Travel insurance claim (unfairly?) denied - Help!

[SparklingPinot]

Hello wise mumsnetters! I am not sure if this is the right board to post on but here goes. Booked a holiday in March. Found a breast lump end May. Went to Doctors very end May - said it’s perfectly normal, I have lumpy breasts etc but will refer me on 2W pathway to hospital for reassurance (as they do with all breast lumps now). 2 weeks later (June) went to hospital where I had a biopsy & breast examination. 19th June I was diagnosed with breast cancer (still thinking I might be able to go on my holiday at this point). Due to surgery this became apparent it wasn’t going to happen or be advisable so rang insurers on 28th June to advise and formally submitted claim a while after (as GP took a while to do their part of the forms I needed). Claim has now been rejected as I should have told them “in a reasonable timeframe” that I was under medical investigation (and paid more ££ for the cover to be upheld). My thoughts are that the timeframes here are still highly reasonable - I could understand if I’d been having tests since April but everything happened so fast! I was wondering does anyone have any advice on how to challenge insurance claims or any positive insights on getting my money back? It feels really unfair!

First of all OP I’m really sorry that you’re going through this, and wishing you a speedy recovery.

Unfortunately your hands may be tied with travel insurance. Check your policy but ours says you have to inform them of any referrals, any investigation of anything, and any new diagnosis, so for ours I would have had to tell them once I received the referral, they would then have undoubtedly increased my premiums, and so would have covered it if I then had to cancel x

I completely understand with the stress and shock of it, that calling travel insurance would have been the last thing on your mind, but realistically you should have called them in May when you were referred on the 2 week pathway for suspected cancer. Doctors don’t use that pathway when everything looks normal just to reassure a patient.

So you were about a month late telling them you had been referred for investigation following finding a breast lump. They usually require to be told about every referral as it happens, even if diagnosis is weeks, months or years away.

You might be able to plead for a partial payout.

OP does it say in the fine print anywhere what they define as ‘a reasonable time frame’?
as if the claim being denied is hinging on that (which seems like it may be a matter of opinion!) then you might have a shot at getting your claim.

wishing you all the best for a speedy recovery. I’m sure this is the last thing you need right now

It all depends on whether the delay in telling them in any way prejudiced the outcome.

So for example where you past refund dates for accommodation or travel.

If you can show that the delay in informing the insurer had no impact on the value of the claim (or difficultly in resolving it) then the insurer cannot rely on the term as it would be deemed to be unfair.

If however, the delay increased the value of the claim or the difficulty in resolving the insurer is within it's rights to apply the term and decline.

So gather the evidence and submit a complaint. The key words that should be included are that you were "in a vulnerable state" and that the claim was "not adversely prejudiced by the delay in notification".

If they decline the complaint then go to the FOS and they should uphold (all the above being true).

I agree it hinges on what your policy says.

I have looked at mine and it says (for example):
“you must notify us immediately” for any changes in health, prescriptions or referrals for investigations of new undiagnosed conditions. “This is so we can confirm whether coverage can continue and if any additional premium is due. Failure to notify us may result in a claim being invalid.”

If yours says “within reasonable timeframe” I agree there may be wriggle room compared to mine which says “immediately”