Wrong information regarding medical claim..

LibbyL92

It’s definitely a lesson learnt. In future I will definitely declare everything. 

It just proves as well you never know when you might need to use insurance. I didn’t think I’d end up in this situation but here we are.

thanks for the feedback everyone. 

HillStreetBlues

You could put in a complaint stating that you believe rejecting the claim fully isn't correct as you believe they still would have insured you if you had declared it.
If they still reject the claim try https://www.financial-ombudsman.org.uk/consumers/complaints-can-help
It won't cost you anything and they will look at claim as see if they made the correct decision.

pinkshoes

LibbyL92 said:

So for the last year I’ve been going through insurance claim. As I fell ill abroad last year (USA) 

I'm assuming the illness is not linked to MH issues and was totally unrelated? 

If this is the case, then I agree with @HillStreetBlues, in that if the claim would have been paid out even if you'd declared it, then you should put in a complaint.

(If the illness was potentially linked to MH issues, then I can see why they won't pay out by you not declaring a prescription/diagnosis)

DullGreyGuy

HillStreetBlues said:

You could put in a complaint stating that you believe rejecting the claim fully isn't correct as you believe they still would have insured you if you had declared it.
If they still reject the claim try https://www.financial-ombudsman.org.uk/consumers/complaints-can-help
It won't cost you anything and they will look at claim as see if they made the correct decision.

If they would cover it or not is irrelevant if they believe it was reckless that the OP didn't declare it... an intentional or reckless non-disclosure results in a void policy under CIDRA.  There really has to be an explanation as to why it was only careless and not reckless.

pinkshoes said:

LibbyL92 said:

So for the last year I’ve been going through insurance claim. As I fell ill abroad last year (USA) 

I'm assuming the illness is not linked to MH issues and was totally unrelated? 

If this is the case, then I agree with @HillStreetBlues, in that if the claim would have been paid out even if you'd declared it, then you should put in a complaint.

(If the illness was potentially linked to MH issues, then I can see why they won't pay out by you not declaring a prescription/diagnosis)

CIDRA doesn't link the claim and the false disclosure, other than if it is careless, they would have insured it but special terms would have applied then those terms are applied. 

Assuming they'd have covered it and accept it was a careless issue but say would have charged £100 instead of £90 then the claim still has to be accepted and 90% of it paid. 

Firstly however is proving it was careless, I'd be looking at the time horizon you were to asked to declare over, if it was any medication in the last 2 years, this was circa 18 months ago then maybe timelines could have been uncertain etc. To play devils advocate if the medicine had been prescribed the week before buying the insurance then no one is going to accept it wasn't reckless (unless the medication was for memory issues maybe)

The second problem is that if the OP declared no medical condition then the uplift in premiums for having a medical condition could be very significant and so even if the claim is accepted the rules about proportion of premiums paid may mean the payout is relatively small.  

Okell

HillStreetBlues said:

LibbyL92 said:

ripplyuk said:

OP, could you please name this company so that I can avoid them? 

Of course. 

Coverwise. (AXA)

My friend has very bad anxiety/depression and is insured by Coverwise / AXA for a few years now, everything is fully declared.
The questions that are linked to that are once declared are:
Have you been referred to a psychiatrist for any of these conditions within the last 2 years?
Have these conditions caused you to cancel or cut short any travel plans?
How many hospital admissions have you had for these conditions in the last 2 years?
Have you had a compulsory admission to hospital as a result of these conditions?
My friend answered yes to the first one then no . zero & no My friend  also have other issues that has been fully declared. Policy was Annual and under £40

So I would be very surprised if they claim they wouldn't have insured you if you have no other health issues.

But isn't the difference between your friend and the OP that the OP didn't fully declare everything?  They didn't declare either the diagnosis or the medication, whereas your friend accurately answered the questions asked.

I suspect many people buying travel insurance do so in what could be described as a bit of a careless manner, and I wouldn't like to say where carelessness might end and where recklessness might begin.  People basically need to ensure that they answer all the questions accurately based on whatever is (or might be) in their medical records.

Unless you've genuinely forgotten something the only real issue(s) should arise if what your GP or specialist has recorded in your notes differs significantly from what you think is in them, and/or the insurer asks a badly framed question.

For example, I renewed my travel insurance last year for the first time post-covid and it was just for a trip to visit relatives in the Isle of Man.  One of the questions asked was - and this is how the declaration appears on the insurance certificate - "Have you been advised to take medication to lower your cholesterol?"

What does that question mean?  In particular, what does "advised" mean, as NICE guidelines suggest that statins "should" be "offered" to everyone over about 55 (I'm not sure of the age but it's around there).  Statins have been "offered" to me, but is that the same as being "advised" to take them, or is it just a "recommendation", or is it something else entirely?

I'd have been happy to go with "Yes - I've been advised but I've told my GP I don't want them", but the agent I was speaking to on the 'phone wouldn't accept that as an answer and asked me to confirm with my GP whether statins were "medically advisable" or "necessary".  After two days and umpteen 'phone calls I eventually got my GP surgery to agree that statins were not necessary (which of course they didn't really want to agree to as they wanted to cover themselves!) as I was just below the 5mmol threshhold, and my insurer was then satisfied that "No - I had not been advised to take medication to lower my cholesterol" - even though I thought I had been so advised.

Frankly I was amazed that my insurer wanted this looked at in such detail - but I'm pleased they did because it helped make me feel happier that I'd declared everything to their satisfaction and that they had a very full and complete answer to the question.

