Travel Insurance Claim - stuck between insurer and GP

shandyhaggis

Dear all

 

I bought travel insurance last year (Saga) and then booked a holiday the following day.

 

The insurance asked me to declare if I had any treatment for cancer in the last 5 years – to which I answered no as I was diagnosed and treated 9 years ago.

 

Sadly in December I started to feel ill again and started the process of scans and tests which were ongoing till I restarted treatment in May.  I spoke to my hospital consultant in Jan and agreed that I wouldn’t travel for risk of infection, fatigue, pain and I needed to make myself available for ongoing tests.

 

In February 3 weeks before I was due to go on holiday I spoke to the insurance company who just told me I needed to get a medical certificate completed by my GP.

 

To complete the form I called my GP for an appointment and was told I couldn’t have one. I was told as it was an insurance matter I needed to send the form and payment of £40 and the doctor would complete the form.

 

I waited for 8 weeks and to my dismay the GP has filled the form in inaccurately.  The GP has answered:-

-              Where you consulted about the patients intent to travel – No (when the GP was informed as I contacted the surgery and wrote a letter outlining the issue and my hospital consultant also followed up with a letter also)

– is the patient fit to travel – the GP answered NA didn’t know the patient was travelling (incorrect as I stated in writing)

-              Date of diagnosis 2020 – which immediately puts me in the non-insured category as anything under 5 years should have been declared.  This is incorrect as I was originally diagnosed in 2015

 

I complained to the surgery and a couple of weeks later I got a call from the surgery manager to say that they had reviewed all the call logs and letters and they have completed the form accurately and honestly and therefore they are not obliged to do anything else.

 

Ive contacted the insurance company and they wont pay up as the GP hasn’t ticked the box to say I wasn’t fit to travel, even though Ive given the GP the information in writing and my consultant has provided my health condition in writing as well.

 

The medical certificate is loaded towards the insurance company:-

-              Only accepts a GP not a hospital consultant

-              Asks the GP if they have seen the patient (which is likely to be no as its an insurance issue)

-              Asks the GP if the patient is fit to travel to which the GP answers NA even though the options available are Y or N

Now Im stuck between the GP and the insurance company during a time where I’m in the middle of treatment and cant work and really don’t have the energy or patience to deal with this sort of thing.

 

I could complain to the ombudsman re the insurance company but I need the insurance company to finish their claim assessment first and as far as they are concerned the issue is with my GP and the claim is on hold.

 

Re the GP surgery Ive no idea how to progress, I have complained in the strongest terms and have got nowhere.  My only other thought was to raise an issue with NHS or to try and claim the loss through small claims court (extreme I know).

 

I could ask for a data subject access request and pull out the key dates and information from that but I get the feeling that if the insurance company don’t get a form with the box ticked then I’m not going to be able to win my claim.

 

If anyone has any ideas on how to break this ground hog day Id appreciate it.

Many thanks

Andrew

DullGreyGuy

Presumably this is your policy book  View 

The wording states it must be "Your Doctor" that says you aren't fit to travel, they define doctor as:

Doctor

A registered practising member of the medical profession who is not related to you or anyone you are travelling with.

As such the evidence could have come from the consultant, or at least a confirmation that they instructed you not to travel, but you now have the bigger problem of the stated diagnosis. Have you asked for a copy of the medical records? I know on my list of existing conditions everything I've had is now listed with a 2023 date because that was the date they migrated records onto a new system.

I had similar issues when trying to buy long term insurance, never found out what the GP wrote as they wanted £100 to show me a copy but it got me declined. Only with the help of a good broker and an expertly drafted letter from my consultant, who argued premiums should actually be lower than the average person, did get the decline reversed and only a modest loading applied. Would always avoid the GP wherever humanly possible. 

saajan_12

Just an idea, you'd need to check but what would happen if you got another GP to complete another form with the correct details? Would still leave you out the £40 for this one, but would the insurance company take the newer form, or need some way to 'break the tie' if there's a contradiction? 

shandyhaggis

DullGreyGuy said:

Presumably this is your policy book

The wording states it must be "Your Doctor" that says you aren't fit to travel, they define doctor as:

Doctor

A registered practising member of the medical profession who is not related to you or anyone you are travelling with.

