Active discussions

Meet the Other Phone. Flexible and made to last.

Meet the Other Phone.
Flexible and made to last.

Buy now

Please or to access all these features

Talk
Money matters

Find financial and money-saving discussions including debt and pension chat on our Money forum. If you're looking for ways to make your money to go further, sign up to our Moneysaver emails here.

Original poster

Travel insurance claim.. wrong information.

41 replies

LibbyL92 · 05/12/2023 22:30

I’m incredibly upset…

So for the last year I’ve been going through insurance claim. As I fell ill abroad last year (USA)

cutting a long story short I was due to receive a determination today to say wether or not the insurance are paying out.

I call up this afternoon and the insurance worker informed me that the claim is successful and they will be making full payment to the hospital. I cried with joy. They went on to explain the next steps and how it could take a few weeks to fully settle. But it was all positive and being handled. Great. Huge weight lifted.

fast forward two hours I get a phone call from the insurance… a different person this time who informs me that the previous member of staff has given me false information and made a big mistake, that they ARE NOT paying out and my claim has fallen through.

by this point I’m besides myself. Crushed.

they’ve offered me £200 compensation for the mistake.

I don’t know where to go with this. The reasons for denying the claim is because I didnt declare medication I was prescribed 18 months ago. (My sickness was not due to or related to anything to do with that medication) oversight. Ok.

But to tell me my claim is successful and completely snatch it away from me again a few hours later…. Surely that’s a big mistake?

I feel crushed.

OP posts:
ThanksButNoThanksImDoneNow · 05/12/2023 22:45

Can you appeal a decision or go through the ombudsman or anything?

Original poster
LibbyL92 · 05/12/2023 22:49

ThanksButNoThanksImDoneNow · 05/12/2023 22:45

Can you appeal a decision or go through the ombudsman or anything?

Because ive not settled on the £200 compensation due to the wrong information being given to me. Someone higher
up is going to call me within 3 days.

im just so upset that a colleague has told me it was all accepted? And then all of a sudden that’s a mistake?

how can someone make a mistake like that? I just don’t understand.

OP posts:
DelightfulDoris · 05/12/2023 22:50

Out of interest, how much is the claim for? What was the hospital bill.

I can’t imagine how you felt when they called you back ☹️

Original poster
LibbyL92 · 05/12/2023 22:53

$2000 :( I have no idea how I’m going to pay it tbh.

im hoping they accept a payment plan or something.

I’ve been crying all evening. Firstly tears or relief and now sheer disbelief. I’m gutted.

OP posts:
Tremblingmadness · 05/12/2023 22:56

Surely if the medication is not linked to the illness causing the claim, you have grounds for appeal against the decision to refuse payment.

I would go to the Ombudsman.

if doing so don’t just accept the compensation they are offering for the mistake. Ask them to put the reasons for declining your claim in writing and also the reasons why they phoned you saying the claim was accepted and then changed that decision almost immediately.

Original poster
LibbyL92 · 05/12/2023 22:59

Tremblingmadness · 05/12/2023 22:56

Surely if the medication is not linked to the illness causing the claim, you have grounds for appeal against the decision to refuse payment.

I would go to the Ombudsman.

if doing so don’t just accept the compensation they are offering for the mistake. Ask them to put the reasons for declining your claim in writing and also the reasons why they phoned you saying the claim was accepted and then changed that decision almost immediately.

Edited

Really?

so the medication was sertraline. I actually never went and picked the medication up. As I read side effects and was put off.

so although it’s on my record I never picked those pills up.

But what about the mistake the first colleague made? Surely that’s more than a small error? We’re not talking about a spelling mistake?

OP posts:
ThanksButNoThanksImDoneNow · 05/12/2023 23:00

how can someone make a mistake like that? I just don’t understand.

that’s how I felt when we phoned and checked that an application for a life insurance policy had been approved (health issues) right before we headed out the door to sign paperwork to buy our first house. If it had been rejected we wouldn’t have signed.
When we arrived at our new home weeks later, there was a letter addressed to us saying the application had been rejected. It was sent to the house we didn’t own at the time we made the application. We got an apology and a ‘the person that sent the letter no longer works here’, were sent a bouquet of flowers and a £50 cheque. It’s baffling how people can be so clueless at their actual jobs.

