Knee ligament injury - what do I need to tell the travel insurer?

Mason

Hello.  My son has recently ruptured his cruciate ligament.  He is due to go on a world trip early next month and the physio who saw him said this should be ok from his perspective and wait for the operation when he returns home in about 7 months if the surgeon thinks he needs one. He has an appointment with the specialist 2 days before he flies out.

When applying for insurance the question is asked if he has a pre-existing injury and he puts in "knee ligament".  It then asks if he has pain, needs crutches, wears a brace.  He could put "no" to all these questions though it does hurt when it "gives way" which is about a once a week event and the pain soon dissipates.  He is also asked if "future treatment" is planned.  This is also tricky because he could live with the tear (plenty do, including me) or have an operation.

Anyway, if he does state that he is expecting "future treatment" then the comparison sites state that they cannot find an insurer.

I'm not really sure what my question is aside from if anyone has any advice on this or had similar things to think about.

Thanks for reading.

MyRealNameToo

Mason said:

Hello.  My son has recently ruptured his cruciate ligament.  He is due to go on a world trip early next month and the physio who saw him said this should be ok from his perspective and wait for the operation when he returns home in about 7 months if the surgeon thinks he needs one. He has an appointment with the specialist 2 days before he flies out.

When applying for insurance the question is asked if he has a pre-existing injury and he puts in "knee ligament".  It then asks if he has pain, needs crutches, wears a brace.  He could put "no" to all these questions though it does hurt when it "gives way" which is about a once a week event and the pain soon dissipates.  He is also asked if "future treatment" is planned.  This is also tricky because he could live with the tear (plenty do, including me) or have an operation.

Anyway, if he does state that he is expecting "future treatment" then the comparison sites state that they cannot find an insurer.

I'm not really sure what my question is aside from if anyone has any advice on this or had similar things to think about.

Thanks for reading.

Read the terms of the policy, it will tell you if you need to inform them of new conditions before travelling. If it's an annual trip policy you almost certainly do. There are some single trip ones that you dont. 

Thanks to CIDRA any failure to disclose can give rise to the insurer being able to void the policy and avoid the claim even if its unrelated to the claim... that said if he claims for his luggage being stolen its unlikely they'll ask for his medical records to check he disclosed appropriately. 

gwynlas

Whilst you do neeed to inform  them of any pre existing condition you can state that no further treatment applicable at this time if it is not scheduled to happen.

Andyjflet

Its a serious injury, you need to tell them of this or its fraudulent, if you are hoping that perhaps he can get flown home should it get worse then perhaps he shouldn't be going. 

TELLIT01

As gwynlas says, he must inform the insurer but stress that no further treatment is planned at present.

elsien

gwynlas said:

Whilst you do neeed to inform  them of any pre existing condition you can state that no further treatment applicable at this time if it is not scheduled to happen.

I would query that given that the OP mentions an operation if he still needs one. If may not be scheduled but it’s still very much on the cards as a possibility. If he has a fall  while he is away and needs surgery I strongly suspect that would be considered a very relevant factor. 

Mason

Thank you for all your replies. It is an interesting situation, I think.  I have an ACL rupture (my fourth) but decided not to get it repaired this time because I no longer play sport that requires pivoting.  My surgeon suggested it was probably better for me to build the leg muscles to compensate rather than repair given the difficulties with finding ligament from elsewhere in my body.  So, I have this injury but will never have the operation. It seems my situation is clear as no further treatment is planned even though I may be walking down a mountain and my knee "goes" (which it does do sometimes) and I damage myself further requiring treatment. How would that be viewed by an insurer?

My son is in a slightly different situation in that no treatment is scheduled but he may have the surgery at a later date on his return.  But because he may have that treatment he appears unable to get insurance, at least via the comparison sites.

I'll call an insurer and ask their thoughts but the trouble with that is I may select a very expensive insurer and not be able to fully test the market.

But, again, thanks to those that replied.

