To think my insurance should cover me nearly dying?!

Yep, agreed but it’s one of those situations where you have to play the game, no matter how much you disagree with the rules.

This will get lost but hopefully you see it.

Insurers are not allowed to decline a claim on the basis of misrepresentation (I.e. not declaring previous history) if that misrepresentation does not prejudice the claim (I.e. make it that you would be uninsurable). They could charge you a high premium but they can't decline the claim outright.

Make a complaint to the insurer (you can't go straight to the FOS until either the insurer has replied or 8 weeks has passed). State that declining the claim on the basis of ibs not being declared is an unfair term and the ibs did not affect the appendicitis and therefore has not prejudiced the claim.

It'll take a while but you should get the claim overturned.

P.s. next time. Declare everything!! Even if it seems inconsequential.

You are insured… until you come to claim.

Absolute scammers

When I mention smugness, I'm referring to the people who are saying 'but of course you should have done xyx', almost gleefully.

Regardless of how things are, I think it is unreasonable for insurance companies to decline to cover an incident that is clearly not linked to any other health situation.

You just answer the questions they ask. From memory, the online questionnaire doesn't ask about ALL GP appointments going back to year dot. They ask for current medication, "recent" GP appointments/consultations/tests etc (they specify the timescale), and ongoing medical conditions, any ongoing undiagnosed conditions under investigation/consultation, etc. If you answer honestly, whether you think relevant or not, they've not got a leg to stand on. You just have to be careful to read the questions tell them exactly what they're asking. Unfortunately it seems a lot of people don't read the questions properly and that's when the insurer can refuse to pay out.

My OH was diagnosed with cancer around 7 years ago. We had two "big" holidays booked which had to be cancelled because he'd be in the middle of 6 months of chemotherapy for the first holiday and would be in hospital for a stem cell transplant for the second holiday at the end of the year. Both insurers paid out with no quibble at all - claims for thousands of pounds as these were expensive holidays for the entire family. He'd declared numerous visits to the GP in the two years' prior, for fainting, heavy bruising, painful bones, etc - the GPs basically fobbed him off and just said it was natural ageing, so OH "could have" shrugged and left them off the insurance proposal. But he included them. That's exactly why the insurer paid out - everything he'd consulted the GP about pointed to his bone marrow cancer, but because he'd declared it and the GP records showed they'd basically not diagnosed anything and told him it was nothing, they paid up as it wasn't OH's fault the GPs were useless!

Also your policy should have a complaints wording somewhere that should set out the process.

But main advice is look at exactly what you were asked for and whether this could reasonably have been expected to include the info about IBS.

Also ask your doctors for a copy of the notes (were you considered formally diagnosed? Was this ever formally communicated to you? This is different to 'if it doesn't get better it might be this...' which implies that as it did get better, it wasn't this)

Ditto here. We're paranoid about disclosing absolutely everything. We both have chronic conditions, but not only do we fully disclose those, we disclose absolutely everything else too. These days it's easy as it's usually just a very long online questionnaire where answering a question leads down a rabbit hole to lots of other questions. It's a pain in the neck, but it's necessary. Either one of us could end up with enormous hospital costs if our condition worsens whilst abroad, so we have to make sure we're fully covered for hospital stays, repatriation, etc. The cost is usually only around £50 more per person, so it's not the cost that's the issue, it's the time and effort in making the declarations.

We also research the country(ies) we are visiting to see what reciprocal health care agreements are in place and what free/subsidised healthcare would be available if necessary. Usually a quick Google leads you to their website which gives an overview of what's available free/subsidised, and what isn't. Good to know so that you can make informed decisions if something does go wrong. Just before Covid we went to Russia, so were absolutely paranoid that we knew exactly what their healthcare system looks like and what to do/where to go if either of us became ill. I think it's vital to do research if you're going anywhere other than the EU as you can't make assumptions about healthcare systems in other continents!

I haven't read the whole thread so apologies if this has already been covered.