Original poster
LibbyL92 · 05/12/2023 23:04

Jesus… I’m so sorry. That’s terrible.

I don't even know what I want the outcome to be.

it’s been a shitshow from the get go.
they’ve been useless throughout. Not once have they ever phoned me to keep me updated. Only today to tell me of that error.

I’ve got a bloody debt collector in USA chasing this payment too. It’s a mess.

OP posts:
Tremblingmadness · 05/12/2023 23:13

I am not a doctor OP and have no idea what Sertraline might be prescribed for, neither do I know what your claim was for. But if you are convinced the two are not connected in any way, you clearly have grounds to ask for the reasons for the claim being rejected, in writing.

Together with reasons for the call saying the claim was accepted, followed by one saying it was rejected, in writing.

Once you have that information, you can decide whether to approach the Ombudsman.

Be aware though, the Ombudsman process can be very long winded.

I went through the Ombudsman over a PPI claim. It was rejected three times but I knew I was right with regard to the point of law that they had misunderstood. I kept asking for escalation, had it referred to a senior Ombudsman and eventually won after four years.

SquishyGloopyBum · 05/12/2023 23:14

Tremblingmadness · 05/12/2023 22:56

Surely if the medication is not linked to the illness causing the claim, you have grounds for appeal against the decision to refuse payment.

I would go to the Ombudsman.

if doing so don’t just accept the compensation they are offering for the mistake. Ask them to put the reasons for declining your claim in writing and also the reasons why they phoned you saying the claim was accepted and then changed that decision almost immediately.

Edited

Please do this. This is excellent advice.

Original poster
LibbyL92 · 05/12/2023 23:19

Tremblingmadness · 05/12/2023 23:13

I am not a doctor OP and have no idea what Sertraline might be prescribed for, neither do I know what your claim was for. But if you are convinced the two are not connected in any way, you clearly have grounds to ask for the reasons for the claim being rejected, in writing.

Together with reasons for the call saying the claim was accepted, followed by one saying it was rejected, in writing.

Once you have that information, you can decide whether to approach the Ombudsman.

Be aware though, the Ombudsman process can be very long winded.

I went through the Ombudsman over a PPI claim. It was rejected three times but I knew I was right with regard to the point of law that they had misunderstood. I kept asking for escalation, had it referred to a senior Ombudsman and eventually won after four years.

Thank you for the advice.

supposedly someone is calling me in 3 days from the complaints department and I will be asking those questions and in writing.

I’m certain that medication (which I never even went and picked up from the pharmacy) is not related to my visit to the ER in USA. No connection whatsoever.

She did say anything within 2 years needed to be declared. Related or not. But I’m going to challenge it.

OP posts:
GrannyAchingsShepherdsHut · 05/12/2023 23:25

Did you declare the depression OP? Not that that's particularly relevant if you, say, broke your ankle. But if you declared the illness, but not a medication that you didn't even take, I can't see they would have a leg to stand on.

If you didn't tell them about the depression at all then I would think that might be trickier.

Original poster
LibbyL92 · 05/12/2023 23:28

I didn’t..

I didn’t see it as a medical condition. It was prescribed 18 months before I even had the holiday. I should have read the small print. I just assumed they were asking for diabetes, asthma, cancer ect.

OP posts:
Twentynone21 · 05/12/2023 23:36

I used to be employed dealing with medical insurance claims. Absolutely complain and contest the decision. Many declined claims decisions are reversed, the underwriter hopes the claimant will accept the decision and go away. There will be the complaints process in your policy document, follow that and be persistent.

stayathomegardener · 05/12/2023 23:37

Hmmm tricky you definitely should have declared depression as it would raise your insurance risk level in general but then for example what if you weren't actually depressed but say had low vitamin D which was resolved by over the counter supplement hence not collecting your prescription...
Can definitely see it both ways.

