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Travel Insurance - pre existing condition

 Poster: A snowHead
Poster: A snowHead
burst my ear drum with cotton buds which resulted me going to hospital and being discharged as it heals on its own. I stayed the night but they discharged me and were aware i was planning a trip the following week.
I developed an ear infection in the same ear after a few days of landing which resulted in surgery and my flight being delayed also my hearinf is now compromised.
I have returned and submitted all documents to insurance company. Waiting for them to get back. Ive been reading some posts about pre-existing conditions and insurance firms which got me worried.Surely it cant go down as a pre-existing condition? Appreciate the input.
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
@Shinobi247, welcome to snowHeads. Sounds like a pre existing condition. Many policies require you to tell them about hospital treatment.

What makes you think your claim is not linked to your burst eardrum?
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
Unfortunately that sounds precisely like a pretty existing condition.
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That's not good news - hope your hearing recovers. Does sound pre-existing, though. Sad What were your financial losses?
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 Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
@Shinobi247, You had surgery while abroad and your return home had to be delayed - is that right?
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red 27 wrote:
@Shinobi247, You had surgery while abroad and your return home had to be delayed - is that right?


Thats correct - end up costing around 40k due to multiple infections after the initial - as soon as I was cleared to fly another one came on!
insurance insist on you paying upfront which I was naive and not expecting
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 Then you can post your own questions or snow reports...
Then you can post your own questions or snow reports...
@Shinobi247, Unfortunately you are obliged to inform your insurer of any significant medical condition that occurs during the term of the policy. It's one of those things that's so easy to forget.

Given the amount of money involved I suggest legal advice may be in order if they reject your claim. It's all about what's 'significant' and 'reasonable', as these legal matters often are

You've seen this link already perhaps

https://www.financial-ombudsman.org.uk/consumers/complaints-can-help/insurance/travel-insurance/change-in-health
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
Quote:
insurance insist on you paying upfront


They do for small sums but not normally £40k. For that kind of money they like to guarantee the hospital bills and take over negotiation directly with the hospital. They can mitigate the cost that way. There must be a reason why they let you manage the situation by yourself.

When you submitted your claim did you make any mention of the perforated ear drum? If you did then I would expect them to dig their heels in. If not, they might just pay up without further investigation. It's a lot of money - if it were me I'd be asking them when they are going to settle. You need to know if there is going to be an issue and then go from there.

I suspect there is a bit more to this story than we are being told?
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Pruman wrote:
Quote:
insurance insist on you paying upfront
.

I suspect there is a bit more to this story than we are being told?


+1
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Ski the Net with snowHeads
I havent mentioned it but they have requested medical records so guess it will show up on them anyway. Not much else to the story.
I think its not the best cover i bought as from what i read you pay up front with the ow cost insurers. Apparently to save operation costs they will then add all your trips claims in one go and refund you when you're back.
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Did you have an EHIC card, @Shinobi247?
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 And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
I should add it wasn't a one off medical expense - its accumulation of multiple procedures that took a few weeks.
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So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
My insurer (LV=) explicitly says when you ring them that new conditions, arising before the renewal date, do not have to be notified. When the time comes to renew, however, you must then disclose them.

However, if I have an injury or illness while on holiday then I, or someone, has to notify them as soon as is reasonably possible. So it's OK not to contact them if I'm being processed in A&E and/or aren't in a state to contact them etc. but I would be expected to tell them while still abroad. Even if I thought it was all OK, they would want to translate and review my discharge report to make sure the hospital wasn't just jettisoning me out of A&E just to get rid of me. Their liability is to get me home safely, even if that means insisting on treatment that they considered essential before it was safe to travel (and paying for it if not covered by the EHIC), and worst case, hiring a medical flight to get me home if the cost of treatment in place was going to be more than the repatriation flight.

