AXA - Pre Existing Condition query (URGENT)

Troublesum1

Sorry to put urgent in tag line but I’m currently on holiday and my wife is getting due to get emergency surgery (2nd of 2 procedures) we’ve been in the hospital for 4 days already (so there’s a day rate for the applied).

So the query here is around pre existing condition. Now as I understand it insurance companies can reject a claim if they believe they have evidence of an Undeclared pre existing condition even if you did not have it diagnosed. Before our trip My wife had some severe back pain which radiated to her ribs and she called 999. They then made a report which is on her medical records and that report says the diagnosis was:

”upper chest and back pain ?? Pulmonary embolism/cardiac pain ?? Gall stone ?? Gastritis ?? MSK pain”

 for the record that “diagnosis” was never told to her we only saw it upon digging through the records.

That day my wife did not go to the hospital as we have a newborn baby and the pain subsided so she instead went to our GP the next day. Our GP diagnosed the issue as “Mechanical pain” and there are a lot of notes surrounding pregnancy and the fact my wife had a C section.

Now tragically on holiday, my wife suffered severe abdominal pain and took herself to the local hospital here (LA, USA). After tests and imaging they have diagnosed the issue as a gall stone issue and initiated treatment which we were fine with since we have travel insurance through AXA. However a family member brought up the fact that AXA may say that there is evidence that this was an undeclared pre existing condition and reject the claim. So I was wondering if anyone here could help (hopefully) put my mind at ease? In my humble opinion our GP diagnosed the issue as mechanical pain and that is the only diagnosis that had ever been communicated to us by the time of buying the insurance. Back pain is such a general symptom surely it can’t be used as evidence for a specific condition.

Please let me know your thoughts

elsien

When I was struggling with a diagnosis through primary healthcare the insurer wanted to know what specific wording was on my GP records. 

This is only a guess, but given that your wife went to the GP following the  999 call and he did not refer her for any further investigations, it seems to me that would be valid reason for a complaint if your insurer try to avoid paying out. They usually ask if you are waiting for the results of any investigations, and your wife wasn’t. 

DullGreyGuy

So did you declare the 999/GP incident or not?

elsien

As above - I was presuming you had declared the GP visit but you may not have done. You need to go back and check the specific questions that were asked when you took out the policy as they do vary between insurers. 

Troublesum1

So in the claim you have to give AXA access to your medical records. I can only assume they will see the 999 call as its in the records.

elsien

You don't have to but they are going to wonder why if you don't. And it does depend if the 999 call made it onto your GP records which will be the insurer first point of call. When I was having this discussion, although I was seeing a physio who had given some possible diagnoses (which later turned out to be incorrect), the insurer was more interested in what my GP records showed following the results of a scan and the physio stuff although done via the GP didn't seem to be on there. They wanted clarification of the exact wording of what the GP had recorded as the cause of my illness.  
 However you did follow up with the GP and the GP gave a diagnosis and did not consider further referral necessary and my layperson's view would consider that would take precedence.

DullGreyGuy

Troublesum1 said:

So in the claim you have to give AXA access to your medical records. I can only assume they will see the 999 call as it's in the records.

Having thankfully not needed to call 999 in my lifetime and certainly not since digital health records I am running on an assumption that it does make it into your core medical records and this should be tied into the subsequent GP appointment during which a diagnosis was given. 

You've avoided the question of if this was declared or not to the insurer... it's also unclear when this incident was relative to both booking the holiday and buying the insurance. 

Troublesum1

DullGreyGuy said:

Troublesum1 said:

So in the claim you have to give AXA access to your medical records. I can only assume they will see the 999 call as it's in the records.

Having thankfully not needed to call 999 in my lifetime and certainly not since digital health records I am running on an assumption that it does make it into your core medical records and this should be tied into the subsequent GP appointment during which a diagnosis was given. 

You've avoided the question of if this was declared or not to the insurer... it's also unclear when this incident was relative to both booking the holiday and buying the insurance. 

Hi sorry I didn’t see your first comment, stuck at the hospital using my mobile to browse.

Not sure what you mean by did I declare the incident or not? As far as I understand you’re only meant to declare known conditions not GP visits or 999 calls. Upon logging into my wife’s NHS records the 999 call is visible. upon opening a claim the insurance ask for the contact details of your GP to request a report. So I assume there is a possibility the 999 call may end up in that report. Personally I don’t see why it should matter anyway given there was no clear/definite diagnosis from the call.

I didn’t declare any pre existing conditions.
The 999 call was made roughly 2 weeks before the beginning of the trip. This was after the flights were booked for the trip.
I actually bought travel insurance earlier during the trip, roughly 1 week into it.
The incident that took us to hospital happened 2.5 weeks into the trip.

My wife has now had the surgery, everything went well. We should be discharged today, as of yet nothing has been flagged as wrong with the insurance but I think they are waiting for my GP’s report. thanks for all your help and consideration. 

DullGreyGuy

Troublesum1 said:
As far as I understand you’re only meant to declare known conditions not GP visits or 999 calls. Upon logging into my wife’s NHS records the 999 call is visible. upon opening a claim the insurance ask for the contact details of your GP to request a report. So I assume there is a possibility the 999 call may end up in that report. Personally I don’t see why it should matter anyway given there was no clear/definite diagnosis from the call.

I didn’t declare any pre existing conditions.
The 999 call was made roughly 2 weeks before the beginning of the trip. This was after the flights were booked for the trip.
I actually bought travel insurance earlier during the trip, roughly 1 week into it.
The incident that took us to hospital happened 2.5 weeks into the trip. 

Unfortunately you understand incorrectly, to take a random insure as an example they state you must declare:

Any disease, illness, symptom or injury for which you or anyone else insured on this policy has:

• Taken any prescribed medication or required medical treatment within the last two years; or
• Consulted a medical practitioner and/or been registered as an in or out patient at a hospital, clinic or GP surgery in the last two years.

You consulted a medical practitioner both in terms of the paramedic and the GP and so it had to be declared. 

Your second major issue is that 99% of travel insurance has to be purchased before you leave the UK... there are specialist policies for those already travelling and never heard of Axa writing those but could be wrong. 

Placitasgirl

I afraid I think DullGreyGuy has a point here... the first page of the AXA travel insurance online quotation process states "There will be no cover for any claims if you have already started your trip", yet you say you purchased the policy part way through your trip. 

https://www.allcleartravel.co.uk/cgi-bin/lansaweb?PROCFUN+allclear7+alv7001+ALC+ENG

Did you enter your travel dates correctly when purchasing the policy or did you enter incorrect travel dates that might have led the insurer to believe you hadn't already started your trip/travel? 

I believe that you may encounter issues if you were outside of the UK when you purchased the policy and didn't declare this, as providing incorrect information will likely invalidate the policy and lead to an automatic decline of any claim. 

Troublesum1

Thanks @DullGreyGuy and @Placitasgirl. Sounds like there are 2 major issues here then. AXA have not yet flagged the trip dates and I’ve sent them the flight booking confirmation. I genuinely had no idea about this rule I just thought if I started the insurance for a date in the future it would work. What a mess..

At this point I’m hoping both issues are overlooked..

Back to the first issue, seems a bit much, I can imagine very little percent of the population declares every GP visit in the last 2 years before their trips. That said I suspect a similarly small percentage ends up actually claiming..