To think my insurance should cover me nearly dying?!

[octavio1996]

Posting here because I’m at my wits’ end and don’t know what to do. Currently stuck in Australia after a total nightmare and my insurance company is refusing to pay out.

Basically, I was travelling here on holiday with DH and the DC (two teens, one younger), having an amazing time. Then out of nowhere, I got really ill massive pain, collapsed, rushed to hospital. Turns out it was a ruptured appendix and I ended up in intensive care for days, genuinely thought I was going to die. DH was beside himself, kids were terrified. The hospital care was amazing but obviously, this is Australia, and the bills are absolutely eye-watering.

Here’s the kicker: my travel insurance is now refusing to pay. They’re saying it’s a “pre-existing condition” (it wasn’t), or that I didn’t declare something minor from years ago that has nothing to do with this. I’ve been on the phone to them constantly, but they’re just fobbing me off. We’ve already had to put thousands on a credit card just to get me discharged. We were meant to fly home next week, but I’m not even sure I’m well enough to travel, and obviously, we can’t afford to stay indefinitely.

Has anyone been in this situation before? Do I have any chance of fighting this, or are we totally screwed? DH is trying to stay calm for the DC, but I can tell he’s panicking too. I just want to go home and not be bankrupt.

TL;DR: Nearly died from a ruptured appendix, travel insurance won’t pay, stuck in Australia with a huge bill. Help!

I would be really hesitant about not declaring your broken ankle. If you fall and injure yourself again they may refuse to cover you.

Hang on. My travel insurance comes with my Bank account, and I've never been asked to fill out any disclosure forms. So how does that work then?

Op, I would fight this to the death. Even go to the press or one of those consumer TV programmes. Or take them to small claims court. Do not back down. Hope you feel better soon.

Hang on. My travel insurance comes with my Bank account, and I've never been asked to fill out any disclosure forms. So how does that work then?

Me too.

Having symptoms of a grumbling appendix that doesn't yet warrant removal?

Get the Australian medical team to write a lower categorically saying the mild ibs was nothing to do with this hospital stay.

@biscuitsandbooks You are giving misleading information. Fortunately I read Ombudman's decisions sometimes - so I know what insurance companies can get away with and what they cant.

Also if you weren't diagnosed with ibs then presumably it would be digestive pain you presented with that you failed to declare? So it wouldn't mention ibs on your notes

You need legal advice not MN. It is always worth declaring EVERYTHING however minor and however historic as obviously insurance companies try and wiggle out of everything. Just not worth the risk, if you are charged a bit more for a policy then that's life. Have people looked at the wording of insurance policies to see what you should declare? Some of it is most bizarre!!

Is it not presented as a list of ailments and you tick whether you have ever visited the dr. So if it said digestive issues and you ticked no visit to Gp then I assume that will be incorrectly declared. Hope you get it sorted Op and I wish you a speedy recovery

The proposal forms are quite clear everything must be declared.

Do you mean that if they ask for everything in the last 5 years you need to ignore that time limit and provide everything before then as well?

Or do you mean everything within their stated time limit?

So does mine but if you read the policy you are under an obligation to proactively inform them of any pre existing etc the onus is on you to tell them not them phone you/write to ask.

I wouldn't know the reason for the sniping posts, just that they are. You are giving some really poor information on this thread and I can't see how that helps the OP.

There was a recent ombudsman decision in favour if the insurance company were a poor woman, collapsed on holiday and was found to have a brain tumour requiring emergency surgery. The brain tumours a sort that's almost certainly going to kill her.

Reason for her claim being denied: she'd recently started HRT. Completely unrelated but she hadn't thought to update her insurers on starting a medication not for an illness but at ease a stage of life!

Very sad, and shows what these insurance companies can get away with.

There's also a toddler who into yesterday was stuck in Mexico, who out of the blue had a brain hemorrhage. They disclosed hospital visits for bronchitis and jaundice as a baby, but seemingly didn't give all the dates, so because mum messed up the admin, baby wasn't covered. They had to fundraise to cover the costs of getting her back to a UK hospital.

I'm really sorry OP, I hope you get somewhere with appeal, but what these insurance companies can get away with is scandalous.

I'm disabled and can't even REMEMBER all the things that have medically happened to me in my lifetime. I have been in and out of hospitals and doctors since birth, it would be IMPOSSIBLE for me to declare every single thing.

It also ties back into the thread about people who 'stupidly' travel without it when they have a pre-existing condition when like I explained then its likely because they couldn't get it. As this thread shows even if they did it likely would have cost a fortune and still found a reason not to cover them in an emergency anyway.

You have to go through the insurance official company's complaints procedure before you can go to the ombudsmen.

Unfortunately, insurance is a highly unethical industry. They are there to make profit and their business model is based on them paying out in as few instances as possible, at the expense of the policy holder.

Be prepared to fight, and keep everything in writing. The insurance company will be counting on a high percentage of people backing down when they first deny the claim, so don't be afraid to persevere!

I hope you're feeling better soon.

how horrendous! I hate insurance companies! Can you get your doctors in Australia to state that this was an acute emergency that could not have been predicted and having some symptoms of IBS several years ago would not have predisposed you to acute appendicitis?
definitely pursue this and don’t give up

DH used to work for the FOS and dealt with many, many insurance complaints. This wouldn't be the first time it happens. Is your insurance underwritten by UK Insurance Ltd by any chance? We have 2 different sets of friends/family who had an absolute NIGHTMARE with them - including a couple where she ended up in intensive care in Peru whilst on honeymoon. This genuinely wouldn't be the first time an insurance company refuses to pay a perfectly valid claim.

First step - ask for your insurance's formal complaint procedure. Submit a formal complaint, in writing (can be via email if they share an email address in their complaints procedure).
Once you exhaust the formal complaint process, THEN you can raise a complaint through the Financial Ombudsman Service.

All the info you need is here: https://www.financial-ombudsman.org.uk/consumers/how-to-complain

Good luck OP.

If an insurer can get access to your medical records when you make a claim why can’t they just do it when you take out the insurance as well and make everyone’s life easier. Insurance is a total state sanctioned legally enforced racket.

i have mine through my bank account - it uses Aviva, and it did ask me if i had any pre-existing conditions and whether i'm currently under investigation for anything.

This is exactly what they do. Someone my DF knew refused to take out any insurance except that which was legally required because insurance is the biggest legalised crime organisation in the world.

Appendicitis has absolutely nothing to do with IBS anyway.

Sorry, but you will have to keep fighting them. Perhaps try one of the newspaper money advice columns.

Because they are dealing with hundreds of new policies every day, but only relatively few claims.

I’m just going on my own experience.

Because they wouldn’t make as much money that way

I was in this situation with my exH who was ill in Vegas....insurance refused to pay. Raise a complaint, and keep pursuing it....we eventually had our case before the financial ombudsman (I didn't know there was different levels until we got there!) but we went to the top and they paid so it's definitely worth carrying on with. Our bills totalled around $47,000 when they all arrived (that was on top of what we'd put on credit cards while we were there!) so don't lose hope, they should pay out....good luck!

You have admitted your own mistake "I’ve never had any issues that should be relevant" which suggests that there were issues that you didn't declare because YOU thought they weren't relevant. If the insurance proposal asks for literally everything, then you declare literally everything! It's not up to you to unilaterally decide what is or isn't relevant.