Travel Insurance medical claim denied by AXA

DullGreyGuy

Annemos said:

It all goes to show.

Policyholders often have a gut feeling for what they feel should be the correct/sensible way to handle a claim. 

But sometimes this is not borne out by the actual Insurance legislation. And Policyholders often have no idea of what is involved behind the scenes. 

It should be taught at school! 

I noticed on the BBC today, the famous storm issue of when is a storm not a storm... when gusts are less than 55mph. 

https://www.bbc.co.uk/news/articles/clyj6y10y15o

It's nothing to do with claims, it's a purchase issue, it just happens the issue has been found at claims stage. 

Maybe they have a gut feeling because they know they weren't honest when purchasing?

I think we are going to disagree on this one. Having renewed my own travel insurance recently I was asked a very simple question, have I seen a medical professional in the last 2 years? I answered yes, the OP appears to have said no despite the fact they had. In this day and age I can see every NHS appointment I've had in the last few years in the app so dont need to rely on my memory.

I'm not going to speculate why the OP answered "no" but we have seen a ton of previous claimants who had problems on here. Whilst a few said they'd "forgotten" about the time they broke their arm or thought their trip in the ambulance was 2.5 years ago many more have stated they didnt think the insurer wanted to about warts, STIs, flu etc. The question isn't "have you seen a doctor about a major condition?" or "have you seen a doctor about a condition that you think we want to know about?" but its "have you seen a doctor?"

The average Travel single trip policy is under £50. In an ideal world an insurer would get a medical report from your GP and quote based on the actual medical history rather than your declaration but GPs charge £100-£150 on average for such a report and if you sell 1 in 10 quotes you do its going well so either average premiums go above £1,000 or people have to answer the question asked rather than try to decide what the insurer may or may not want. 


Storm is a bit of a distraction. I dont know your relationship status but the other night I went to the pub with the Mrs. I was in a shirt and a thin jumper, she was in a vest, long sleeved wool top, thick jumper, padded coat, scarf, hat and gloves. The dictionary definition of storm, cold etc are highly subjective as illustrated by the fact I was dressed for a mild autumnal evening and she was dressed for artic exploration yet we were in the same conditions. Insurers, nor the ombudsman, likes uncertainty. As a consequence rather than leaving it to Oxford or Webster to define what a storm is many policies have their own definition to avoid subjectivity. It's of little surprise that budget policies have stricter/harder definitions and top quality policies are written on an all risks basis and so dont need to define a storm as they cover everything unless explicitly stated otherwise. 

Annemos

I absolutely agree with you on the Travel Insurance Questions.

But Policyholders don't seem to understand the importance of what they are being asked. Or think they are being asked something different. Or don't spot a problem in the wording. Or assume something that is not there. 

That's why I say, every person should be trained on this in their last year at school!  Maybe the Martin Lewis TV program should cover some Helpful Hints on what everybody should be looking out for in their Insurance. (As well as  just the money-saving aspect.)


Until I had that big claim, I was also clueless. For years I travelled to the Himalayas to visit Buddhist monasteries, way above 2,500 meters. I had absolutely seen that "Trekking, Hiking and Rambling" above 2,500 meters was not allowed..... but I thought I was fine because I was just visiting monasteries with a taxi! 

It was not until I started to look at Trustpilot, that I saw a chap's claim denied for sitting in a car in Bolivia, I think it was. And above 2,500 meters. 

I contacted the Insurer and they said we are not allowed to do anything at all over 2,500 meters. (Small print says.... if you are doing anything else please contact us... but I did not see that bit.) 

It was lucky I did not have an incident during all those years! 


Re the storm definition.... it's just that so many policies do have it in there. Mine certainly does. But until someone points it out, many people don't seem to know it's in there. 

user1977

Annemos said:

Re the storm definition.... it's just that so many policies do have it in there. Mine certainly does. But until someone points it out, many people don't seem to know it's in there. 

But surely even the most ignorant policyholders would understand that there has to be some sort of dividing line between "storm" and "it's a bit windy today"?

DullGreyGuy

Annemos said:

I absolutely agree with you on the Travel Insurance Questions.

But Policyholders don't seem to understand the importance of what they are being asked. Or think they are being asked something different. Or don't spot a problem in the wording. Or assume something that is not there. 

That's why I say, every person should be trained on this in their last year at school!  Maybe the Martin Lewis TV program should cover some Helpful Hints on what everybody should be looking out for in their Insurance. (As well as  just the money-saving aspect.)


Until I had that big claim, I was also clueless. For years I travelled to the Himalayas to visit Buddhist monasteries, way above 2,500 meters. I had absolutely seen that "Trekking, Hiking and Rambling" above 2,500 meters was not allowed..... but I thought I was fine because I was just visiting monasteries with a taxi! 

It was not until I started to look at Trustpilot, that I saw a chap's claim denied for sitting in a car in Bolivia, I think it was. And above 2,500 meters. 

