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Insurance stupidity

 Poster: A snowHead
Poster: A snowHead
I have a Diamond multi trip world wide Ski Club of Great Britain policy which I have bought as it covers heli skiing.

I have unfortunately badly damaged my knee two weeks before I am due to go off to Canada but still want to go on the holiday, albeit I shall be hobbling although no chance of skiing.

I have just contact the insurers to ask if I can claim the difference between heli-skier rate for the holiday and non-skier/hotel rate and they say NO

They would apparently prefer to be looking at a £6,000 claim rather than something like a Can$3000 claim!

Is this stupidity or what?
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
@FFIRMIN, indeed - cancel and rebook?
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Well, the person's real but it's just a made up name, see?
Problem is with the airfares, I booked a year ahead and got a really cheap business class return fare, it is now £8k on the website! Otherwise that is exactly what I would do but rebooking the flights would be something of an own goal as I would still have to pay the non skier heli rate on top of the pricey air fare and with the poorly knee the flat bed option is highly desirable so as to avoid the risk of DVT Bit of a dilemma but total financial madness on the part of the insurer. I have emailed a former colleague who is fairly senior in the insurance organisation and I will be taking this up with the MD on Monday! It makes no sense at all but is probably a box ticking exercise. However you would think there was an escalation procedure or an unusual situation rather than a flat NO.
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@FFIRMIN, good luck
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 Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
Sometimes insurance is slightly illogical. When I broke my ankle (but hobbled in a ski boot as I didn’t believe it was broken at the time) we drove from Saas Fee to Visp in my own car rather than get a taxi, saving a good chunk, but the did need to get a taxi from the car park to our flat once back in resort as it is car free. They wouldn’t pay that taxi as it wasn’t a trip to/from hospital (obviously, it’s an electric buggy rather than a car) but they would have covered ambulance or taxi all the way to/from Visp which would have included the bit to the flat. In trying to save money for them we ended up having to stump up the 20CHF for the taxi.

Granted the rest of the service was great from them and they dealt with everything quickly it seems that to reject one receipt was a bit tight when they would happily have paid more.
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Bad luck on the knee injury, @FFIRMIN. Can't help with the insurance.
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FFIRMIN,
Sorry to hear about the injury. Bit of a bummer, that... Sad

It's good to see that you are still positive about going on the trip. I imagine (in similar circumstances) I would be less so...

Good luck with the insurance. Their stance does indeed seem ridiculous.
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After all it is free Go on u know u want to!
I shall keep working at the insurers until I am due to head off later in the week. I have emailed their "costs containment" department and will endeavour to try and take this much much further up the line. They can potentially save £3000 by chipping in the difference between skier and non skier rate in the Lodge rather than paying out a maximum claim of £6,000. It seems to me like a no brainer but there you go, there are not always great brains at admin level where there are boxes to tick and no scope for imagination.
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But they work on risk, @FFIRMIN. The likelihood of having to pay out the maximum claim rather than the certainty of losing revenue now....
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@pam w, i got the impression that @FFIRMIN "would" cancel because of injury so the insurance would be paying £6k for sure
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Ah yes - you're probably right, @holidayloverxx, I wasn't sure I'd read it right.
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FFIRMIN, Insurance co. are in the business of making money, and tend to know that business pretty well. As pam w, says they work on risk - make an assessment of that, and then make a decision based on it wink

You are asking them to pay for a part of your holiday you cant now take advantage of, but want them to cover the rest as normal. Have you told them what the damage is to your knee, and can obviously prove that you are unable to ski ? Hence the reason to claim ?

I went to Canada with a torn meniscus a few years ago and skied, rightly or wrongly I didn't inform the insurance co. as I know what the answer would be. I was prepared if the worst happened, to sort things out myself - and be aware of potential complications while there Smile

