Page 2 | Travel insurance claim.. wrong information.

LibbyL92 · 2023-12-05T22:30:23+00:00

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.

KingsleyBorder · 06/12/2023 08:03

Unfortunately, however, you can’t just ignore the payment demands coming from the hospital while you wait for the insurance to pay out.

If you let that debt mount up and it has interest or court fees added then you may not get that extra back from the insurers. You should do whatever you can to settle that debt asap, then the insurers should eventually reimburse you if the depression and the hospitalisation are indeed unconnected.

I would suggest that you go to the CAB for in-person advice.

KingsleyBorder · 06/12/2023 08:14

Oh and I know you’re annoyed and upset about the misinformation they gave you about accepting the claim, then saying that they were not accepting it after all.

The £200 they have offered you for the distress that caused is actually quite reasonable. Legally, they are free to change their minds if they want to, especially as they corrected the mistake very quickly. You should accept the £200 but say clearly in an email
“I accept the £200 offered to me for poor customer service. However I do not accept that cover has been validly declined and will continue to pursue my claim under the policy”.

They’ll probably withdraw the £200 offer but it’s worth a try. What you must avoid doing is anything that suggests you are taking £200 in full and final settlement of all claims under the policy.

gotomomo · 06/12/2023 08:23

Unfortunately it's the underlying medical condition that you didn't declare that puts you in breach - is there any convoluted way it could be connected to the claim?

The ombudsman or one of the better newspapers consumer help columnists may be able to help, the guardian are very good if they are willing to take it on, but to anyone reading this thread, declare everything! if you read the small print it's usually gp visits and upwards in last 2-5 years depending on policy, procedures had and medications taken but some have longer periods of exclusion eg mine doesn't require you to list antibiotics as long as it a max 7 day course for a condition.

LubaLuca · 06/12/2023 08:24

If the insurance company won't reconsider, your best chance of getting the ombudsman service to uphold your complaint will be to prove that the T&Cs of the policy were unclear or misleading, which they could well be.

I agree about accepting the £200 on the proviso that you consider that compensation only for the distress and inconvenience caused by being given incorrect information on the phone i.e., you're not accepting their outcome.

TroysMammy · 06/12/2023 08:38

In my surgery any prescriptions not picked up are coded "prescription not collected" and the date of the prescription. The pharmacy that shares the building gives us back the not collected scripts too. Other pharmacies don't.

Could you ask the pharmacy if they have a record of the script not being dispensed?I

However the GP notes would say that during the consultation that medication was recommended for your problem and even though you didn't take it the GP wouldn't know that unless you contacted them to have it recorded on your notes. Even that information probably wouldn't hold up a claim.

I imagine it is upsetting but insurance companies do look for any way to invalidate a claim which is why everyone should ensure they include everything on the form no matter how trivial they think it is.

KingsleyBorder · 06/12/2023 08:41

LubaLuca · 06/12/2023 08:24

If the insurance company won't reconsider, your best chance of getting the ombudsman service to uphold your complaint will be to prove that the T&Cs of the policy were unclear or misleading, which they could well be.

I agree about accepting the £200 on the proviso that you consider that compensation only for the distress and inconvenience caused by being given incorrect information on the phone i.e., you're not accepting their outcome.

With respect @LubaLuca this has nothing to do with the policy being unclear or misleading. That would only help if it turns out the medicated condition of depression was indeed connected to the reason OP was hospitalised, and she then has to argue that it wasn’t clear she needed to disclose them.

But that argument would be much weaker. The strong legal argument is that the undeclared condition and medication had no connection to the hospitalisation. It would not be helpful to go in with any additional arguments about an unclear policy in the first instance. It will just confuse things.

Rocknrollstar · 06/12/2023 08:57

We had something similar and owed over £250000 in America. You can go to the ombudsman. I would suggest that you ask for a payment plan to pay off the debt. Because we owed so much we went to a solicitor who scared the insurance company into paying. The lesson for us all is that you must declare everything to the insurance company before you travel.

Original poster

LibbyL92 · 06/12/2023 10:08

KingsleyBorder · 06/12/2023 08:14

Oh and I know you’re annoyed and upset about the misinformation they gave you about accepting the claim, then saying that they were not accepting it after all.

