Parents’ travel insurance refusing to pay out - what can they do?

[89DaysToLoseIt]

well, more specifically, my mother’s insurance.

my mum and dad have had separate insurance policies for about three years now, after my mum’s insurance refused to insure my dad due to his health conditions. my mum stayed with them as they offered her a good price. a few months ago, they had to cancel a trip because my dad was taken ill.

my dad’s policy has paid out straight away after the submission of a medical report. my mum’s insurance is refusing to pay out on the basis of my dad (who’s not insured with them), having not disclosed his health conditions to them! what’s their recourse here?

Ombudsman it’s going to have to be,then. Insurers are total bastards: the default setting is so often to say no and hope the policyholder will go away.

I think this will be their next step, plus heading to the ombudsman

Do you have a policy schedule? Can you obtain one if not. It will be clear who is listed as an insured person on this (and Aviva’s terms use this to define the insured person).

There is also a clause in the Aviva direct policy terms (I can’t see you’ve shared a link to the relevant terms here, so I’ve used these as a proxy).

They say that if your travel companion had an illness that you could have foreseen impacting the holiday at the time of booking, then this won’t be covered. I don’t have details of why they’re cancelling but is there a chance that they fall within this clause?

It not, then I would go to the ombudsman with the policy schedule and their response to say your dad isn’t an insured person so their reply makes no sense.

They don't appear to have this clause. Aviva haven't pointed to this clause at all.

But in any event, the illness couldn't have been "reasonably foreseen", his AF had been medication controlled for 7 years when he had his attack, which was out of the blue and left his consultant stumped, so they wouldn't have had to declare it.

Unfortunately this insurer has been known to use bad faith practices to maintain a healthy loss ratio (low proportion payouts) while spending millions on advertising to project an image of trustworthiness.

Did your mum call in to make the claim? They will gleefully take any inconsistencies from the claimant to aggressively deny a claim.

If your father's insurer will payout for your mother's costs, best to proceed with that claim process - your mother's insurer will be happy to delay the claim as well as deny as both tactics are proven to result in the claimant giving up.

But also, they had declared it! That's what's frustrating them so much. Aviva knew about all of these issues three years ago, so they're just refusing to pay

But you need to declare when a policy is renewed - you can’t rely on information from 3 years ago.

It is a fairly standard clause in travel insurance that you need to declare health conditions of a family member or travelling companion if their illness would cause you to cancer, and I suspect that may be what they mean by “he is insured’, although they don’t seem to have communicated this very clearly. I am surprised that Aviva can’t point to this in their T&Cs, as it’s clearly there in their direct travel insurance policy wording.

In that case I would also be getting a letter from the consultant to that effect and going to the ombudsman.

But I’d want to be sure first that the policy schedule definitely didn’t refer to your dad.

If it is insurance with a bank (and it sounds like it is) then at what point is it renewed? My travel insurance continues provided I make the monthly payment on my bank account, so at best it’s a monthly renewal. You can’t expect me to re-declare all medical issues every month?

I have taken a look at Aviva's insurance policy. Whilst the wording they are using in rejecting your mother's claim is inappropriate as your father is not classed as an insured person under the terms of the policy, there is a specific exclusion for "any claim for a medical condition if any person upon whose good health your trip depends had a serious, chronic or recurring illness, injury or disease which you were aware of at the date you took out or renewed your policy or when you booked your trip (whichever is later) unless the condition was disclosed to and accepted by us."

The question is whether the disclosure when they refused to insure your father is enough to mean it was disclosed to and accepted by Aviva. I suspect the fact they refused to insure him is enough to mean it was not accepted by them.

If your mother wants to pursue this, she needs to lodge a formal complaint with Aviva. If they continue to refuse, she needs to exhaust their complaints procedure and get a letter of deadlock from them. She can then refer the matter to the Financial Ombudsman.

Again, OP, can you link to the policy wording? Because it sounds to me like they may be communicating badly and / or citing the wrong grounds for refusing a claim but it would be standard that this sort of eventuality would not be covered. People here may be able to help but not without the policy wording.

