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?

Which is fine but you risk not being covered if their health, if related to any such appointment, means you have to cancel a trip. It won’t invalidate your insurance but it will impact your ability to claim for any pre-existing condition they have.

But why, when my insurance has no term that requires me to declare this? They can’t unilaterally make up rules later. Why two years? Why not 5? Why not their entire life?

If your policy doesn’t have a term such as this then fine, although that would be very unusual.

It is limited to two years because that is a reasonable time frame that makes the possibility that something more might arise from it reasonably foreseeable. Ultimately it is unlikely that a trip to the GP for a cough is going to directly be linked to something that means you’ll need to cancel your holiday. But if your nearest or dearest has a significant and known health issue you should let them know or risk not being covered. It is what it is.

Normally when I book a holiday for two us there is only one booking. I am the lead booker and I am the one who pays £3k or whatever for the holiday. You can't cancel half a holiday. Were there separate flights and hotels booked separately by each of your parents? If not then perhaps father should just claim for it all. Is the objective here to recoup lost costs or to make a point?

Fwiw my insurance is with Aviva via a NW bank account. It covers DH even though he isn't named
I paid an extra £400 because of pre-existing conditions for both of us.

The FCA don't handle consumer complaints. OP can go to the FOS, but only after she has exhausted the insurer's complaints process and got a deadlock letter. However, since every Aviva policy I have looked at required her mother to disclose her father's pre-existing medical conditions, either because he was also covered by the policy or because they were travelling together, I doubt she has a case. The fact his conditions were disclosed to the insurer some years ago in the context of his insurance policy is unlikely to be enough.

Well if we look at the Aviva policy the OP mentions doesn’t say it, nor does mine so I’m not sure it is usual that you have to declare all close family member appointments - OP’s policy says if the insured person knew of of a family members illness or injury that could be expected to affect the holiday it should be declared, which is a world away from actively making enquiries of your family to declare every appointment over to last two years.

What exactly does your insurance (or most recent insurance) policy say?

Staysure have a very good reputation

They don’t say you have to actively make enquiries, neither did I. They say you have to inform them, as you quote. If you don’t inform them because you don’t know / didn’t ask or because you knew but didn’t tell them it won’t make any difference when it comes to trying to claim. The only relevant points are whether it counts as pre-existing and whether you informed them.

Whether I knew or not is relevant, as it explicitly says that I must inform them of conditions I knew about - not all conditions that exist.

I appreciate that may be difficult to prove, but given there will be witnesses to give evidence in a court case and the test would be balance of probabilities, then it should be a winnable case if you genuinely didn’t know.

Mine is the same - I just contact my insurer (Aviva) to update them on my medical issues before I book a new holiday. The last time I did this we had to pay an additional annual premium due to DHs recently diagnosed AF, but were told that we wouldn’t need to declare anything such as change of medication for conditions already listed up to the point that the additional premium is due for renewal.

I suppose the insurers would argue that if someone became ill / died and as a result you would therefore cancel your holiday, then you’d most likely be aware of any pre-existing health condition that could result in death?
In the OPs parent’s case, her mother knew of a pre-existing condition of her husband, indeed the insurer she continued to use refused him insurance because of it. What she should have done was contact the insurer immediately before booking the latest holiday to confirm her insurance status given her husband was now insured with someone else.
Im not sure why they haven’t claimed on his insurance if, as the Op states, he’s sure the claim would be accepted.

If you’re referring to OP’s policy, we don’t know what it explicitly says, we haven’t been given the link to the wording. It is highly unlikely it refers simply to what someone "knows" as the basis for cover or not as that is obviously difficult to prove and Aviva won't have had the trainee draft the policy wording. Any description of a policy saying as such is likely to be a précis and actual, full policy wording is key.
It certainly isn't the wording in any Aviva policy those on this thread have already looked at.

In any event, OP’s mum did know in this case, and the insurer could easily prove that since he’d been refused cover previously. So it's moot.

Again, you don’t have to report everything to have insurance. You do have to report anything for which you want any consequential cancellation to be successfully claimed for if it is defined as pre-existing. If you haven’t, you will have very limited options to successfully challenge denial of cover. If your parent / spouse / child etc has a serious health condition that might threaten your holiday then you are likely to know and best advised to notify. It is not actually that onerous in practice.

For the avoidance of doubt, this is pretty close to my area of practice so I’m not just speculating.

We cancelled a holiday when mil got ill and was expected to die. She didn't as it turned out.
She was not travelling with us. But we could not go with her being so ill.
We were covered and they paid out because her illness was entirely unexpected. If it had been a long term condition they would not have paid as you are meant to tell your insurance about the health of anyone you are likely to have a cancel your holiday for even if they are not traveling with you.
In your case, if you are saying you can't go because dh is ill and you did not declare his condition when you took out the cover they probably won't pay out. Does that make sense?

