confused about the rules for surgery

helenajosephine

Hi 

I have an annual travel policy that I took out in May 2022. I booked flights for Greece in January 2023 to travel in June 2023, and then the OH was subsequently diagnosed with a hernia and surgery has been advised... however, we are currently waiting for a date. I have notified the insurance company (Staysure) of his diagnosis and the situation we're in, and that I don't want to /intend to cancel our holiday, but if the surgery is offered at a time that either makes it difficult for him to travel, or is during the time we should be away then my thoughts were that I would claim cancellation.  It seems, however that this might not be possible. I was informed that if he has the surgery and is fit to travel, or if he doesn't have the surgery and has the doctor's confirmation that he is fit to travel, then we are covered. But we are not if we need to cancel because of the surgery, including complications from it! How does that work? I took the policy out in good faith on the basis cancellation due to illness is covered, yet the discovery of something that needs surgery doesn't seem to qualify as an illness for which we can claim. If anyone can explain and advise how I don't lose the costs of two flight tickets to Greece, I would be very grateful. 

eskbanker

helenajosephine said:

I was informed that if he has the surgery and is fit to travel, or if he doesn't have the surgery and has the doctor's confirmation that he is fit to travel, then we are covered. But we are not if we need to cancel because of the surgery, including complications from it! How does that work?

Aren't these two entirely different aspects of the policy - the first is saying that if he travels then normal cover applies while away, but the second is saying that they won't reimburse cancellation costs if he doesn't travel?  I'd have thought that there'd be more information needed for the second part, in terms of whether cancellation was pre-emptive or if he was signed off as unfit to travel....

helenajosephine

Thanks for the response eskbanker. That's exactly what I don't understand - it seems that even though the condition that has arisen since taking out the policy it is being ruled out as a reason for paying out if we need to cancel our holiday. I probably wouldn't have booked the flights if I had been aware at the time that the OH would require a surgical procedure. I need to check your suggestion about what happens if he's unfit to travel, but the conversation I had with the insurance company this morning definitely seemed to be along the lines of 'if he comes out of the surgery OK then we're insured, but if he doesn't, then we're not'  

lisyloo

I am wondering if you have misunderstood and/or they haven’t explained it properly - bear with me,

are they saying:
if he has the surgery and is signed off or hasn’t had the surgery by the time of travel = fully covered
cancellation = covered
Subsequent cover for this condition after the cancellation claim = excluded

If you suspect there may have been a misunderstanding then I suggest using chat and spelling it out as above. 

Personally I would screenshot any important answers as well as try to get an email transcript.

anything you don’t agree with ask them to refer you to relevant policy paragraphs 

SiliconChip

I had to cancel long haul flights that had been paid for months earlier (and insurance taken out at that time) because a subsequent emergency admission to hospital led to a diagnosis that required surgery to resolve the issue. I wasn't able to get a definite date for the surgery but because I probably wouldn't have been fit to travel even if the surgery happened before the date of travel I decided to cancel about 2 months before departure. Fortunately I had chosen flexible flights so the airline refunded the bulk of the costs but the insurer (Aviva) was happy to cover the cancellation fees and some other costs that had been incurred, so all it cost me was the policy excess. I did have to provide a lot of supporting documentation.

As it happens my first surgery date was set for about a month after I was due to travel but Covid came along and cancelled that, and I eventually had it about 4 months later when hospitals started to do non-emergency surgery again.

helenajosephine

Hi lisyloo. Yes, I may have misunderstood the conversation and will try to clarify with them tomorrow. however the amendment to the policy document in relation to the newly declared medical condition states: 
"Full cover is provided for emergency medical treatment and repatriation, providing you are not travelling against your home country doctor's advice. However, this policy will not provide cover for cancellation or cutting short your trip as a result of the condition you are awaiting surgery/a procedure for. All other declared medical conditions are fully covered."  

So, this is why I'm confused. 

