policy T&Cs for pre-existing conditions

stars99

My Planet Earth travel policy contains the clause "we are unable to provide cover for any undiagnosed medical condition". This seems to me to get them off the hook for most non-accident medical claims. Is this a normal clause? Or have I just picked a particularly tight insurer? Is it even legal - it has the whiff of an unfair contract. And yes, I am getting stung by this clause in my current claim.

eskbanker

I'd assume that the wording is intended to cover conditions likely to be present (when buying the policy or when travelling) but without formal diagnosis, e.g. where awaiting test results.  What's your scenario?

katejo

stars99 said:

My Planet Earth travel policy contains the clause "we are unable to provide cover for any undiagnosed medical condition". This seems to me to get them off the hook for most non-accident medical claims. Is this a normal clause? Or have I just picked a particularly tight insurer? Is it even legal - it has the whiff of an unfair contract. And yes, I am getting stung by this clause in my current claim.

It's not unusual for them to refuse to cover any already declared pre existing conditions if you have new symptoms which haven't been diagnosed or are awaiting test results.

TELLIT01

'Undiagnosed medical conditions' are those where a doctor has been consulted about an issue but tests are required, and have not been completed.

heatherw_01

It means where you have symptoms and haven't had a full diagnosis.

Say you have fatigue and have blood tests and a appointment coming up. That wouldn't be covered.

NoodleDoodleMan

TELLIT01 said:

'Undiagnosed medical conditions' are those where a doctor has been consulted about an issue but tests are required, and have not been completed.

That's it basically.

TELLIT01

heatherw_01 said:

It means where you have symptoms and haven't had a full diagnosis.

Say you have fatigue and have blood tests and a appointment coming up. That wouldn't be covered.

If you just have symptoms but have requested medical advice, I'm not sure that would be picked up by the insurer in the event of a claim as there would be nothing on medical records.

DullGreyGuy

stars99 said:

My Planet Earth travel policy contains the clause "we are unable to provide cover for any undiagnosed medical condition". This seems to me to get them off the hook for most non-accident medical claims. Is this a normal clause? Or have I just picked a particularly tight insurer? Is it even legal - it has the whiff of an unfair contract. And yes, I am getting stung by this clause in my current claim.

You need to take it in the context of where its written, having found their policy book its in connection with the health declaration you make when buying the policy. So, if you are thinking of buying a policy from them today they won't cover that weird pain you've been having but haven't seen the doctor about yet. If you have a different weird pain whilst on holiday that is covered. 

TELLIT01 said:

'Undiagnosed medical conditions' are those where a doctor has been consulted about an issue but tests are required, and have not been completed.

No, you dont have to have consulted a doctor about it. It also includes anything thats just symptoms and also things you have spoken to other medical professionals about (dont think our GP has any doctors left, all appointments are with a practice nurse or physicians associate)

Realistically its hard for the insurer to find out if you have had symptoms but not told anyone other than for the fact most claimants let it slip anyway

sheramber

Had you consulted anyone about the undiagnosed condition e.g. regarding symptoms, in the last 12 months?