Are travel insurance claim firms deliberately obstructive?

jayemmemm

After decades of paying for travel insurance, I have had to make a claim for a short UK trip that got abandoned when my wife was hospitalised unexpectedly on our day of departure. Our insurer (Virgin Money), like, it appears, many (most?) others uses a third party claims company CSA. The experience has not been a good one. It seems to me that the business processes, online claim submission web sites and forms for claims are deliberately designed to trip up genuine claimants and put barriers in their way. We have already had a completely spurious attempt by the claims company to reject our claim on the grounds that the policy only applies for UK visits away of at least 2 days, when it was perfectly apparent from the (extensive) evidence provided and the claim form submitted that our booked trip was for 8 days. The company sets very strict rules about how to respond to the rejection email, such that if you simply do a reply, it gets discarded automatically. Deliberate, surely.

On checking Trustpilot, I find that this claims comapny has possibly the lowest score I have ever seen, and the reviews show a litany of obstructive behaviour, which appears to be quite deliberate.Some of the stories are harrowing, and exhibit a throroughly mendacious mind set. I particulalry note examples of someone being pursued by debt collectors for $100k of US medical fees because the claims company is in dispute with its US affiliate, and another case where the claimant had the claim rejected because the doctor's certificate had not been stamped by the surgery, despite the form not requiring this, or having a space for such stamp.

If I am right, then it begs the question of who is actually regulating and controlling this apparently systemic bad practice. Insurance is supposed to be in "utmost good faith", but the insureres and their third parties seem to have developed a view that this obligation only extends to the insured.

TELLIT01

At times I do wonder it claims management companies get a percentage from the insurance company for every claim they refuse to pay out on.

Annemos

When I read the Poster, I also start to wonder if AI is kicking in. No Human Intervention at all?

DullGreyGuy

I personally would always take the reviews on Trustpilot for companies likes CSAL with a pinch of salt... generally people are more likely to post negative than positive comments, no one is going to be happy that they've had to make a claim or want to brag that they dealt with CSAL so inevitably its going to be worse than other companies. 

There are a number of negative points listed that are ultimately user issue not a CSAL one... one customer complained that they deducted an excess per traveller but thats how travel insurance works, limits and excesses are per traveller not per trip/incident. Several say CSAL was the underwriter for their policy but CSAL are a TPA not an insurer and (as of 2022) part of the Galleghar group (worlds 4th largest insurance broker)

Most the complaints are about being slow to respond... unfortunately this sort of thing becomes a self fulfilling prophecy as there are people like the poster on here yesterday who say they called 6 times in 24 hours or another prior poster who said they'd sent over 100 emails in a month. Yes it would be great if someone was sitting waiting for your to call or for your email to enter their inbox but thats not the service you get when 99.9% of people buy on price. By sending dozens of chasers etc you're just making the queue longer. 

Asking for the same thing again is poor practice, it can be symptoms of poorly designed systems and/or staff under too much pressure. Many claims systems I've seen have been left very flexible so it can easily deal with lots of different types of claim (important if you are a third party supplier to a range of clients) but it means its not simple to quickly check if you've received something or not... in my claims days it was even worse as we had paper files so you had to go find the physical file or read through 100+ comments which couldn't be searched or filtered. As a technical claims handler I wasnt targeted on call handling time etc but on my file closure rate whereas those in the front line teams couldn't afford the impact on their Average Handling Time to go find the file which could be either 1) on the shelf, 2) in the file handlers to do box 3) in the mail room either waiting for post to be put in and go in my to do box or there waiting to be returned to the shelf. 


The FCA regulates TPAs and the FOS will look at escalated complaints. You should however read your policy book on who to complain to about Claims matters, sometimes its the TPA, sometimes its the insurer. Do whichever it says and you can escalate to the FOS either 1) when they give you their final response or 2) if 8 weeks have passed since the complaint was made, whichever is sooner.