So I suspect they won't be happy about you're not telling them anything at the time. I suspect their view will be that it meant they couldn't judge whether you were being discharged reasonably, whether the treatment that you got was warranted, or the best for you in the long term. And it that they didn't have the opportunity to organise a medical repatriation that would have ended up costing a lot less.
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 You know it makes sense.
You know it makes sense.
Not sure I understand this - I've had to invoke travel insurance a couple of times for accidents and on each occasion I've made sure the insurance handlers were dealing direct with the hospital. In fact in the US I ended up driving round a few hospitals/clinics with a broken leg until I found one willing to operate that way (given the bills US facilities can run up it's a risk otherwise)
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 Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
Shinobi247 wrote:
I should add it wasn't a one off medical expense - its accumulation of multiple procedures that took a few weeks.


OK, potentially therein lies the issue.

I'm not a travel insurance expert per se but my time in and around financial services hasn't been wasted. To begin with, travel insurance only offers cover for emergency medical treatment - it is not PMI (private medical insurance). If it was PMI it would cost many times what it does already and involve a far greater degree of underwriting. So, your travel insurance is designed to fix you up and get you home in order that you can continue treatment or get mended properly at home either via the NHS or via whatever PMI you have in place. Multiple procedures for an ear infection and a £40k bill suggests more treatment and cost than necessary to me. Sorry.

Travel insurers either have in house emergency assistance or they outsource it. Whichever way, there will be a Medical Director who has a duty of care to you in just the same way a NHS doctor does, and they carry indemnity insurance in just the same way. Travel insurance Medical Directors are versed in travel medical matters. When you are abroad and require emergency medical assistance you are meant to contact your insurer as soon as practicably possible. Once you do that you are in the hands of the Medical Director and they will liaise with the medical facility you are in. If it's Europe and EHIC applies, or Aus/NZ, they may require you to move to a state facility to mitigate cost, but only if it is practical to do so. They decide, for example, when and how you travel home with consideration given to DVT risk on long flights etc.

What Medical Directors do not like is when customers make demands or take matters into their own hands. If they cannot manage (or haven't been given opportunity to manage) someone's care and repatriation, then they will wash their hands of it and suggest you sort out your own problem and pay for it as you go, making a claim on your return.

In your case, what it sounds like to me, is that you didn't contact them and took various decisions of your own volition that set in train multiple procedures that they may not have agreed to. By the time you involved them it was too late. I don't know. Whatever it was, they let you get on with it and in my experience that is because they didn't get the opportunity to manage the situation from the get go. Something wasn't right so they'd rather you dealt with the situation and made a claim on your return so they could argue it then. Travel insurance is, after all, just a financial indemnity product, the main reason they take over the big medical claims is so that they can stop unnecessary medical procedures and contain costs. They may pick up on the pre-existing medical condition, they may pick up on having perhaps more procedures than strictly necessary, they may be worried about fraud - I'm certainly not accusing you of that, it's just something they have to consider - inflated medical claims in places like Cyprus, Mexico, Spain and others is an industry in its own right.
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 Poster: A snowHead
Poster: A snowHead
Shinobi247 wrote:
I havent mentioned it but they have requested medical records so guess it will show up on them anyway.


Firstly, welcome to snowheads, pity it's not under more pleasant circumstances for you.

I had a discussion with my insurer (AXA) when my son broke his arm a few weeks before a planned holiday. The options were: a) pay an additional premium (about £50-100, can't remember exactly) to cover any complications related to the arm _unless_ we had completed all follow-up treatment (which was the eventual case), b) cancel and insurance would refund, or c) go, but not have anything related to the arm covered (which seemed high risk) - I was also told that non-disclosure would have been the same as option (c).

I would expect your insurer to reject the claim a) for pre-existing condition and b) for non-disclosure of material facts (you didn't tell them about the hospital visit in the claim).

You might have a reasonable argument that you thought the hospital trip was a "once and done" event and you were fully cured, so didn't notify them before travel and more than you'd mention something trivial like stubbing your toe (although "overnight" suggests non-trivial to me). To me, the non-disclosure of this makes it look like you have something to hide.

In your position, I'd contact them and fess up to the hospital visit, so at least the non-disclosure issue is off the table.
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
At what point did you take out the travel insurance? If I'm reading the initial post correctly, you perforated the ear drum a week before your holiday, so not necessarily a pre-existing condition, but did the hospital give you the OK to fly and go on holiday?
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