anyone good at insurance law?

[hatwoman]

I had a ski-ing accident earlier this year - had to be helicoptered off the slopes and taken to 2 hospitals. After being stitched up I took a taxi back to the resort (the consultant didn;t even want me to do that - he wanted someone to pick me up. obviously there was no-one so he agreed it would be ok.

2 days later I had to go back to the hospital - the only way of gettting there and back was by taxi. I spoke to the insurance company and after expressing some initial doubt as to whether this would be convered they said ok.

fast forward several months - I (finally) get a response to my insurance claim. the settlement if £300 short. apparently the taxis weren;t covered. I have read the policy and it does indeed list taxi fares under the exlusions. It says "taxi fares (with the sole exception of the taxi costs
incurred for the initial journey to a hospital abroad due to an Insured Person?s illness or injury)," are not covered.

now I have a 3 of questions on this.

1. if it's part of the standard exclusion why was there ever any doubt about whether it would be covered, let alone a verbal confirmation that it would be

1. what does "initial journey" mean? It's an ill-defined concept imho. The first journey to hospital was in a sodding ambulance.

1. the phrase "fit for purpose" keeps coming to my mind. now I was half way up a mountain with no other way of getting to hospital for my follow up appointment. i was badly injured and needed to see an eye doctor to see if I'd done serious damage to my eye. Now if I buy medical insurance that does not cover the cost of me getting to hospital then, regardless of what it says in the policy, surely it's not "fit for purpose". Did I imagine that this might be legally relevant or have I got a point? The ridiculous thing is that if I had declined the follow-up appointment, and instead decided 2 days later that my eye was really hurting (it was) and called an ambulance it would have cost a shed load more but would have been covered. aaaargh.

I'm so annoyed about this. Surely I;ve got a leg to stand on? any ideas?

Hatwoman, I don't know much about UK insurance law (which is presumably the one governing your policy)

But what springs to mind is that in some countries it is cheaper to call an ambuance than a taxi. In France for example, there are non-emergency amublances which are basically just ordinary cars but with some extra bits (eg blue light) and a driver trained in assisting injured people.

Most travel insurers exclude taxi fares, so its not uncommon.

Your only hope is if you got the name, time and date of the person who verbally confirmed it would be refunded you can try and appeal and there are several stages you can go through to do this.

Based on past experience, I'd say there was not a high chance of a refund.

They give you a load of flannel about being the "human face of insurance" when in actual fact they have sold you an insurance policy that doesn;t cover you to get to hospital when you are battered beyond recognition and have potentially done serious damage to your eyesight. marvellous.

Contact the insurance ombudsman, they're your best bet IMO.

did you read your policy documents at the time you received them?

If you'd read the documents beforehand you would already have known that taxis were not covered by the policy.

The adviser in question shouldn't have told you that the taxi fairs would be covered, so you could put in a written complaint about him/her and he/she will be reprimanded accordingly, but in financial terms it was written in black and white in your policy documents that the fairs wouldn't be covered. Therefore you don't have a leg to stand on, sorry.

on the one hand yes, it was written in black and white. on the other hand law is not always quite so simple as that. which is essentially why I was posting. I suspect, increasingly, that I won't get my £300. and it won't be the end of the world. but what I am most annoyed about is that having bought the insurance I was under an illusion that if I needed emergency medical treatment I would not incur substantial costs. and I hope other people aren;t under the same illusion.

and I love the idea that reading the 30 page policy before I went away I would have absorbed every word (not knowing which words would later become particularly relevant) and then remembered them all when I was seriously injured...their own people don;t even know what it says!

I am in shock. They just phoned me up to say they would cover the taxis. no written appeal or complaint - just me having a rant on the phone yesterday, and pointing out to them that I was up in the mountains probably 100km from the hospital with no other means of transport.

I'd love to know why the change of heart - whether it was because they found the log of telephone call where I;d been told they would cover the cost, or whether they realised it was a totally reasonable cost that came within the spirit, if not the letter, of the policy.

The whole thing has made me feel really quite horrible. It's brought it all back to me - just how hideous and scary it was, going in a helicopter and an ambulance, on my own, unable to see, in a neck brace, not knowing if I'd broken my neck or not, not knowing if I'd lost an eye....I was so lucky.