Travel insurance double standards - what to do next?

bimbowoman2

My elderly mother was rushed to hospital on 5th July with bleeding stomach ulcers and was treated and released 4 days later.  She was meant to be travelling to Majorca at the end of August and had taken out insurance with avanti.  She was going with a friend who also used same company but separate policy. The hospital advised she could not fly and had to remain in uk for 6 months.  The doctor at the hospital did not send this letter until 15th July- the day avanti gave as a cut off for losing 30%.  So the letter and claim was sent to avanti via email on 18th july.

so they have written and advised my mum - who is 80 years old has lost 30% of cost but the other lady has been paid out in full? There were 2 separate call handlers.

can anyone recommend what I do next? She was and still is genuinely ill, blood transfusions and low iron count still and is very distressed by this situation.  We have asked avanti to review this but have been advised it will take 8 weeks? Why has her friend got paid in full when she was not ill at all?

many thanks in advance

eskbanker

What do the policy terms say about this situation, both for the person deemed unfit to fly and for the companion?

DullGreyGuy

bimbowoman2 said:

My elderly mother was rushed to hospital on 5th July with bleeding stomach ulcers and was treated and released 4 days later.  She was meant to be travelling to Majorca at the end of August and had taken out insurance with avanti.  She was going with a friend who also used same company but separate policy. The hospital advised she could not fly and had to remain in uk for 6 months.  The doctor at the hospital did not send this letter until 15th July- the day avanti gave as a cut off for losing 30%.  So the letter and claim was sent to avanti via email on 18th july.

so they have written and advised my mum - who is 80 years old has lost 30% of cost but the other lady has been paid out in full? There were 2 separate call handlers.

can anyone recommend what I do next? She was and still is genuinely ill, blood transfusions and low iron count still and is very distressed by this situation.  We have asked avanti to review this but have been advised it will take 8 weeks? Why has her friend got paid in full when she was not ill at all?

many thanks in advance

The policy terms will state the minimum they have to do, there is no law or regulation that says an insurer cannot payout more than what the terms require them to do. Case handlers may be given discretion and so two cases may not have the same outcome and especially if there are two different case handlers. Even if it's the same case handler just their general mood may result in a difference of outcome. 

In this particular case they may decide that the friend, who has no rights to speak to the doctors etc, should have more discretion applied because they cannot chase them up etc whereas your mum/her family could be chasing the Dr for being slow etc.

Ultimately you need to register a complaint with them and await their response. The ombudsman gives them up to 8 weeks to respond but most respond much quicker. What you may find is that they state they correctly applied the terms on yours and they cannot discuss someone else's claim or state that they made a mistake on the other claim but won't be recalling the extra payment.