I always buy travel insurance over the phone so I'm always talking to a human being. All you need to do is to answer the questions they ask accurately and truthfully. Nothing more.

So I get asked if I've ever had any heart related medical issues and if I've had any other medical conditions treated or diagnosed in the last 12 months.

Those are the questions they (Saga) ask and those are the questions I answer. Apart from heart related issues they don't seem to want to know about anything you haven't consulted your doctor about or been treated for in the last year. I've even volunteered information and they've been quite clear that if it wasn't in the last 12 months they don't need to know.

Unless the OP has simply gone out and bought travel insurance on the basis of "what's the cheapest out there" rather than "what's the best I can afford" I find it difficult to believe that her insurer would nit-pick on symptoms from years ago that never resulted in a diagnosis and which were irrelevant to the current health emergency.

Apart from that I wish her good luck and agree she needs to make a formal complaint against her insurer and follow it up with a complaint to the FSO if necessary.

NB1 - I'm not saying this is the case with the OP so don't shoot me down, but if you are buying travel insurance it makes no sense not to truthfully and comprehensively answer all the questions you are asked and to "forget" something. Your insurer will find it even if you've "forgotten" it.

NB2 - the OP's previous symptoms of possible IBS from years ago are obviously not relevant to her current problem so her insurer should not be able to rely on them for not paying out. (Well I say that but I'm not a doctor. Maybe possible IBS symptoms from years ago do indicate that you'll get appendicitis down the line. All the more reason to buy over the phone and answer only the questions you are asked. If the questions are unclear, ask for clarification)

I don’t understand why it’s a non declaration if it’s outside the time limit they ask for … say two or five years? I had childhood chest/wheeze issues. I’ve not had any antibiotics ( for anything) or inhalers for 25 years at 45. I would not disclose it as it’s more than 5 years ago. so how would that be a non declaration? It’s ridiculous. No one remembers everything they see a doctor for in decades especially with non follow up/further treatment.

Insurance companies seem to seek anyway to get out of paying.

How can you remember every little thing though? Remembering you had cancer is one thing but remembering you mentioned you had constipation once or a sore big toe twenty year’s ago seems a bit much.

Is it AXA, by any chance? They are the most disgusting company I have ever had the misfortune to deal with. They made a traumatic emergency situation abroad a million times worse. And then were just as bad when we got home and had to recover expenses.

Also clearly state in writing the mental distress this is causing you and tell them you want to make a formal complaint (after you have all the info)

This is very good advice. Also your local MP could intercede on your behalf when you get home- there is a potential public policy issue at stake here.

Obviously depends on the circumstances. But once you're stabilised after being blue-lighted, there can be opportunities to take stock of what's happening, what's needed, etc. Even after an operation, you can usually "choose" to continue where you are for convalescence and recovery, i.e. stay where you are, or get transferred out somewhere else. I think the insurance would look at the chain of events, urgency, options, etc. The basic premise under law is that you have to minimise your costs as far as you are able. If you're not able, then fair enough. But if you make expensive "choices" then you bear the potential consequences. I think the insurer would be interested in the chain of events that left the OP getting treated in a private hospital rather than a state hospital. I.e. was it a "blue light" emergency admission, what it a life or death emergency operation, etc - very different to if she'd walked into a private street corner clinic complaining of stomach pains and had the operation a week later!

It's like if you have a car accident that's not your fault. You can claim a "like for like" hire car, but you can't claim a Porsche hire car if it was your Nissan Micra that got pranged (unless the Porsche was the only hire car available when needed!).

Hi OP

As a general rule they can only decline a claim if they can prove that if the full medical history had actually been disclosed, their underwriting guidance is to decline to insure you, or insure you but exclude various conditions that they would deem to be related including appendicitis.

Have they done this? If the claim goes to the FOS then this is what they're likely to look at. If it turns out that they would have insured you but charged more premium or changed the terms (something like an increased excess) then the FOS is likely to rule that they should apply these terms retrospectively.