I contacted the Insurer and they said we are not allowed to do anything at all over 2,500 meters. (Small print says.... if you are doing anything else please contact us... but I did not see that bit.) 

It was lucky I did not have an incident during all those years! 


Re the storm definition.... it's just that so many policies do have it in there. Mine certainly does. But until someone points it out, many people don't seem to know it's in there. 

Insurance is seen as a distressed commodity purchase. No body buys insurance because they want to or fancy it. No one brags down the pub that they've treated themselves to Hiscox policy this year rather than their normal Axa policy. If people do brag, it's that they've managed to save £X by buying from some unheard of overseas budget insurer. 

Its the same for marketing of consumer insurance, its all about price and discounts because people arent willing to pay 5% more to have a dedicated claims handler or a 24/7 claims line. Infamously Sir Fred of RBS fame once complained that DL (an RBS subsidiary at the time) always focused on price rather than better service and he personally came up with the "twins" advert which was DLs worst performing ad by a miles ever. 

People dont read what they're buying, they simply want cheap and arent interested in anything else until something happens and they lose out. Motor and Home in particular your reliant on these companies to potentially pay out hundreds of thousands if not millions and yet most have no idea who their insurer is and at point of purchase will go with the unknown offshore company to save £2 a year. 

I dont think its an "importance" issue, its a combination of laziness (they want the process over as soon as possible rather than going off to find the V5c to confirm when they got the car) and second guessing. The number of people that have posted on here that they filtered their pre-existing conditions to those they thought the insurer wanted to know rather than answer the Q which was any conditions in last 2 years. 

Annemos

user1977 said:

Annemos said:

Re the storm definition.... it's just that so many policies do have it in there. Mine certainly does. But until someone points it out, many people don't seem to know it's in there. 

But surely even the most ignorant policyholders would understand that there has to be some sort of dividing line between "storm" and "it's a bit windy today"?

(Oh at last... I found out how to quote!)

I fear it is often not until one has actually had a Claim that was denied or reduced and perhaps read some Ombudsman's cases, that the brain starts to kick into gear to develop an Insurance mind. (Or hears of someone who has had a Claim.)

I have a Maths degree and I did Income Tax research in my job for many years. But the nuances of how I should be approaching my Insurance Policy had passed me by until I claimed. My claim was so involved that I realised I needed to heavily research (Subsidence). That's when my Insurance brain started developing. 

Now I have gone over the top. My Policies and my Life worry me a lot. So I do try to help people out on here, if I can. 

One bitten, Twice shy! 

TELLIT01

I don't know if there is any legislation to prevent it, but I do remember reading about an intention by Parliament to prevent insurers refusing to pay out when an undisclosed medical condition was not related to the condition being claimed for.  There is clearly no link between strained knee ligaments and tachycardia.  If the OP gets nowhere with AXA I would certainly be looking to the Ombudsman.

DullGreyGuy

TELLIT01 said:

I don't know if there is any legislation to prevent it, but I do remember reading about an intention by Parliament to prevent insurers refusing to pay out when an undisclosed medical condition was not related to the condition being claimed for.  There is clearly no link between strained knee ligaments and tachycardia.  If the OP gets nowhere with AXA I would certainly be looking to the Ombudsman.

They went the other way, they made it law that it can be declined when it's not relevant assuming the non-declaration is deemed to be reckless (rather than careless)

Consumer Insurance (Disclosure and Representations) Act 2012

What they did do however is say a consumer only has to answers the questions asked and doesn't have to offer up anything that isnt asked for. Similarly you cannot have vague questions like "please tell us any other relevant information" which otherwise would have bypassed the first point. 

SiliconChip

DullGreyGuy said:

Annemos said:

It all goes to show.

Policyholders often have a gut feeling for what they feel should be the correct/sensible way to handle a claim. 

But sometimes this is not borne out by the actual Insurance legislation. And Policyholders often have no idea of what is involved behind the scenes. 

It should be taught at school! 

I noticed on the BBC today, the famous storm issue of when is a storm not a storm... when gusts are less than 55mph. 

https://www.bbc.co.uk/news/articles/clyj6y10y15o

In this day and age I can see every NHS appointment I've had in the last few years in the app so dont need to rely on my memory.

Maybe your medical professionals are more assiduous at updating records that feed into the app but it is definitely not the case that I can see all of my appointments. Recently I have been able to see appointments at my own GP surgery, and the app seems to be increasing the history that is retained, but it doesn't show all appointments that took place at other medical centres or at hospitals (generally but not always referrals from my own practice). It's why I have been keeping my own records for at least the past 7 years, so that I can refer to them should I need to.

sheramber

I had AXA travel insurance many years ago .

One of the medical statements was to give details of any visit to your doctor in the last 2 years.

goldiethedog

Thanks so much for all the answers so far!  The policy was taken out with Coverwise and the insurers were AXA. I just checked and it appears this would have been the way it was sold: