Flexicover insurance & general advice needed for claim

skunkmonkey · 5 September 2009 at 6:29PM

My gf and I have just got back from New York, we went for 6 days and booked flights and hotel privately so no travel agents involved. The problem was that my gf had some dodgy food within a couple of hours of us arriving (last Saturday). We had to call a doctor out twice (Sunday and Wednesday, as she had got worse rather than better!), he diagnosed gastro-enteritis. She couldn't leave the room from Sat afternoon until Thur evening (for obvious reasons - it was BAD food poisoning), managed to get out of the hotel for an hour or two on Thu evening but this was so tiring that Friday she needed to stay in bed pretty much til we had to leave the hotel for the airport.

We were insured with Flexicover. I am sure they will reimburse for the costs of having to get the doctor to the room (we have notes and paperwork from the doctor showing that he diagnosed gastro-enteritis, and I can print off credit card statements).

We had to pay for an extra night in the hotel, as our check out was midday and the flight was 11.30pm - there was no way she would be able to wander the streets or wait in the lobby for such a long time. I am hopeful that this will also be reimbursed.

During the many hours I spent in the room (as she didn't want to be left alone for obvious reasons), I went over the insurance policy, and came across:

No section of this policy shall apply in respect of you not enjoying your journey or not wanting to travel.

My question is: is there a legal definition of not enjoying a holiday - and when it comes to food poisoning that can incapacitate someone for 5 straight days, would I be able to claim back the costs of the hotel (and flights)? Given that we did want to go home early (doctor would have authorised this) but she was too unwell to fly, technically we would have saved the insurance company money, as two flights from US to UK at such short notice would not be cheap, and definitely more than the cost of our hotel for those few days. Obviously we did not enjoy our trip, but does anyone have any experience of:

a) how reasonable Flexicover are when it comes to reimbursing people?
b) being in a similar situation where a severe bout of food poisoning ruined the entire holiday?

As Flexicover claimline is (unhelpfully) only open Monday - Friday 9- 5, I would appreciate it if any advice could be given before I phone them on Monday.

On a side note, we went back to the restaurant, and while they refunded our meal and apologised, refused to take matters any further, informing us that only a lawsuit would possibly result in any other payout from them (as a lawsuit would surely have to prove that they caused the food poisoning, which, even though we know it was them, can be a lot harder to definitively prove in a court!)

Sorry if this is a long message, but thought I should include as much info as possible.

dacouch · 5 September 2009 at 6:38PM

Flexicover is a trading name of Citybond who are not to bad although can often take some time to answer their phones. The policy is underwritten by Europ Assistance who are not to bad an Insurer.

What the you are not covered for Failure to Enjoy your Holiday means (Its a common exclusion) is actually to stop people claiming for say when they go to Disney World and did not enjoy it perhaps because it was raining. In addition Insurance covers you for specific perils eg cancellation, medical etc etc. It does not cover consequential losses. A consequential loss would for instance be your return flight is delayed and you claim on the Insurance for that. But as a consequence of you missing your flight you are sacked from your job for being late back to work.

Ring them on Monday and put your claim in, they should have no problem with the extra hotel accomadation if it was medically necessary.

skunkmonkey · 8 September 2009 at 12:44PM

OK I have rung Flexicover, who have told me to make my written claim with Mondial (Anyone know who they are?).

From this call, as expected they will pay doctors fees on production of medical certificates (which we have).

However they will not pay for the extra nights accommodation, as it was a "consequential loss". I find this ridiculous, as although it was medically necessary, we could not be expected to call the doctor out again just so he could put in writing that this was the case?

The other part I find ridiculous is that as mentioned in my first post, I requested that they cover the hotel bills for the period she was ill. They said no as it was not covered due to "loss of enjoyment". But also said that if she had gone to hospital and stayed a few nights they would have paid them. Does this not seem ridiculous - if you have food poisoning you do not need to go to hospital, though you would be perfectly justified in doing so. Obviously a few nights in hospital would be far more expensive than two call out fees for a doctor. The policy does not mention anything about how medical treatment MUST be at a hospital for it to be valid so they cannot refuse this claim surely?

dacouch · 8 September 2009 at 12:50PM

If you had stayed in hospital they would have paid the hospital bill if it was medically neccessary, if you do not go into hospital they will not pay your hotel bill as you would have had to pay the hotel bill anyway.

If the doctor confirms that it was medically neccessary for you to check out later then the Insurers will probably pay the extra days hotel bill for the late check out. Without confirmation from the doctor you have very little chance.

Here is a case note from the Ombudsman on a similar case to yours

56/2
travel insurance – whether insurer should pay curtailment claim when policyholder was taken ill but did not return home before scheduled end of the holiday
In April 2003, while on a cruise with his wife to celebrate their silver wedding, Mr B tripped on some steps and broke his leg. After his leg had been put in plaster, Mr B was prescribed strong painkillers and spent the remainder of the cruise – a total of 11 days – in his cabin.
When the couple returned home, Mr B submitted a claim under his travel insurance policy for medical expenses and for the curtailment of his and his wife's holiday. The insurer settled the medical expenses claim. However, it rejected the curtailment claim in its entirety, on the grounds that Mr and Mrs B had not left the ship and returned home before the scheduled end of their holiday.
After Mr B disputed this decision, the insurer agreed to meet half of the curtailment claim. It paid the cost of the final 11 days of the cruise (less the policy excess) – but only for Mr B, not for his wife.
Mr B said the insurer should pay for his wife as well, because after his accident she had remained in the cabin to look after him. However, the insurer disagreed, so Mr B came to us.
complaint rejected
The travel policy provided cancellation cover '... if you are forced to curtail your trip and return home after departure as a direct and necessary result of any cause outside your control...'.
There had been no medical reason for Mr B to leave the ship and return home before the end of the cruise. He and his wife would have preferred to return home, but this was not the same as being forced to do so. We were satisfied that the insurer's payment of half of Mr B's curtailment claim was fair and reasonable, and we rejected the complaint.

http://www.financial-ombudsman.org.uk/publications/ombudsman-news/56/56-travel-insurance.htm

Flexicover insurance & general advice needed for claim

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