Good luck with your plan, and I hope the knee isn't too long before its back to normal.
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I am pretty sure that a "claims adviser" has a script to run to and has no discretion to deviate. My doctor is providing a letter to confirm that I cannot ski for now and when the knee settles I will be sent for appropriate tests and an orthopaedic opinion. I would imagine that the insurers if willing to accept that the skiing aspect of the holiday is a complete no no they will decline to cover any claim in connection with the knee if I were to travel. That would seem entirely reasonable. This is something of an interesting minefield in insurance terms. There is a clause in the policy about cancelling due to "disinclination to travel". Could they apply this to a pre holiday injury which while not preventing travel per se does preclude the insured from undertaking the main purpose of the trip (skiing and heli skiing at that). So fit to travel but not fit to ski making one disinclined to travel!? A possible get out for insurers? One would hope not when the cover is provided under the nomenclature of the Ski Club of Great Britain . The only reason I pay for the extremely expensive annual worldwide SCBB policy is to ensure that heli skiing in N. America is included in the cover. My 70 year husband was quoted nearly £1000 for the SCGB policy for this year but in fact is not skiing due to recent hip replacement and we therefore purchased alternative annual world wide cover including cruising for a "mere" £200. Last year we paid circa £350 for both of us for the Ski Club of GB policy as we were both under 70 and heli skiing but we took out alternative cover for our cruise. I presume the hugely increased SCGB quote for my husband for this year was due to his age, at the time I sought the quote I did not mention the hip replacement so that was not a relevant factor in the quote. So I shall set about the insurers again tomorrow but endeavour to get beyond the automaton claims team response. Will let you know how I get on. Having worked in the insurance industry myself for 19 years I totally understand some of the issues but equally there are times when commonsense should prevail.
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 You know it makes sense.
You know it makes sense.
lampygirl wrote:
In trying to save money for them we ended up having to stump up the 20CHF for the taxi.


That's sadly where you went wrong. Insurer will never do you any favours and will always work directly from the script so the best thing you can do is use all your entitlement.

Yeah it sucks, yeah premiums go up because everyone is spending more, but insurers are definitely 'all or nothing' when it comes to claims.
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Otherwise you'll just go on seeing the one name:
My insurance drama was bonkers last year when I did my pelvis at the BB. It took nearly a year to settle the whole claim (which covered 3 different sections), the main sticking point being the cancellation of the trip I'd booked which would follow the BB by 2 weeks. I'd cancelled it with a day's notice since this was when I was formally told by the trauma dept doctor not to ski for 2 months, since the GP won't write such letters.

The main sticking point was that, in the questionnaire for my doctor, there was a question which said "when could the need to cancel the patient's trip have earliest been anticipated". My GP took the term 'anticipated' quite literally and the date she gave was the date of the injury. Her thought was that once I got injured, I could have anticipated that I might need to cancel. Not an unfair point. But likewise, had I cancelled the trip without the authority of the trauma dept, the insurer would have tripped me up by saying that I had no right to cancel without being told to do so and thus it was my choice not medical advice. So you're basically screwed either way.

So I then had to get a further letter from the GP which literally just said "my patient first anticipated the need to cancel on the day of the injury, but did not receive an appointment at the trauma clinic for 2 weeks and once he received their advice, he cancelled the trip immediately" and included evidence of the appointments. But the letter cost me £15 (in addition to the £15 for the questionnaire which started the hassle in the first place); and the insurer says that this cost cannot be claimed as part of the claim.

As @FFIRMIN said, the claims people have no discretion. It's not so much due to a script - it's just that the broker doesn't have the authority to make decisions on behalf of the actual insurer.
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 Poster: A snowHead
Poster: A snowHead
Insurance companies just give you the impression of being covered ... a bit like a comfort blanket.
When in fact it is very rare to get anything back out of them.

Its a shocking industry.
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
DrLawn wrote:
Insurance companies just give you the impression of being covered ... a bit like a comfort blanket.
When in fact it is very rare to get anything back out of them.

Its a shocking industry.


Really Confused You either have a skewered idea of the industry or just use the wrong insurance companies.
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Well, the person's real but it's just a made up name, see?
I almost always self insure, but when I have dealt with other peoples' insurance companies, I've found that they always "try it on" at first. They behave as if they are in a position of strength and have a go at dictating what they think I can claim from them... which as a victim of their customers is not really how the law works. In this case the situation's different, but I'd be surprised if they did not become more reasonable once they realize that you're not going to give up without a fight.

You should probably also contact the heli company to see if you can persuade them to keep your money as a credit. They will almost all do that for good/ repeat customers. Moving their profit around is a better long term commercial approach than taking short term gains. I an others I know have benefited from this approach on multiple occasions. They can hold you to it, but they never held me to any of it.

If the insurance company insists on refunding everything, then I'd send them the receipts and let them get on with it. If they want to pay for the whole thing, that seems to me to be really their problem. I can't see any UK court agreeing that it makes sense to cancel a flight then rebook it. You've told them what you are going to do; if they want to pay more, well.... I think they'll change their minds once an adult sees the claim.
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FFIRMIN wrote:
I have a Diamond multi trip world wide Ski Club of Great Britain policy which I have bought as it covers heli skiing.

