To think my insurance should cover me nearly dying?!

I don't have experience with health insurance but we've had issues with a car insurer and complained to the ombudsman who advised that an independent insurer review the case. They found in our favour and the ombudsman eventually ordered the insurer to fix our car after a second complaint. It took ages though as the ombudsman don't get back to you quickly so it's unlikely you will resolve the issue without paying upfront. Good luck, they will try anything to avoid paying.

I think they do it to defraud the nhs by claiming they’ve given advice to x number of patients so they can tick boxes on funding applications as “management” of conditions. My gps have always asked if I’m depressed and looked disappointed when I said no - apparently depression was at one time a trigger for additional funding for the surgery. OH is constantly asked if he had erection problems but he’s never once mentioned anything like that. They seem obsessed to diagnose some things and ignore other things you do tell them about. I’m convinced they’re just following the money these days.

No, that’s incorrect reasoning. The reason it’s difficult to claim on is because the acceptable conditions are on a list so you need to get one of them. Many conditions are not covered, even if they are ‘critics illnesses’ and so people assume everything is included. Also there are specific levels of severity that are required and often people don’t meet those.
if you compare it to income protection insurance, CIC is very tricky to successfully claim on and yet it’s the one that everyone takes out.

@Badbadbunny yes I’m with you about how great the NHS app is but how difficult it can be to put something right

when I started getting the info in the app I could see they said I’d repeatingly refused any stop smoking advice and help for smoking for the last 3 years

i've never smoked in my life (well maybe a couple 30 years ago in high school). It took me ages to get my records updated.

Check the fine print. My bank account technically offered "free" travel insurance but it wouldn't my existing medical condition so was effectively worthless.

I believe it was possible to pay a surcharge to be covered, in my case it was cheaper to get better, more comprehensive insurance elsewhere!

Surely you have to reveal everything even if your bank gives you free insurance. They won’t ask- you have to tell them!

You were lucky!

In any insurance you have to declare absolutely everything. Sorry that’s happening to you. Must be awful. I just see people not taking insurance very seriously then they get into a lot of trouble. Insurers need to know everything to they can assess the risk. They can’t if you don’t tell them

any update OP? Although I reckon the refused claim with good reason

@JasonMurrayMint we have bank account travel insurance too. I had a catastrophic bleed two days before a big pre planned road trip including expensive flights, car hire and some hotels. It was completely out of the blue and not expected by either nhs or me, but it was related to day surgery I’d had to remove bad cells two weeks before. I hadn’t thought to tell the insurance company anything, and they have no information about my medical history. They paid out with just a letter from the hospital and sent well wishes. They never asked a single thing about my medical history, and I’m not even the named person on the bank account, just the live in partner.

Sorry if someone has already replied to this, haven’t RTFT.
There Is likely a number to call to disclose pre existing medical conditions when you have travel insurance via a bank account, they sometimes charge an extra fee for you to be covered.
The bank should have explained this to you when you signed up for the account, especially if there is a fee for it, as the product may not suit your needs if you can’t be covered and therefore you could have a claim of miss-selling…

Isn’t most bank cover wanting conditions within the last year? The year starts at the renewal date. I have bank insurance that moved from Uk insurance to aviva and pretty sure both want 1 year.

Never heard of last 5 years or decades. Do you mean that because it is rolling, they are picking out from previous years what you did not declare? Even though not in current year.

If it’s not the case please tell me !!!

I agree.

On my NHS Direct App, it shows I have a medical condition of "De Quervain's Disease". I'd never even heard of it before I checked the app and certainly never been told that I had it and not receiving any form of treatment for it. Turns out it was from about 20 years ago when I had stabbing pains up both wrists and the GP referred me to a consultant - he didn't diagnose it (not to me anyway), but wanted to give me steroid injections which I refused as I didn't want to go down that route as the first level treatment, so he suggested wrist splints instead for which he wrote back to the GP to ask him to refer me to the phyisotherapy dept for wrist splints to be issued. I got them, wore them a few months, pain disappeared, splits put into the bottom drawer, forgot all about it for 20 years until I saw the "condition" on the NHS App. Eventually, after a LOT of effort and hassle, I got the GP surgery to remove it from my "list of conditions".