God, I do wonder what the point of having a policy is. They will find some loophole whatever you do.

I wouldn’t be surprised if they have the details wrong on their database and they still have your DF as being insured with them. This coupled together with ignoring the evidence that has been submitted to them.

A literal “computer says no”.

Or when they set up the individual policy the previous history was not registered. It may even have been a gdpr issue that details of df were not copied over and dm would need to restate it.

Agreed we don’t have OP’s but I have taken a snip of Aviva’s actual policy documents for direct insurance and it does indeed say this. The picture is in another post of mine on this thread but I’ll add again here.

I also work in a sector that requires careful wording of legal documents and legal interpretation, so while not insurance the skills read across - which is why it’s frustrating that people on the internet are citing some 2 year rule for close family members GP appointments that I cannot see any grounding for. Even if I have to disclose the appointments, where is this 2 year precedent coming from? Is there case law to support this? Because it’s sure as not in the Aviva insurance terms, and as far as I can see not in my travel insurance terms either.

If you are travelling as a couple, you have to insure as a couple. Otherwise the health condition of your partner will not be considered, if you have to cancel.
I have to declare all kinds of conditions for my DH and found one who would insure us both together, though it can be expensive.
Otherwise, holiday in uk

Presumably as Staysure are willing to cover full cost of cancellation the holiday was booked with him as lead passenger? I don’t think it is necessarily true that they need a joint policy though.

It IS in the policy (assuming it’s a Saga policy)

”Health - it is very important that you read the Medical Declaration section on page 11. This applies to all insured persons and anyone else upon whose good health your trip depends.”

”Medical conditions of travelling companions, close relatives, close business associates, or people with whom you were going to stay, whose health may affect your decision to travel, may not be covered.”

”What is not covered… any claim if at the time your policy starts … any person on whom the trip depends including the person with whom you are travelling… or a close relative… had a medical condition… for which they were receiving treatment…”

Your mum needed to declare her husband’s pre-existing medical conditions on her policy, even those he is not an insured person, as he falls within the definition of a “close relative” and his health affected her decision to travel. It doesn’t matter that your dad was previously insured with them, the onus was on your mum to declare all material facts.

You possible recourse is to ask the question… if mum had declared her husband’s pre-existing medical condition, would Saga have (i) excluded all claims arising from it or (ii) covered it possibly for an additional premium? If the latter, you may be able to argue that the non-disclosure hasn’t caused any prejudice to the insurer. They may be persuaded to pay the claim and deduct any additional premium which would have applied.

(Former Saga / Aviva travel insurance manager)

Oh God, yes definitely.

You’ve had some very good advice from @prh47bridge and @AgentLisbon

You keep saying that the wording being cited isn’t in your mother’s policy. Have you reached that conclusion because you’ve read through her policy booklet yourself or because Aviva haven’t specifically pointed your mother to the relevant policy wording in their correspondence?

I suspect the case handler’s explanation for declining the claim isn’t very clear. If you escalate your complaint to Customer Relations, you’ll get a proper explanation with reference to the relevant policy wording.

Ok, here's my take on this - the insurance company already knew that dad had health conditions and refused to insure him so they were not going to forget that fact when mum turned it to a single policy failed to declare it.

It's well known and documented that insurance policies do not pay out for existing health issues that aren't declared, the onus is on the traveller to declare it.

A health condition doesn't become non declarable just because it's managed by medication, he always had the potential to forget meds or suddenly take unwell with it.

I'd be wary of wanting multiple insurance policies to pay out for the same person and same event in case it raises any red flags of possible insurance fraud.

I’m with Staysure and they have always been brilliant and paid out a big claim. Not always the cheapest but always worth it. Im
so sorry your mum is having this stress and hope it gets sorted, but if not then hopefully Staysure will cover her part too.

I think there are two issues here.

1: Possibly a poor explanation/wording from the call handler at the insurance company. OP has understood this as "Your father has an insurance policy with us", when they could actually mean "Your father is an insured person under the policy for the purposes of making a claim based on his health condition.'

2: OP's position is that her father's condition was disclosed to the insurer, at the time they refused him coverage and her parents' joint policy was cancelled. I expect the insurer's position is that this disclosure was in relation to the old, cancelled policy, and that her mother's new single policy did not contain this disclosure. They may even feel that because they refused coverage, no official disclosure took place.

You could certainly make the argument that it was poor form from the insurer not to transfer that information over to the new policy. On the flip side, her mother has a responsibility to check that her declarations are correct and up to date.

Again, tough to know without seeing the policy but it may be that there's a requirement to inform them of a non-policy holding travel companion's existing health conditions prior to every trip. Someone might go on four trips with four different people per year, that's a lot of personal data to hold indefinitely.

If her parents are adamant that they want to pursue this and they've exhausted the complaints procedure, ombudsman is the next step. If the above is true though, I don't think they're likely to succeed.