Try not to panic. Have a really careful look what they asked you for when you signed up. Usually it's any doctors appointment in the last x years, hospital stays, pre existing conditions. It if was any doctors appointments then it's a bit more tricky.

Also Google the insurance act and innocent misrepresentation. There is a difference between someone who concealed something deliberately (committing fraud) and someone who didn't disclose something as it didn't seem to matter. The onus is on the insurer to ask you very clear and specific questions. If they had just asked you about pre existing conditions then I'd say that not clear as it's not a 'condition' assuming you weren't formally diagnosed and have had ongoing symptoms.

If I was you I'd be asking one of my friends if I could use their details to get a quote (giving a different phone no eg one of your kids, that won't flag on their systems) and change the answers to fully disclose all the info on the potential IBS. This might give you a clearer idea on where you stand / insight into their underwriting process, and also potentially give you some evidence that they are acting unfairly (if they would cover a new person)

Might be worth threatening to get social media / news sites involved

Good luck and please update the thread if you want any more specific advice

I can't see how they can turn you down for not having IBS. You went with bloating- you were tested and didn't have a diagnosis of IBS.
They are totally at it- refuse you for non disclosure in the first instance and hope you don't chase it. You need to be clear you are fighting it.

I don’t think people are meaning to be smug - many of us are just going off our own experiences or those of friends and family.

I personally know someone who was denied an insurance payout based on non-disclosure so I’m extra paranoid about declaring things now.

All these smug people saying 'well you do need to declare everything ya know' are speaking from a position of not having anything like this happen to them. I bet you've got vague medical bits you've forgotten about too.

I think the layperson would reasonably expect appendicitis to be covered unless they were specifically diagnosed with a grumbling one beforehand.

If I broke my leg I wouldn't expect insurance to decline it based on also having hayfever.

It's awful.

I'm genuinely confused, how far back are we expected to list complaints?

If you went to the doctor in 2001 complaining of feeling nauseous is that going to be on your records and affect a claim?

I recently added HRT to my insurance as I saw the story about the woman with a brain tumour, but never would have thought to ...

How many of us declare that we take the pill, have a coil etc? Maybe you don't need to if you get the over the counter one you pay for, but do if you get one that's prescribed. Absolutely bonkers.

There is genuinely some evidence that people suffering from IBS and other chronic bowel conditions do indeed appear to be at an increased risk of going on to develop issues with their appendix, however I don't think that's why they have refused this claim. I have a feeling they are using non disclosure of previous investigations, but I don't think it is right or fair.

I had insurance through I think Avanti, I ended with my first ever UTI and fever about a week before we were to go away, I could not stand I was in so much pain never mind go on holiday. I ended up in A&E with suspected sepsis but would they pay for the missed holiday? would they hell I lost £2500

They said that I should have seen my GP who would have said if could go on holiday or not but you cannot see a GP, specially not for UTI 😬

I do not bother with insurance now they take your premium but not pay out, I just go without

It might not have been IBS. Is there anything in your records that subsequently suggests a different reason for the symptoms? You can request your data from your surgery to be sent by email or I think some data may be available online in England. Scrutinise what is on it and tell them if it was never diagnosed and was subsequently found to be wind or whatever. Also, there is no link between the 2.
The process if they continue to refuse is then time consuming and you may have to bite the bullet. You can take it through the complaints department of their underwriters and if they still refuse you can then go to the Ombudsman. Their decision is likely to be final even if you are inclined to take it to court you won't get far if the Ombudsman finds against you.
Personally I'm horrified at the number of times insurance companies refuse to pay out and the Government should do something about it. Can you get your local MP on board?
You have my sympathies but brace yourself for 'the long game'.

But the issue comes down to what is a pre existing condition.

i have been to the doctor with a litany of ENt problems. All have come back as benign. I just have an awkward head! 😅 nothing is very serious, just annoying at times. Absolutely no pre existing condition to report. I am officially suffering from nothing whatsoever. What do I need to declare?

How the fuck would you know or be able to choose in an emergency?