Medical travel insurance claim refused

jimmy2268

Hi, really appreciate any advise here.

My wife and I were recently due to go to Portugal for a few days when my wife did something to her back and was advised by our GP not to travel. We had taken out travel insurance and declared a number of pre-existing medical conditions. Back pain was not on my wife's record.

Our claim was rejected on the basis that not all pre existing medical conditions were declared, even though they were entirely unrelated to Her back or anything muscular or anything remotely similar. 

Does this seem right, or do we have a case to make a complaint and argue our position further? I could understand if we were claiming for something that was on her medical record that we had not declared as a preexisting condition, but that is not the case here. 

Thanks in advance.

MyRealNameToo

jimmy2268 said:

Hi, really appreciate any advise here.

My wife and I were recently due to go to Portugal for a few days when my wife did something to her back and was advised by our GP not to travel. We had taken out travel insurance and declared a number of pre-existing medical conditions. Back pain was not on my wife's record.

Our claim was rejected on the basis that not all pre existing medical conditions were declared, even though they were entirely unrelated to Her back or anything muscular or anything remotely similar. 

Does this seem right, or do we have a case to make a complaint and argue our position further? I could understand if we were claiming for something that was on her medical record that we had not declared as a preexisting condition, but that is not the case here. 

Thanks in advance.

CIDRA, the law on disclosure for consumer insurance, allows an insurer to void a policy and avoid a claim for intentional or reckless non-disclosure (or false disclosure). If the non-disclosure was considered careless rather than reckless then it comes down to if they would have offered cover had the true/full disclosure been made. If they wouldnt then again it's an avoided claim, if they would then they can discount the claim by the percentage of difference in premiums. 

Under this legislation the non-disclosure, which is basically fraud, doesnt have to have anything to do with the claim though clearly like your case its more likely to be caught if it is. Had you claimed for a lost suitcase instead they too could have voided the policy but would have been unlikely to request for medical records to spot the non-disclosure. 

So... why didnt you disclose them? 

At the end of the day you having nothing to lose by contesting but you have to do so on the grounds that you were an idiot not that you intentionally didnt declare them. Contesting on the grounds that the undeclared conditions weren't related to the injury is irrelevant 

KxMx

For some policies anything and everything has to be declared in terms of pre existing conditions, 
failure to do so will void the whole policy meaning any claims are invalid.

I'd suggest reading the policy wording, if you feel the above isn't the case you can first try the insurers complaint procedure, then the ombudsman. 

MyRealNameToo

KxMx said:

For some policies anything and everything has to be declared in terms of pre existing conditions, 
failure to do so will void the whole policy meaning any claims are invalid.

Never seen any policy where everything has to be declared... couldn't see the ombudsman upholding a case where you claimed as a 45 year old but its declined as you didnt declare going to the doctors as a 5 year old with a rash. 

Most policies will ask about certain major issues (cancer, strokes etc) as an "ever" but then for everything else it's in the last X years. If its last 3 years you do have to declare everything and not pick and choose what you think they will be interested in. 

jimmy2268

MyRealNameToo said:

jimmy2268 said:

Hi, really appreciate any advise here.

My wife and I were recently due to go to Portugal for a few days when my wife did something to her back and was advised by our GP not to travel. We had taken out travel insurance and declared a number of pre-existing medical conditions. Back pain was not on my wife's record.

Our claim was rejected on the basis that not all pre existing medical conditions were declared, even though they were entirely unrelated to Her back or anything muscular or anything remotely similar. 

Does this seem right, or do we have a case to make a complaint and argue our position further? I could understand if we were claiming for something that was on her medical record that we had not declared as a preexisting condition, but that is not the case here. 

Thanks in advance.

CIDRA, the law on disclosure for consumer insurance, allows an insurer to void a policy and avoid a claim for intentional or reckless non-disclosure (or false disclosure). If the non-disclosure was considered careless rather than reckless then it comes down to if they would have offered cover had the true/full disclosure been made. If they wouldnt then again it's an avoided claim, if they would then they can discount the claim by the percentage of difference in premiums. 

Under this legislation the non-disclosure, which is basically fraud, doesnt have to have anything to do with the claim though clearly like your case its more likely to be caught if it is. Had you claimed for a lost suitcase instead they too could have voided the policy but would have been unlikely to request for medical records to spot the non-disclosure. 

So... why didnt you disclose them? 

At the end of the day you having nothing to lose by contesting but you have to do so on the grounds that you were an idiot not that you intentionally didnt declare them. Contesting on the grounds that the undeclared conditions weren't related to the injury is irrelevant 

Thanks for the detail. The reason for non-disclosure is that.... we forgot about things from almost 2 years ago that were minor but on the GP record. And this is the first time we've had a claim rejected having previously claimed successfully a few times.

MyRealNameToo

jimmy2268 said:

MyRealNameToo said:

jimmy2268 said:

Hi, really appreciate any advise here.

My wife and I were recently due to go to Portugal for a few days when my wife did something to her back and was advised by our GP not to travel. We had taken out travel insurance and declared a number of pre-existing medical conditions. Back pain was not on my wife's record.

Our claim was rejected on the basis that not all pre existing medical conditions were declared, even though they were entirely unrelated to Her back or anything muscular or anything remotely similar. 

Does this seem right, or do we have a case to make a complaint and argue our position further? I could understand if we were claiming for something that was on her medical record that we had not declared as a preexisting condition, but that is not the case here. 

Thanks in advance.

CIDRA, the law on disclosure for consumer insurance, allows an insurer to void a policy and avoid a claim for intentional or reckless non-disclosure (or false disclosure). If the non-disclosure was considered careless rather than reckless then it comes down to if they would have offered cover had the true/full disclosure been made. If they wouldnt then again it's an avoided claim, if they would then they can discount the claim by the percentage of difference in premiums. 

Under this legislation the non-disclosure, which is basically fraud, doesnt have to have anything to do with the claim though clearly like your case its more likely to be caught if it is. Had you claimed for a lost suitcase instead they too could have voided the policy but would have been unlikely to request for medical records to spot the non-disclosure. 

So... why didnt you disclose them? 

At the end of the day you having nothing to lose by contesting but you have to do so on the grounds that you were an idiot not that you intentionally didnt declare them. Contesting on the grounds that the undeclared conditions weren't related to the injury is irrelevant 

Thanks for the detail. The reason for non-disclosure is that.... we forgot about things from almost 2 years ago that were minor but on the GP record. And this is the first time we've had a claim rejected having previously claimed successfully a few times.

Then thats your argument, they were minor and you had either totally forgot about them or thought they were over 2 years (if that is what the cut of was on the insurance). 

If its Reckless or Careless becomes moot if they wouldnt insure you had it been declared so really depends on the conditions and the insurers risk appetite. If you forgot to declare toothache they may accept that, if you forgot to declare cancer they probably won't.