KingsleyBorder · 05/12/2023 23:38

You have good grounds to challenge the declinature of cover. The basis of your challenge is Section 11 of the Insurance Act 2015. It was a big change in the law at the time and some insurance companies still have staff who don’t understand what it means. I’ve screenshotted a leaflet that explains it. Do not accept this as a final decision.

Travel insurance claim.. wrong information.
Original poster
LibbyL92 · 05/12/2023 23:47

Thank you for taking the time to find and post that. I really do appreciate it.

I’m really not good with things like this. What do I need to say to them?

OP posts:
Original poster
LibbyL92 · 05/12/2023 23:48

I just had zero knowledge I had to. I’m massively regretting it now and it’s definitely and eye opener and lesson moving forward.

OP posts:
Original poster
LibbyL92 · 05/12/2023 23:49

Thank you.

so a case of phoning back, and complaining? If their adamant I needed to include the depression what can I say?

OP posts:
Original poster
LibbyL92 · 05/12/2023 23:56

KingsleyBorder · 05/12/2023 23:38

You have good grounds to challenge the declinature of cover. The basis of your challenge is Section 11 of the Insurance Act 2015. It was a big change in the law at the time and some insurance companies still have staff who don’t understand what it means. I’ve screenshotted a leaflet that explains it. Do not accept this as a final decision.

Not sure if my previous reply notified you. (I’m not good with tech)

But can you explain what that means? And how do I word that to them?

also, thank you for taking the time to find and post that.

OP posts:
Soberfutures · 06/12/2023 00:14

Did you get a paper prescription or was it sent electronically to a nominated pharmacy?

If a medication is not collected it gets returned to the spine and can be traced as expired. Maybe this can prove it was never in your possession. Ask the pharmacy it would have been sent to for the information.

Original poster
LibbyL92 · 06/12/2023 07:11

Soberfutures · 06/12/2023 00:14

Did you get a paper prescription or was it sent electronically to a nominated pharmacy?

If a medication is not collected it gets returned to the spine and can be traced as expired. Maybe this can prove it was never in your possession. Ask the pharmacy it would have been sent to for the information.

Would have been electronically. I wil see if I can phone them today.

OP posts:
MontyDonsBlueScarf · 06/12/2023 07:50

When you talk to them, you need to get really clear about why they're denying the claim. Is it because you didn't tell them about your condition, or you didn't tell them you had been prescribed medication, or you didn't tell them that you'd been taking medication? If they're saying you didn't tell them about the condition then there's not much point arguing that you never picked up the medication.

The screenshot that @KingsleyBorder posted means that you will need to show them that whether or not you were depressed in the past made absolutely no difference to your claim. For example, if your claim arose from being a passenger in a train that came off the rails then your history would have had nothing to do with it. On the other hand if your depression led directly to the situation that caused your claim then they'd probably be right to refuse it.

If it's not clear cut, it may help if you can get a letter from a medical professional saying that the two were in no way related.

KingsleyBorder · 06/12/2023 07:55

Just tell them that you don’t accept the decision.

Then say what you have said here- the depression was in no way connected to the reason you were hospitalised.

Therefore refusing cover breaches Article 11 of the Insurance Act 2015.

You do not need to say any more than that. Let it go to the ombudsman if need be.

To help you understand, read the screenshot carefully and look at the example about the sprinkler.

In a medical context a similar example would be that you do not disclose that you are on heart medication. You are then hospitalised because you break your leg.

I give this advice because you have said that you are 100% certain that the depression was not connected to the hospital stay. If there is any room for doubt in that then the argument won’t work, and it’s on you to prove it.

KingsleyBorder · 06/12/2023 07:56

Wholeheartedly agree with your post @MontyDonsBlueScarf (we cross posted). The not picking up the medication is a red herring and not relevant.

Keep it simple.