MyRealNameToo

Mason said:

Thank you for all your replies. It is an interesting situation, I think.  I have an ACL rupture (my fourth) but decided not to get it repaired this time because I no longer play sport that requires pivoting.  My surgeon suggested it was probably better for me to build the leg muscles to compensate rather than repair given the difficulties with finding ligament from elsewhere in my body.  So, I have this injury but will never have the operation. It seems my situation is clear as no further treatment is planned even though I may be walking down a mountain and my knee "goes" (which it does do sometimes) and I damage myself further requiring treatment. How would that be viewed by an insurer?

My son is in a slightly different situation in that no treatment is scheduled but he may have the surgery at a later date on his return.  But because he may have that treatment he appears unable to get insurance, at least via the comparison sites.

I'll call an insurer and ask their thoughts but the trouble with that is I may select a very expensive insurer and not be able to fully test the market.

But, again, thanks to those that replied.

Ultimately on a long enough timeline it's likely many will need some form of procedure or surgery and in particular if they have degenerative issues like arthritis. Insurers arent asking about what may happen in 3-10 years time. 

Planned, unless there is any helper text that defines what they mean, will take its plain English definition and as long as your interpretation of it is reasonable the FOS will agree with it even if its not what the underwriter had intended when writing the question. For your injury there is no surgery planned, yes were you to do another injury that may change but so too may you need surgery on your shoulder were you to injure that. So as long as you've answered the questions honestly and the insurer accepted the condition you'd be fine. 

For your son I'd personally say there is a planned operation, its not in the diary yet but you know its going to be happening, so a plan for plan almost. So unless he intends to refuse treatment and can document it then answering "no" to planned future treatment would seem on weak ground unless you feel confident in arguing a plan for plan isnt a plan and your interpretation of planned meant there was a date set for it and so would then be a roll of the dice if the FOS agree that the interpretation is reasonable. 

sheramber

Mason said:

Thank you for all your replies. It is an interesting situation, I think.  I have an ACL rupture (my fourth) but decided not to get it repaired this time because I no longer play sport that requires pivoting.  My surgeon suggested it was probably better for me to build the leg muscles to compensate rather than repair given the difficulties with finding ligament from elsewhere in my body.  So, I have this injury but will never have the operation. It seems my situation is clear as no further treatment is planned even though I may be walking down a mountain and my knee "goes" (which it does do sometimes) and I damage myself further requiring treatment. How would that be viewed by an insurer?

My son is in a slightly different situation in that no treatment is scheduled but he may have the surgery at a later date on his return.  But because he may have that treatment he appears unable to get insurance, at least via the comparison sites.

I'll call an insurer and ask their thoughts but the trouble with that is I may select a very expensive insurer and not be able to fully test the market.

But, again, thanks to those that replied.

You need to answer the questions truthfully. Not fudge around answering .

If you are asked have you had? then the answer is yes. 

If you should have told them and didn't , then any claim for a subsequent injury would be denied. 

If they knew about the injury and assessed your policy with that information , then as long as you answered the questions truthfully, you would be covered, 

If you make a claim for a medical condition the insurance company will contact your GP for your medical history.

If ant doubt, then contact companies directly.

Comparison sites are for straightforward cases.

Mason

MyRealNameToo said:

Mason said:

Thank you for all your replies. It is an interesting situation, I think.  I have an ACL rupture (my fourth) but decided not to get it repaired this time because I no longer play sport that requires pivoting.  My surgeon suggested it was probably better for me to build the leg muscles to compensate rather than repair given the difficulties with finding ligament from elsewhere in my body.  So, I have this injury but will never have the operation. It seems my situation is clear as no further treatment is planned even though I may be walking down a mountain and my knee "goes" (which it does do sometimes) and I damage myself further requiring treatment. How would that be viewed by an insurer?

My son is in a slightly different situation in that no treatment is scheduled but he may have the surgery at a later date on his return.  But because he may have that treatment he appears unable to get insurance, at least via the comparison sites.

I'll call an insurer and ask their thoughts but the trouble with that is I may select a very expensive insurer and not be able to fully test the market.

But, again, thanks to those that replied.

Ultimately on a long enough timeline it's likely many will need some form of procedure or surgery and in particular if they have degenerative issues like arthritis. Insurers arent asking about what may happen in 3-10 years time. 