I have unfortunately badly damaged my knee two weeks before I am due to go off to Canada but still want to go on the holiday, albeit I shall be hobbling although no chance of skiing.

I have just contact the insurers to ask if I can claim the difference between heli-skier rate for the holiday and non-skier/hotel rate and they say NO

They would apparently prefer to be looking at a £6,000 claim rather than something like a Can$3000 claim!

Is this stupidity or what?


I am a bit puzzled what your point is - maybe I haven't understood. You took on a deal which included heli skiing. You now cannot heli ski. The company is presumably prepared to pay out if you cancel your holiday. You haven't. Why should it pay you - unless the t&c say that it will compensate you for heli skiing you cannot undertake because of injury - in which case that is presumably what the company will do?

I wish you the best of luck with this (and sympathise about the injury).
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Nope I didnt "take on a deal which included heli skiing" I booked a weeks heli skiing and independently flights to Canada. I have an elderly relative in Vancouver who I wish/need to see each year and always make the effort to travel over a week early to see her before travelling across the Rockies to Calgary to join up with the heli ski company and go into the lodge for a week. This year as it happens my husband is going into the lodge on a non skier package as he is post hip replacement so, since my return flight is not until the end of the heli week, it would seem sensible, and I would like, to go into the Lodge for the week on the same basis and obviously not to ski. Yes, I could cancel the whole thing, claim circa £6k from the insurers and rebook to travel out without the heli package included. I am of course obliged to advise the insurers that I have an injured knee under the terms of the policy so whether I travel out to ski or not to ski they will almost certainly advise that any issues with the knee will not be covered and if they do that since the policy is Ski Club and therefore demonstrably in this instance intended to cover skiing they would have to advise the cancellation route or at least they shoul. So there in lies the rub. They pay £6k and the whole trip is cancelled or they could mitigate their costs and make a significantly reduced partial payment. Yes philwig I have already contacted the heli ski company to see if there is anyone on their waitlist who would be glad of the spot and you are right they may well give me a partial credit anyway but thats a different issue. I have behaved as I believed was absolutely the honest and decent way which was to seek to mitigate costs and losses as soon as it became clear that I would not be able to ski. Under the terms of the policy if you suffer injury in resort there is a small daily payment towards the cost of "loss of use of ski package" so had I gone without telling them of my injury "then experienced" an injury on day one I would almost certainly have been entitled to at least a partial payment but I have been up front with everyone from the moment I hurt my knee. I am not hopeful that commonsense will prevail.
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@achilles, +1 and that is what the Financial Ombudsman would also say. For the insurer it's not about the money, it's about adhering to the Ts&Cs and being compliant. There's no cancellation claim if there is no actual cancellation.

The insured is still on risk and intends travelling with a "badly damaged" knee which has now become a pre-existing medical condition. That's another matter.
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What is the SCGB doing to assist, given that it is their branded product?
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After all it is free Go on u know u want to!
I have contacted the Ski Club. This only happened on Friday afternoon so it is early days but I am booked to travel on Thursday.
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@FFIRMIN, sorry, I simply cannot see how the insurance company is failing to comply with its contract with you.
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@FFIRMIN, I'm not sure why (I presume I have misunderstood) you can't just cancel the heli lodge, claim that cost, ignore the unconnected flights and use them and ask the lodge for a price??

Although my experience of heli lodges is thet the better the skiing, the less there is to do if you are not. A non-skiing holiday in a heli lodge would not be my idea of fun.
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I don't really see the issue - they'll pay out if you are not certified fit to travel and therefore cancel. If you travel anyway you're in no man's land so I see why they wouldn't pay out.

