spanish, is alone in a foreign country, is in a cheap Air BNB out of any metropolitan areas to save money and therefore not near public transport.  Perhaps I could have hired a private nurse or admitted her to hospital in which event that would prove much more expensive that having me remain as carer.  So I hear you, but still believe the insurance company are acting unreasonably.

They all have iPhone and Android apps, most of which respond fairly well to searches in english and Rappi can be set to english. Plus you can also use Google/Apple Translate if you dont know eggs are huevos etc

The issue is that in your first post you stated that the main driver for you needing to stay was for the practicalities of getting food to the property and such because she had to isolate but that is going to be a hard sale, you were in north america not a tribal region of the amazon. Their internet works almost as well as the UK's does and they've a very similar range of options for ordering online where you can have the luxury of using online translators. As such even if the policy gave cover for someone else staying, which it doesnt appear to, then you'd be on poor grounds.

If the argument is that she was bed ridden and needed someone to physically care for her then that may result in a different outcome if your policy provided such cover but your initial post here argued on practicalities of isolation not illness. If the claim form was similar then their position is understandable. All however appears fairly moot though as the policy doesnt provide for a second person staying, even those that do normally require prior authorisation which you didnt seek.