I think the question is very badly phrased* and I wonder how many people answer it wrongly - whether intentionally, recklessly, carelessly, or wholly inadvertantly.


*It's not really a question about whether you've been "advised" to take a medication, it's about whether you've been told that it's medically necessary to take it - I think...

DullGreyGuy

Okell said:
I suspect many people buying travel insurance do so in what could be described as a bit of a careless manner, and I wouldn't like to say where carelessness might end and where recklessness might begin.  People basically need to ensure that they answer all the questions accurately based on whatever is (or might be) in their medical records.

Unless you've genuinely forgotten something the only real issue(s) should arise if what your GP or specialist has recorded in your notes differs significantly from what you think is in them, and/or the insurer asks a badly framed question.

There certainly can be carelessness/forgetfulness... forgetting that appointment for an ankle pain that the GP said to see if it goes away and come back if its still there in a few weeks and it wasn't so you didn't. Or the insurer asking for info in the last 2 years and you think that was about 30 months ago when it was actually 22 months. 

There are plenty of reckless ones too though... recently had bronchitis as a result of the annual flu/cold season and had a weeks antibiotics but the person thinks/says "thats not the sort of thing the insurer means" so doesn't declare it... similarly a broken leg in summer when playing football etc. Plenty, when challenged, claim to remember injuries/illnesses but somehow just decided that the insurer wasn't interested so didn't declare even though the question was clearly stated as all injuries, illnesses and symptoms. 

HillStreetBlues

DullGreyGuy said:

HillStreetBlues said:

You could put in a complaint stating that you believe rejecting the claim fully isn't correct as you believe they still would have insured you if you had declared it.
If they still reject the claim try https://www.financial-ombudsman.org.uk/consumers/complaints-can-help
It won't cost you anything and they will look at claim as see if they made the correct decision.

If they would cover it or not is irrelevant if they believe it was reckless that the OP didn't declare it... an intentional or reckless non-disclosure results in a void policy under CIDRA.  There really has to be an explanation as to why it was only careless and not reckless.

But what they believe doesn't have to be the final word.
Hence the  suggesting to take it to the Ombudsman, as they will rule if that believe is correct if they have declined it for that reason.

DullGreyGuy

HillStreetBlues said:

DullGreyGuy said:

HillStreetBlues said:

You could put in a complaint stating that you believe rejecting the claim fully isn't correct as you believe they still would have insured you if you had declared it.
If they still reject the claim try https://www.financial-ombudsman.org.uk/consumers/complaints-can-help
It won't cost you anything and they will look at claim as see if they made the correct decision.

If they would cover it or not is irrelevant if they believe it was reckless that the OP didn't declare it... an intentional or reckless non-disclosure results in a void policy under CIDRA.  There really has to be an explanation as to why it was only careless and not reckless.

But what they believe doesn't have to be the final word.
Hence the  suggesting to take it to the Ombudsman, as they will rule if that believe is correct if they have declined it for that reason.

The ombudsman too isn't the final word either if you want to be picky as you can always go to court if the ombudsman sides with the insurer. Success rates however are very low. 

HillStreetBlues

DullGreyGuy said:

HillStreetBlues said:

DullGreyGuy said:

HillStreetBlues said:

You could put in a complaint stating that you believe rejecting the claim fully isn't correct as you believe they still would have insured you if you had declared it.
If they still reject the claim try https://www.financial-ombudsman.org.uk/consumers/complaints-can-help
It won't cost you anything and they will look at claim as see if they made the correct decision.

If they would cover it or not is irrelevant if they believe it was reckless that the OP didn't declare it... an intentional or reckless non-disclosure results in a void policy under CIDRA.  There really has to be an explanation as to why it was only careless and not reckless.

But what they believe doesn't have to be the final word.
Hence the  suggesting to take it to the Ombudsman, as they will rule if that believe is correct if they have declined it for that reason.

The ombudsman too isn't the final word either if you want to be picky as you can always go to court if the ombudsman sides with the insurer. Success rates however are very low. 

Also being picky then the order would matter, if you went to the court first and court sided with the insurer,  you can then raise it with the Ombudsman.

Grumpy_chap

HillStreetBlues said:

DullGreyGuy said:

HillStreetBlues said:

DullGreyGuy said:

HillStreetBlues said:

You could put in a complaint stating that you believe rejecting the claim fully isn't correct as you believe they still would have insured you if you had declared it.
If they still reject the claim try https://www.financial-ombudsman.org.uk/consumers/complaints-can-help
It won't cost you anything and they will look at claim as see if they made the correct decision.

If they would cover it or not is irrelevant if they believe it was reckless that the OP didn't declare it... an intentional or reckless non-disclosure results in a void policy under CIDRA.  There really has to be an explanation as to why it was only careless and not reckless.

But what they believe doesn't have to be the final word.
Hence the  suggesting to take it to the Ombudsman, as they will rule if that believe is correct if they have declined it for that reason.

The ombudsman too isn't the final word either if you want to be picky as you can always go to court if the ombudsman sides with the insurer. Success rates however are very low. 

Also being picky then the order would matter, if you went to the court first and court sided with the insurer,  you can then raise it with the Ombudsman.

I don't think that would work as the court is the higher authority, so any subsequent appeal to the Ombudsman would likely be rejected on that grounds.
I also understand that the court would look unfavourably on a claimant that had not sought to exhaust all versions of ADR first.
So, AIUI, the order would matter.