Another time, I looked on the app to see what the GP had noted about a consultation I'd had - it was absolutely not an accurate reflection of what I'd reported nor what the GP had responded. Things had been missed out and a couple of things that hadn't been said were included. Again, took a lot of effort, but I had the record corrected.

Makes sense to keep an eye on the NHS app to watch what they've put on and check it's accurate!

This is why you should check your medical records periodically to make sure that it’s accurate so that insurance companies can’t misconstrue complaints. My doctor had stated in my records that my first pregnancy was unwanted which is completely untrue it was unplanned not quite the same thing.

Ask the insurance company for their complaint process and start a stage one complaint. If you get no luck, ask to do to a stage two complaint. Again, if no luck, go to the Financial Ombudsman.

The not declaring is usually for things they would never have offered cover for. Mild IBS isn’t something they’d never cover for. They are being unreasonable .

That's just ridiculous! I would expect them to pay. I don't see how mild IBS from years ago can be linked to a burst appendix. I never knew you had to declare every single thing when applying for travel insurance, which when you reach middle age, will take a good hour or two to remember everything back to childhood. Who has time to do that? There seems little point in taking out travel insurance now. Just have to hope you don't fall ill on holiday or if you do, just expect to die in the street rather than rack up thousands of pounds for surgery. Wishing you best of luck in getting them to pay up.

I would challenge this on 2 grounds- 1- if it’s not been diagnosed it’s not a pre-existing condition. You can’t be expected to declare every time you have something that sends you to the GP

2- if the non-disclosure is not related to the incident, then they should not be able to avoid the policy in the entirety. Rather they can reduce the amount that they indemnify you in proportion to the increase in premium they would have charged if you had declared it. Frankly I doubt the premium would have been any different

make a formal complaint and good luck

No one knows if their appendix will burst. That’s one of life’s surprises. Is it bc you didn’t tell them that you were going to be out of the country. I’ve heard stories like that. Crazy.

I once forgot to declare that my smear test had picked up that I had thrush, and tried to deny me cover for a broken leg..10 years later. It was covered in the end.

I wouldn't remember every detail of every Dr appointment in my life. I don't think any insurance company has asked for that level of detail for travel?

I merely don't buy insurance as its prohibitively expensive and risk OF not being able to get a claim approved after paying ££££. It's the reason I don't got to America

All you need is a battle when you have been so ill. ...........

I don't go abroad now because I cannot afford the insurance for my plethora of health problems. I suspect that even if I paid out for the insurance they would find a way pof wriggling out of any claim as the problems are complex.

I haven’t RTFT so sorry if I’m repeating what’s been said. I’ve worked in the insurance industry for 15 years so just wanted to provide some insight from an insurance perspective.

You need to exhaust the insurers own complaints procedure before you can escalate to the ombudsman, get started on that asap. The insurers will be charged by the ombudsman to handle the complaint so it’s not really in their interest to let it escalate that far.

Typically with insurance they can repudiate the claim if they can demonstrate that had they been aware of whatever they allege was undisclosed they would not have provided cover. If they would have not provided cover or perhaps provided cover with some specific exclusions had you notified them of “previous IBS” then they do have grounds to dispute your claim. I’m not saying they are right, as I can’t see how the two are connected if I’m honest and it does seem a bit far fetched.

Unfortunately you might be in for bit of a battle but do not give up, press them, make sure they confirm their position in writing. Keep it all. Push for a complaint to be logged if not already and make sure they stick to the complaints time line set out.

Hope you manage to get resolved and you have a smooth recovery.

Another insurance company blag. I find that most insurance policies are guaranteed to pay out on everything - except a claim.

The earrings will be because you opted not to insure them out of the house as it will have been more expensive.
If the bikes were expensive enough to insure you should have had a receipt even if you paid cash. Did you have no photos of them or anything? Just playing the devil's advocate here and looking at it from the other side