It isn't difficult to find the terms of Aviva's travel insurance. A simple Google search brought them up, which is why I was able to quote the relevant section in my post above.

I think from what Ive read about this over the years, a lot of people are not really covered by automatic bank account insurance provisions. They think they are and its sold as a perk of the account (which no doubt you are paying for) but when people have dug down to look at the details you cant possibly be covered. Well you personally might be, but a lot of people have GP appointments or test they're waiting for, referrals they're waiting for and no insurance will cover for that, but if something happened and they request your medical records and find out that you had a infection they didnt know about or you're waiting for a ct scan or the results of one or whatever it is, and you havent declared it, it will just make the whole policy void.

Surely that has to be in the actual wording in the mothers policy though?

You’d assume so, and this is where it becomes unstuck.

We’ve asked them multiple times to show us where this is stated in her policy and it’s not!

I also don’t know where it ends? I had surgery 8 weeks ago and have an antibiotic cream now because I had a bleeding episode - do I need to declare this to them???

Yes, if you’ve got any travel booked or are planning to book any, you need to inform the Medical Screening Team that you’ve had surgery and have had a bleeding episode, and they’ll let you know if they accept it or not. As someone else has said, the terms of the “free with bank account” type insurances are even worse than normal.

Theres nothing else anyone here can say if you’re sure that your mums policy wording is different to what we’ve all found, though. You’d need to upload a copy of hers. From what I can see, Aviva has included that as a term in every update since 2022 at least, I didn’t look before then.

We can help with an Ombudsman complaint once you’ve got the right wording. It doesn’t overly matter what they’re stating the issue is - if the ombudsman finds against them, they may order an additional payment to you for poor communication/inconvenience, but their case won’t be thrown out because they’re badly communicating the reason for exclusion to you, if they are excluded, sadly. The only upside of that for you is that you’d probably get between £50 - £200 more in compensation.

Otherwise your mum can just document it all and send it to the Ombudsman, if you’ve got a letter of deadlock, and they’ll make a decision. Cases tend to get worked on and resolved a bit faster if they’re well presented but it doesn’t really affect the outcome.

Best of luck with it.

OP - without emotion and factual. What did the decline letter say?

Many policies will expect you to notify them if someone close to you has a condition that could foreseeably cancel travel as it would increase your premium.

The purpose of insurance is you pay relative to your risk. Your mum had a higher risk of cancelation due to your dad's condition. If they didnt know about this your mum wouldn't have the correct cover so it would be reasonable to decline.

Aviva wouldn't have connected a declined policy with your mums policy and therefore would not have known about your dad's condition.

And yes. If you were going on holiday you would need to let your insurance know about your anti biotic cream. You need to let them know about everything prior to the trip.

If they have complained "several times" why have they not already gone to the ombudsman? The ombudsman will review the declinature against the policy wording and there's your answer.

The term and conditions of Aviva's travel insurance can be seen at NTRTG10145.pdf. It contains the words I quoted yesterday several times. Are you saying that your mother's policy had different terms? Or is this the wrong insurer?

Given your DF’s insurer will make good the loss for both your father and mother why not just go with that, then move your mothers policy away from Aviva and move on.

Principle or no principle it’s really not worth the trouble.

It’s annoying op won’t confirm the correct pw or post the decline letter. We can’t provide correct advice otherwise.

i have said multiple times this term is not in her policy! I don’t have the exact policy to quote at the moment but we have asked them to point to a term like this multiple times and they can’t - because it is not there!

That my father is an insured person (he’s not) and he failed to disclose his health conditions (he didn’t)

If they have raised a complaint, they need the firm to issue a final response letter and then they can go to the FOS

It seems fair enough to me - they'd refused to insure him as a policyholder, so why would you expect them to pay out when he is the third party who caused the policyholder's trip to be cancelled? They laid their cards on the table when they originally refused to insure him.

But they're not refusing to pay out for his costs, just your mums who wasn't ill and technically could have continued on her holiday?