Thanks SiliconChip, hope you're fully recovered now. Yours sounds very like our own scenario, apart from the fact I don't have flexible flights. I'm wondering if I need to talk to the insurer, rather than Staysure as the broker. The thing is it may not be an issue (i.e. he has the op and all is fine, or the op doesn't happen until after our holiday and he can get a fit to travel note from the doctor), but I thought insurance was to cover you when unforseen things like this made it not fine ;(

Brie

I'm confused about what has happened (& would like to know how this is resolved as we also have a policy with Staysure)

So you have an annual policy and have, no doubt, declared a number of medical issues.  And then in January you booked a holiday and subsequently discovered a new medical issue?  In that case I would expect you to be covered. 

If however, you had taken out the policy, had discovered a new medical issue and then had booked something without having told Staysure then I would understand them NOT covering the cancellation.

sheramber

The way the insurance seems to work is if an unexpected illness occurs preventing you travelling- with medical confirmation of unfit to travel, you are covered.  In that case you are not choosing to cancel.
However, if you notify them of a change of circumstances such as a new condition arising, they review the policy and decide whether to cover the new condition and , if so, what , if any,  additional charge is payable as this new condition changes the terms of the policy.

In your case it appears they are not prepared to cover you  if you choose to  have the surgery before travelling and need to cancel.

You could choose to wait until after the holiday.

eskbanker

helenajosephine said:

"However, this policy will not provide cover for cancellation or cutting short your trip as a result of the condition you are awaiting surgery/a procedure for."

I'd read that as meaning that they wouldn't cover cancellation if the condition flared up and prevented/curtailed travel, rather than specifically cancellation to allow for the surgery itself, but worth clarifying with them.

helenajosephine said:

The thing is it may not be an issue (i.e. he has the op and all is fine, or the op doesn't happen until after our holiday and he can get a fit to travel note from the doctor), but I thought insurance was to cover you when unforseen things like this made it not fine ;(

Trouble is, when a condition is declared, and remedial action is known to be needed, it becomes more of a foreseen issue than an unforeseen one....

lisyloo

Ok, so they are declining to provide medical cover if he’s still awaiting surgery.
in this scenario I believe you are entitled to claim cancellation (this is a seperate section to the policy from medical cover).
so you’re right they aren’t giving you the option in that scenario. They can choose to do this if they’d prefer to pay for your holiday than take the risks of insuring you abroad.
They will deduct 2 excesses (I’m assuming 2 of you are travelling).

how long ago was he referred?
has he looked at options for having the surgery in another location (where waiting lists may be shorter).
what is your preferred outcome?

helenajosephine

Thank you all so much for your responses... I'll try to respond to them individually. 

Brie - I took the policy out in May 2022 and booked the holiday in Jan 2023. The OH went to the doc in February when he was diagnosed and referred for surgery - he's now waiting for date to be called for the op. 

eskbanker - I see your point about once the condition is known, it is forseen, but I can't get past the fact that it wasn't a 'known' condition that might cause us a problem with our travel arrangements either when I took out the policy or booked the holiday. If he had ignored it (he's not in pain or debiltated), we hadn't been aware of the need for surgery and it had caused an issue immediately prior, or whilst we were on holiday, would that mean we still wouldn't be covered for cancellation/ curtailment because it was a pre-existing condition we didn't know about? I guess this is a question I might need to direct at the insurance company. 

sheramber - re my comment to eskbanker, the think is we aren't 'choosing' to cancel the holiday, but I would hope that we would be insured if a) an op date came up that meant we couldn't go on holiday, and/or b) that we would be covered if any post-op complications prevented us from going. It may be that the op is scheduled for a date after our holiday (given how tricky it is to get in at the moment), but the British Hernia association suggests not to delay an op if you're offered one. 

lisyloo - the referral for the operation was in February. My preference would be for him to have the op as soon as possible and be repaired and for us to still be able to go on holiday. I'm trying not to stress him out with my stress over the fact that any issues with with the op means we lose the whole cost of our holiday.