You're both proposing to travel to the lodge and not ski? That sounds crazy to me. Why not take advantage of your injury and get a total cancellation of the trip for you and your husband and book a separate trip to see your relative in the future.
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If accommodation and travel were booked separately, can't you just claim for the cost of the accommodation and heliskiing and keep the flights? Then stay somewhere else more interesting and with more to do if you can't ski. If however your mobility is impaired by your injury,why not cancel it all and go and visit your aunt at another time when flights are cheaper?
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Both going to the lodge and not skiing? Yes Dave of the Marmottes we have ended up both not skiing, sadly. I organised this trip so a whole bunch of friends could meet up, this was before my husband caved into the ever pressing need for a new hip. They are a great bunch of people and now I cant ski I simply dont think it reasonable not to go on the trip, we are all getting older and for some of us there may be few chances to catch up all together again. The UK agent for CMH thinks there may be someone who might take my skiers slot in which problem solved. No, I cant really cancel and travel at a less expensive (flight) time the relative in Vancouver is in her late 80s. Both in a lodge for a week and not skiing, they are beautiful places, the food is good, the hot tub is wonderful with amazing views of the local peaks and glaciers, the company will be great, I/we dont often get a chance to just chill and read, do Su Doku, wander about maybe a little snow shoeing if the leg permits, further develop my very novice Bridge skills, etc. etc. In the pre ski week we are planning a trip to Vancouver Island which we love so all in all if I can get a contribution equal or even near to Skier minus Non-skier rate I shall be very happy.
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 You know it makes sense.
You know it makes sense.
Oh well good luck then. If I was the insurance co clearly you are demonstrating the skiing isn't of the essence of the holiday so I wouldn't be looking to pay out. I think you are in a very specific niche so I'm not surprised the insurance co doesn't want to allow partial cancellation.
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I am very lucky that good sense has prevailed and after a bit of chasing the brokers have agreed to accept the claim for "partial cancellation" . I think this demonstrates remarkable flexibility from the insurance industry and sound commercial commonsense. It is always worth pushing just that little (or lot) more when there is a first refusal to ensure escalation to someone who can exercise a level of discretion that is not afforded to first line claims handlers. This was particularly irritating for me having worked in the insurance industry for many years and knowing that if the issue can be queried at the right level it can quite often be resolved to the mutual benefit of both claimant and insurer. So its off to Canada for me and I will have to grit my teeth each morning as our friends head off into the best late season snow the area has had for many years and my new ski boots will stay at home in their box for another year! Oh well more time to get really fit for next year! Thank you to those of you who commiserated, my husband and I are very good at sitting looking at beautiful scenery and we never bored so we will undoubtedly find plenty to do and then when I get back I shall have to grapple with the Health Service to find out what is going on in my knee!! Hope you have all enjoyed the great season this has turned into, it has been good to see the very recent pics of new snow and snowheaders enjoying it.
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 Poster: A snowHead
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@FFIRMIN, a good result. Enjoy your relaxation.
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Obviously A snowHead isn't a real person
Thank you Hells Bells
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@FFIRMIN, Good result. As with many things the key in the system seems to be finding the right person. Unfortunately most organisations it seems are set up to frustrate that.
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Congratulations! Hope the NHS will sort out your knee - was it a skiing injury? I have been advised by an NHS physiotherapist that if I damage eg my ACL the NHS will say I'm too old (at 73) to have it repaired. She thinks I'm foolish to carry on skiing - but it's just far too much fun isn't it?
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No, Jehu not a skiing injury - I got pulled onto rough ground by one of my dogs and I am not sure if I twisted my knee which caused me to fall or whether as I tripped and fell I twisted it but I lay on the ground and thought about skiing for a couple of minutes before getting up and frankly it wasnt too bad at the time and with elevation in the evening and lots of Ibuprofen to reduce the swelling I thought it was getting better but on Friday last I was walking across a perfectly flat car park and something went pop inside and there was acute pain followed by more swelling so I suspect (but am not a medic) that I had sustained a partial tear of something (ligament?) which was settling but would have gone/did go on a subsequent occasion. I am sure if I had gone skiing it would probably have happened within a couple of turns! So its now a wait and let it settle then investigate job. Given that 70 is the new 50 I think your physiotherapist is a bit presumptuous, in the heli ski world there are lots of people still doing it well into their 80s and lots of them have new knees and new hips some even multiple replacements and there are also inevitably lots of people with ligament repairs. Should the worst happen I would "shop around" for a more helpful orthopod (do they do ligaments as well as bones) who would think differently. On the other hand there are lots of people with torn ligaments who ski with braces so its obviously horses for courses. You are certainly right its far too much fun to give up even if, in my case, I am already somewhat limited by another medical condition but as long as I can I shall as I am sure you will!
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Jehu wrote:
Congratulations! Hope the NHS will sort out your knee - was it a skiing injury? I have been advised by an NHS physiotherapist that if I damage eg my ACL the NHS will say I'm too old (at 73) to have it repaired. She thinks I'm foolish to carry on skiing - but it's just far too much fun isn't it?


I presume your physiotherapist is not a skier then? wink
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Quote:


I presume your physiotherapist is not a skier then?

Correct.
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After all it is free Go on u know u want to!
FFIRMIN, Pleased you ended with the desired outcome, enjoy the trip and don't envy your friends too much Madeye-Smiley
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