As such the evidence could have come from the consultant, or at least a confirmation that they instructed you not to travel, but you now have the bigger problem of the stated diagnosis. Have you asked for a copy of the medical records? I know on my list of existing conditions everything I've had is now listed with a 2023 date because that was the date they migrated records onto a new system.

I had similar issues when trying to buy long term insurance, never found out what the GP wrote as they wanted £100 to show me a copy but it got me declined. Only with the help of a good broker and an expertly drafted letter from my consultant, who argued premiums should actually be lower than the average person, did get the decline reversed and only a modest loading applied. Would always avoid the GP wherever humanly possible. 

Many thanks for the advice.

I got a form completed by my hospital consultant so knowing that the 'must be complete by a GP' statement is a contradiction to the policy is really helpful.   Unfortunately the new hospital consultant didnt see me at the time as Ive been referred to another hospital so has had to answer No to - where you consulted in relation to the patients intent to travel. 

Its crazy Ive no idea how anyone can fill the form in to these standards as GPs wont see you for insurance claims but the form seems to insist that they do.

On the positiive the new consultant did put the correct dates on the form.

I'll try and progress with this version but I predict a rejection again.

Best

shandyhaggis

saajan_12 said:

Just an idea, you'd need to check but what would happen if you got another GP to complete another form with the correct details? Would still leave you out the £40 for this one, but would the insurance company take the newer form, or need some way to 'break the tie' if there's a contradiction? 

thanks Ill try the consultants version and see if that works.

I really dont see how insurance companies can demand something very specific as evidence knowing that its almost impossible when there are other methods of providing evidence which should be acceptable.  Its just not reasonable.

I will talk to the ombudsman tomorrow and ask for their help as well.

Best

DullGreyGuy

shandyhaggis said:
Its crazy Ive no idea how anyone can fill the form in to these standards as GPs wont see you for insurance claims but the form seems to insist that they do.

On the positiive the new consultant did put the correct dates on the form.

I'll try and progress with this version but I predict a rejection again.

They wouldn't be seeing you for an insurance claim, they'd be seeing you if you were ill and were asking them if you are ok to travel or not... many people who claim do so for relatively modest conditions under the care of their GP rather than cancer or a heart attack etc. The problem is that the system is clearly very open to abuse if you can simply reclaim £20,000 from the insurer by saying you had a dodgy tummy but didnt see anyone and just self treated.

If you do see and ask the consultant instead of the GP it's always worth asking them to include their recommendation not to travel in the letter to the GP.  

When it comes to then making the claim and asking the GP to complete the form then that is non-NHS work and so they charge. 

shandyhaggis said:
I will talk to the ombudsman tomorrow and ask for their help as well.

No harm in having a conversation with them but remember the person you are speaking to is a front like call operator with modest amount of training having to cover the whole spectrum of financial service issues so their knowledge isn't always great. 

Similarly if I were you I'd decline their offer to send a letter to your insurer for you... I doubt it's changed since my days and is a stock letter where the agent can type in up to three lines of text about what the complaint is about. Given how long customers complaints often are they dont always pick the most salient points etc when trying to condense it down in the 30 seconds wrap up time they get to actually do the letter after speaking to them. In fairness to them... you try condensing your first post to 3 lines! 

SevenOfNine

Perhaps PALS can help with the GP. I've turned to them twice for assistance to get something done, more to avoid the need to complain formally. They were very helpful. 

https://www.nhs.uk/nhs-services/hospitals/what-is-pals-patient-advice-and-liaison-service/

shandyhaggis

SevenOfNine said:

Perhaps PALS can help with the GP. I've turned to them twice for assistance to get something done, more to avoid the need to complain formally. They were very helpful. 