The £200 they have offered you for the distress that caused is actually quite reasonable. Legally, they are free to change their minds if they want to, especially as they corrected the mistake very quickly. You should accept the £200 but say clearly in an email
“I accept the £200 offered to me for poor customer service. However I do not accept that cover has been validly declined and will continue to pursue my claim under the policy”.

They’ll probably withdraw the £200 offer but it’s worth a try. What you must avoid doing is anything that suggests you are taking £200 in full and final settlement of all claims under the policy.

Edited

Thank you so much.

100% dead set certain that my hospital visit was no way involved with my mental health.

and even if I had declared the mental health pills it would not of changed the outcome of the visit/short term illness.

I will challenge this.

thank you for making it clear.

OP posts:

Original poster

LibbyL92 · 06/12/2023 10:12

gotomomo · 06/12/2023 08:23

Unfortunately it's the underlying medical condition that you didn't declare that puts you in breach - is there any convoluted way it could be connected to the claim?

The ombudsman or one of the better newspapers consumer help columnists may be able to help, the guardian are very good if they are willing to take it on, but to anyone reading this thread, declare everything! if you read the small print it's usually gp visits and upwards in last 2-5 years depending on policy, procedures had and medications taken but some have longer periods of exclusion eg mine doesn't require you to list antibiotics as long as it a max 7 day course for a condition.

100% not connected to the claim. There is no way it could have been connected..

it’s something I will take of of checking in the future. I can imagine 100s of people making the same mistakes.

OP posts:

Original poster

LibbyL92 · 06/12/2023 10:14

Rocknrollstar · 06/12/2023 08:57

We had something similar and owed over £250000 in America. You can go to the ombudsman. I would suggest that you ask for a payment plan to pay off the debt. Because we owed so much we went to a solicitor who scared the insurance company into paying. The lesson for us all is that you must declare everything to the insurance company before you travel.

that must of been an incredibly stressful, scary time. I’m so glad you managed to get things sorted.

a lesson learnt, absolutely! I will absolutely everything from now on.. no matter how small it seems.

OP posts:

Original poster

LibbyL92 · 06/12/2023 10:17

TroysMammy · 06/12/2023 08:38

In my surgery any prescriptions not picked up are coded "prescription not collected" and the date of the prescription. The pharmacy that shares the building gives us back the not collected scripts too. Other pharmacies don't.

Could you ask the pharmacy if they have a record of the script not being dispensed?I

However the GP notes would say that during the consultation that medication was recommended for your problem and even though you didn't take it the GP wouldn't know that unless you contacted them to have it recorded on your notes. Even that information probably wouldn't hold up a claim.

I imagine it is upsetting but insurance companies do look for any way to invalidate a claim which is why everyone should ensure they include everything on the form no matter how trivial they think it is.

I will phone and ask.

Next time I take insurance out I will go through with care and make sure I’m fully covered and have declared everything.

one simple mistake to something so unrelated has been incredibly upsetting.

OP posts:

KingsleyBorder · 06/12/2023 10:58

Don’t tie yourself up in knots phoning pharmacy/surgery, it’s really not relevant.

And you are covered. The law makes that clear. You just have to follow the appeal process.

KingsleyBorder · 06/12/2023 10:59

The law was changed so that mistakes relating to unrelated things no longer had a catastrophic impact on cover, it was precisely to deal with the situation you are in.

Original poster

LibbyL92 · 06/12/2023 11:15

KingsleyBorder · 06/12/2023 10:59

The law was changed so that mistakes relating to unrelated things no longer had a catastrophic impact on cover, it was precisely to deal with the situation you are in.

Thank you so much. You’ve made things really clear and I’m already feeling loads better. I massively appreciate it. I had no idea about that change. So thank you.

OP posts:

squeekychicken · 06/12/2023 11:55

Im not an expert but I don't think emphasising the not picking up or taking the medication is good. You were given a prescription for a medical condition and you refused to take it against I would assume medical advice?
I'd focus on how your illness on holiday was in no eat related to MH.

Original poster

LibbyL92 · 06/12/2023 12:16

squeekychicken · 06/12/2023 11:55

Im not an expert but I don't think emphasising the not picking up or taking the medication is good. You were given a prescription for a medical condition and you refused to take it against I would assume medical advice?
I'd focus on how your illness on holiday was in no eat related to MH.

Thank you, I agree!

OP posts: