confused about the rules for surgery

tightauldgit

From the info you've given it does seem a bit confused and I think you need to get clarification from the insurer. 

Given the timelines that you've spelled out I don't see how the insurer can say you aren't covered for cancellation - you took out insurance, booked a holiday, then got news of a condition that means you might not be able to travel - unless they are arguing that he's actually fit to travel and you are choosing not to go and to have the surgery instead. If that's the argument then I'm not sure exactly what the situation would be - while it's hugely inconvenient you COULD tell the NHS you are unavailable for that date and reschedule the surgery so whether the insurer could rely on that I don't know. 

On the other hand it could just be that they are saying if you choose to travel then you won't be covered for any expenses related to this condition but can still cancel and be reimbursed. Does he perhaps need a doctor to class him as unfit to travel? 

The only other thing I can think is that because you've informed them of the condition but not taken any specific action as a result they're now claiming it's a pre-existing condition and they won't cover you for anything that happens from now on including having to cancel but that would seem hugely sketchy given the timeline so that doesn't sound right at all. 

lisyloo

"On the other hand it could just be that they are saying if you choose to travel then you won't be covered for any expenses related to this condition but can still cancel and be reimbursed."

I think this is highly likely (This was if they travel after surgery).

onashoestring

Some extracts from the financial ombudsman webpage which provides guidelines for these types of situation. 

“A significant change in health …could also include ….

• you were going to have a major operation close to the date of your trip”

“An insurer can change or end an insurance contract if your circumstances change during the course of the policy which significantly alters the insured risk.”

”If your insurer withdraws cover entirely, we’d expect them to offer to cover the costs of cancelling any holiday which was due to be taken during the policy year. Even if cancellation isn’t medically necessary at that point, we think this is the fair and reasonable thing for insurers to do.”

”Trip cancellation charges

• When looking at complaints about charges for cancelled trips, we’ll take account of the travel company's cancellation policies. Usually the closer it is to the date of the trip, the larger the charge will be – up to the full cost of the holiday.

  We’d usually say it’s fair for the insurer to pay the amount that would’ve been charged at the time we think you should have called to tell the insurer about your change in health.”

“Often, you may want to go on the holiday anyway, so you’ll find cover elsewhere. So we might think it’s fair for your insurer to pay the difference in premium up to the value of any cancellation claim we would’ve expected them to pay.”

https://www.financial-ombudsman.org.uk/consumers/complaints-can-help/insurance/travel-insurance/change-in-health

sheramber

The OP will have the right to cancel now as the insurance have said they will not cover them. they have not been told they  cannot. 

The policy states they will not cover anybody who is on a waiting list for treatment.  As the husband has ben put on a waiting list for an op, the policy terms have been changed due to a change in circumstances.

But they will not cover them for cancellation due to surgery as the potential surgery is now a pre existing condition. It is now a known risk that the insurance company do not cover.

A claim for cancellation due to the withdrawal of cover is different to a claim for cancellation due to  the surgery.

The person the OP spoke to will not work in the claims section so cannot give any information on cancellation.

But the problem is, the OP does not want to cancel now, due to lack of cover. She wants to wait and cancel if  the potential surgery prevents  travel.

That is the risk  the  insurance company have said they will not cover.

lisyloo

So they are not going to lose thousands just an excess x 2 which they agreed to.

onashoestring

@helenajosephine to summarise:

You correctly informed Staysure about a significant change in health.

You also stated that you did not want to cancel the holiday ( so were not claiming for cancellation of the holiday ) 

They re-assessed the risk based on this new information and declined to provide cover for cancellation or cutting short your trip as a result of the condition you are awaiting surgery/a procedure for. They are entitled to do this . 

They should at this stage cover cancellation of the holiday. However you told them that you still wished to go ahead with the holiday .

As you now know that Staysure policy will not cover the cost of the 2 flight tickets if you have to cancel  because of the hernia surgery. So  If you need this cover , you will have to find an insurer who will cover for this scenario and take out a new policy with them .

The financial obudsman state “ Often, you may want to go on the holiday anyway, so you’ll find cover elsewhere. So we might think it’s fair for your insurer to pay the difference in premium up to the value of any cancellation claim we would’ve expected them to pay.”

https://www.financial-ombudsman.org.uk/consumers/complaints-can-help/insurance/travel-insurance/change-in-health

This means that Staysure should cover the cost of your new policy. The difficulty maybe that they may view that you have accepted the amended policy they offered. You need to make it clear in writing that you do not accept the amended policy . That you want to cancel your policy and for them to pay for a new policy that covers you . 

You however, will need to do the research and find a new policy that covers you. 

helenajosephine

Hi Everyone

Thank you so much for all your ongoing advice and information on how I stand with my insurance policy. Sorry its taken so long to respond, but the OH was contacted by the hospital early in the week and scheduled his operation for Saturday... he is now recovering at home. TBH he definitely wouldn't be fit to travel today, but the surgeon is confident that, other than not being able to lift heavy objects, he'll be almost as good as new within the next couple of weeks. 

I have informed our insurance company (again), and they more or less offered exactly the options you have suggested (thanks Onashoestring). However, given the prognosis from the surgeon, I still didn't see there was any reason for to cancel, so I have taken the informed risk that if something related to the surgery means it all goes pear shaped, we won't be covered. 

I do really appreciate all your help. Usually I just buy our annual travel insurance and forget about it, so this has been really tricky to get my head around (as you can probably tell), and I've got to try to negotiate a policy renewal next month, so that's going to be fun!  

Brie

@helenajosephine
glad you sorted both insurance and OH's surgery.  wishing him a speedy recovery and you both a happy holiday when you finally get to go.

helenajosephine

Thanks Brie