Planned, unless there is any helper text that defines what they mean, will take its plain English definition and as long as your interpretation of it is reasonable the FOS will agree with it even if its not what the underwriter had intended when writing the question. For your injury there is no surgery planned, yes were you to do another injury that may change but so too may you need surgery on your shoulder were you to injure that. So as long as you've answered the questions honestly and the insurer accepted the condition you'd be fine. 

For your son I'd personally say there is a planned operation, its not in the diary yet but you know its going to be happening, so a plan for plan almost. So unless he intends to refuse treatment and can document it then answering "no" to planned future treatment would seem on weak ground unless you feel confident in arguing a plan for plan isnt a plan and your interpretation of planned meant there was a date set for it and so would then be a roll of the dice if the FOS agree that the interpretation is reasonable. 

That sounds the most reasonable of responses. I tend to agree that it wouldn't be acceptable to say "no" just because a date isn't in the diary.  Law should be reasonable and, from a neutral standpoint, it is reasonable to assume that my son would have the operation so anything that affects him because of his knee should be covered by paying the extra for the risk.

Thanks for responding.

MyRealNameToo

Mason said:

MyRealNameToo said:

Mason said:

Thank you for all your replies. It is an interesting situation, I think.  I have an ACL rupture (my fourth) but decided not to get it repaired this time because I no longer play sport that requires pivoting.  My surgeon suggested it was probably better for me to build the leg muscles to compensate rather than repair given the difficulties with finding ligament from elsewhere in my body.  So, I have this injury but will never have the operation. It seems my situation is clear as no further treatment is planned even though I may be walking down a mountain and my knee "goes" (which it does do sometimes) and I damage myself further requiring treatment. How would that be viewed by an insurer?

My son is in a slightly different situation in that no treatment is scheduled but he may have the surgery at a later date on his return.  But because he may have that treatment he appears unable to get insurance, at least via the comparison sites.

I'll call an insurer and ask their thoughts but the trouble with that is I may select a very expensive insurer and not be able to fully test the market.

But, again, thanks to those that replied.

Ultimately on a long enough timeline it's likely many will need some form of procedure or surgery and in particular if they have degenerative issues like arthritis. Insurers arent asking about what may happen in 3-10 years time. 

Planned, unless there is any helper text that defines what they mean, will take its plain English definition and as long as your interpretation of it is reasonable the FOS will agree with it even if its not what the underwriter had intended when writing the question. For your injury there is no surgery planned, yes were you to do another injury that may change but so too may you need surgery on your shoulder were you to injure that. So as long as you've answered the questions honestly and the insurer accepted the condition you'd be fine. 

For your son I'd personally say there is a planned operation, its not in the diary yet but you know its going to be happening, so a plan for plan almost. So unless he intends to refuse treatment and can document it then answering "no" to planned future treatment would seem on weak ground unless you feel confident in arguing a plan for plan isnt a plan and your interpretation of planned meant there was a date set for it and so would then be a roll of the dice if the FOS agree that the interpretation is reasonable. 

That sounds the most reasonable of responses. I tend to agree that it wouldn't be acceptable to say "no" just because a date isn't in the diary.  Law should be reasonable and, from a neutral standpoint, it is reasonable to assume that my son would have the operation so anything that affects him because of his knee should be covered by paying the extra for the risk.

Thanks for responding.

The much of the law is created by politicians who have their own motivations for deciding how the law should operate. The remaining part is set by case law, when senior judges pass judgement on cases under appeal... the joys of common law legal system 

"Reasonable" unfortunately is very subjective, we often get conflicting posts on here where two people have gone through a similar situation but walked away with polar opposite views. On terms in a contract etc the law is arguably generous in that if the party that didnt write the terms has a reasonable interpretation generally the law supports it even if its very different to what the author of the contract had intended. 

On the flip side if you intentionally declare you are a PE Teacher on your home insurance when actually you are a professional footballer then the insurer could void your policy and avoid a claim for flood damage even though the loss has nothing to do with the false declaration... this will probably split the visitors here and some would feel its very unreasonable.