Great idea - I had forgotten about PALS - Ive thought of using them several times due to incompetent Drs and Consultants and poor NHS service but wanted to keep a good working relationship.  If I dont get anywhere Ill try PALS....

katejo

shandyhaggis said:

saajan_12 said:

Just an idea, you'd need to check but what would happen if you got another GP to complete another form with the correct details? Would still leave you out the £40 for this one, but would the insurance company take the newer form, or need some way to 'break the tie' if there's a contradiction? 

thanks Ill try the consultants version and see if that works.

I really dont see how insurance companies can demand something very specific as evidence knowing that its almost impossible when there are other methods of providing evidence which should be acceptable.  Its just not reasonable.

I will talk to the ombudsman tomorrow and ask for their help as well.

Best

I recently read someone's account of how they cancelled a trip at the last moment due to testing  positive for Covid. Their insurer would only pay out if the person arranged a face to face appointment with a GP to confirm diagnosis! My Practice has refused to see anyone with Covid symptoms ever since it all started. Even now we have to declare on an online  consultation form whether we have been in contact with Covid recently! Isn't this a way of insurers ducking their responsibilities?

DullGreyGuy

katejo said:

shandyhaggis said:

saajan_12 said:

Just an idea, you'd need to check but what would happen if you got another GP to complete another form with the correct details? Would still leave you out the £40 for this one, but would the insurance company take the newer form, or need some way to 'break the tie' if there's a contradiction? 

thanks Ill try the consultants version and see if that works.

I really dont see how insurance companies can demand something very specific as evidence knowing that its almost impossible when there are other methods of providing evidence which should be acceptable.  Its just not reasonable.

I will talk to the ombudsman tomorrow and ask for their help as well.

Best

I recently read someone's account of how they cancelled a trip at the last moment due to testing  positive for Covid. Their insurer would only pay out if the person arranged a face to face appointment with a GP to confirm diagnosis! My Practice has refused to see anyone with Covid symptoms ever since it all started. Even now we have to declare on an online  consultation form whether we have been in contact with Covid recently! Isn't this a way of insurers ducking their responsibilities?

If it states that is the requirement in the policy book then no, thats not a way of "ducking their responsibilities" but a way of limiting their liability to enable them to price the policy cheaper as thats what 99% of people buy on the basis of. 

If you can self certify illness you introduce a massive moral risk that if you decide you dont want to travel because now the weather forecast is bad or you've read bad reviews of the hotel your staying at or you've broken up with your g/b/friend that you were going to be travelling with etc all you have to do is say you had a bad stomach and couldn't travel to get a near full refund rather than admitting the real reason which wouldn't be covered. Rather than everyone paying an extra £200 per traveller instead they state that all medical reasons for not travelling must be confirmed by a medical professional 

shandyhaggis

Hi all

Im back looking for help again:-( 

On the positive I managed to get the insurance company to pay out in full.  I pointed at the issue of the medical certificate they provided requiring a GP to complete and that the claims team wouldn't accept anything else verses policy which says  "Your Doctor" that says you aren't fit to travel, they define doctor as 'A registered practising member of the medical profession who is not related to you or anyone you are travelling with.'

It took 7 months and a lot of help from my consultant to write supporting letters etc.

I decided to do the right thing and told Saga of the policy claims process misalignment, they told me to talk to Collinson and raise a complaint with them.  I told them I didn't want to complain but didn't want others to suffer in the same way that I have.  They pointed me to Collinson, so I raised a complaint with them.  Now the Collinson complaints handler is very aggressively not dealing with the complaint but rather focussing on the detail of my claim, he has asked me for even more medial information which in my view should have been asked for at the time and is just not relevant.  I think he's looking for loop holes in my medical record to say that I didn't declare something, I get the feeling he wants to try and get the money back.  Ive made the point that Im just trying to help them fix an error and that Im not looking for recompense in any way but he keeps alluding towards me not declaring medical information and suggests that Ive broken the law.

The fact is I declared everything I was asked to declare at point of sale.   

I spoke to the FOS yesterday and they just told me to answer his questions and give him a chance to answer the complaint but his line of enquiry makes me feel very uneasy and I honestly don't want to be lead down this path as Im sure he will find something to hold against me.  He knows the policy and process better than I do!

Im quite lost for words.  Any advice would be appreciated

Best

Andrew