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!

For insurance purposes everything even if benign. This is what I do on e mail so there is a paper trail. E mail everything however random so that they have nothing to use against you!

Today DH has just booked us a 5 day trip to Italy through a Travel Agent. They would not insure him as he had an MRI last week due to arthritic knees! I have countless medical issues all under control with medication but it worries me about getting adequate insurance.

When it comes to claiming, insurers will ask to see your medical records. If it turns out that you haven’t included things, they will deem that as a non-disclosure. Whether it will result in them refusing to pay or not probably depends on the company, but it’s always better to be overly honest than to think “ah, that won’t matter”.

Ultimately insurance companies exist to make money - so if they can avoid paying out, they will.

I'm sorry that this has happened, OP. My DH had a ruptured appendix abroad and it was horrible. I contacted our travel insurance at the time, who assured me that they would pay out. In the end, the overseas hospital unexpectedly refused to actually charge us so we didn't have to claim.

Yanbu to expect a payout in these circumstances. I really hope you get it sorted, and that you make a quick recovery.

This ^^
It’s absolutely correct. As @Cyclebabblesays put a complaint in to the insurer and then, if the insurer does not resolve, to the FOS. You MUST do it in this order or the FOS will reject your submission.

This

I am an insurance lawyer and we do not have the full history from the OP.

I think if they ask specific, unambiguous questions then obviously they must be answered correctly but I’m assuming they're not expecting you to volunteer old, vague information they haven't asked for. Year’s ago I had a critical illness insurance. Having read up on it over the years it seems it can be a difficult insurance to get a payout for. I got my payout very easily so I must have filled in my forms accurately.

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I guess some do! Others seem to ask for anything in the last 12 months, anything you are under a specialist for.

'but disclosing all health issues is the norm with travel insurance'
That's surely the crux of it. IBS is not a health issue for the OP. It's also a functional condition or a diagnosis of exclusion. She had some minor symptoms years ago and no specific diagnosis was made, at least not with her knowledge. No one can possibly be expected to remember every single occasion they have seen a GP. Any insurance company trying to wriggle out of paying on this basis is simply trying to wriggle out of paying.

Yes, ultimately it depends on the policy and what OP was asked when she took it out. It does all sound very odd, though.

@biscuitsandbooks First reputable insurers do NOT require you to notify anything that has ever been in your medical records, that's nonsense. If you/ your relatives have insured with companies that specify that more fool you. If you/they have had claims refused did you use the Ombudsman?

Secondly there is legislation about unfair contract terms in this country. I've never insured with a company that would ask for my entire medical history but if I had and had a claim refused for something minor I'd go to the Ombudsman and argue irrelevant and unfair contract term. The legislation about this requires you to disclose what a "reasonable consumer" would declare. Incidentally the HRT claim was being looked at again in the only report I could find. I'd declare it as it's medication if I was on it but wouldnt expect to pay much more to have it included.

If you lie when taking out insurance then yes the Ombudsman will decide against you. But there have been cases, not currently on the website, where the Ombudsman has ruled against companies who refused a claim for something in the medical history the ombudsman agreed a reasonable consumer would not have considered it necessary to declare.

So - having tried to provide some reassurance - the thing people need to be concerned about is getting drunk. That can invalidate your travel insurance. The one time I've had to claim on travel insurance for a hospital visit abroad they were very keen to test for alcohol. However the claim was paid without a complaint being needed since the amount of alcohol that had been consumed was small.

Get onto Martin Lewis. This is just the kind of fight he likes.

That's why I often think threads like this are worthwhile, Umbilicat, even if the OP mentions things which don't make sense on the face of it

It's the sharing and extra info we all get that helps IME, and if it's helped you too that can only be good

To follow up I remembered another tiny thing, added it to my policy and have been charged £30 for it, which is annoying but better that way round than having an entire claim denied because I didn't mention it. I'm going to have a policy of listing everything mentioned to the GP in the past year in future.

All to the good, @Umbilicat

@anyolddinosaur thankfully I've never had to claim on my travel insurance, but when I last took it out (well before COVID) I was asked about everything I'd seen a doctor for in the last x amount of years - I think maybe two or three? I don't remember which insurer it was though.

The person I know who had their claim refused had their complaints dismissed by the Ombudsman on the basis of non-disclosure. This was car insurance rather than travel, but it's made me incredibly cautious ever since. I would rather over-declare than risk not saying something and getting refused a claim.

Why are people still going on about insurers and ombudsman when in this case they shouldn’t be involved - this is why we have reciprocal agreements between countries

Because the discussion has evolved a bit and people are finding it interesting.

I think there must be more to the OP's story than we're being told, otherwise (as you say) she shouldn't have any issue getting her treatment covered.

Reading this all with alarm. I have a long history of various medical stuff including cancer.

I have to have specialist travel insurance as there are only three who will consider me - and only one who does not cost more than £2k just to insure me. However it takes me about three hours to get insurance online as I have to go through all my conditions that I’ve currently got. And if you press one button incorrectly you literally have no way to correct it and have to start again! Not just that part again, the whole claim again. It is appallingly bad, but that’s what I have to work with as a cancer patient.

But there are plenty more illnesses and chemo related stuff in the past that haven’t bothered me for 20 years eg appendicitis or UTIs when I was having chemo (only caused by chemo, never had one since). Do I literally have to ALSO include stuff from 20 years ago in case I have something else (eg bowel perforation (never had it, just using an example) because otherwise they might say it’s related to the appendix op you had 20 years ago? Or related to the C-section I had with my children? Do I have to declare c-sections? Do I have to declare covid? - I had to call the GP as I got a chest infection but recovered and that was five years ago. Where do you draw the line?

I am Australian but my family are English - there is reciprocal rights unless you went to a private hospital but as an emergency I doubt it? When we land we can get a temp medicare card (equivalent of NHS) - ring medicare and ask for advice? I am pretty sure you can also go to medicare and get a refund. My english hubby went to A&E twice last visit and staying in hospital for a few days and he just had to show his english passport.

Have you now enrolled in medicare?
UK reciprocal healthcare agreements with non-EU countries - GOV.UK

@joshingaround biscuitsandbooks has been panicking people - and she's wrong. She now admits that her insurer only asked for something like 2 or 3 years - it was most likely 2 years - for any visits to a doctor. You do have to declare conditions that are ongoing but not e.g. your C section. You declare covid if you saw your gp in the last however many years they ask for - so maybe yes if within the last 2 years but not from 5 years ago. You also have to declare any conditions they specifically say they must be told about if you have ever had them, so things like heart problems and breathing issues including asthma. So I'd phone up and ask if a one off chest infection counted. I cant remember but cancer if probably one of the "ever had it" things you must declare.

Anything I'm doubtful about I phone and ask them, you may be told they dont want to know if it's in the past or that they can cover you for a small amount extra - I had to pay about £2.50 once because an infection meant a gp visit.

But the in the OP’s case the GP suggested her symptoms could be due to IBS. However, she may not actually have had IBS. I bet the GP could write a letter of support if asked to do so for a fee

And HRT isn’t even medication! It’s hormones.. madness !!

I checked with our insurer and It is regarded prescription medication and you do need to declare it. It made no difference to the policy cost.