 Poster: A snowHead
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A word of warning for anyone with Virgin Money Club M travel insurance or who is thinking of signing up for it. I emailed them about an aspect of the cover for winter sports and their answer also told me that "the following medical conditions will not be covered under the medical expenses benefit of the policy while participating in winter sports: osteoporosis, osteopaenia, thinning bones, fragile bones, ligament damage, Achilles tendon injury, or patellar dislocation."
I could not see how this could be consistent with the policy wording, because there are no special exclusions for medical conditions that only apply whilst participating in winter sports. So I telephoned the number for disclosure of medical conditions to check this and they confirmed that this is a special exclusion of certain medical conditions which only applies to winter sports. The agent said the exclusion applies even if the condition is disclosed. When I asked which part of the policy says this, they eventually admitted that it isn't in the policy yet, but it will be included in the policy document next time the policy is revised in February 2027. Nevertheless, the agent insisted that this exclusion is already in operation, even though it won't be made public until nearly a year from now.
This is surely legally untenable. I very much doubt that they can enforce this exclusion until such time as they do include it in the policy document or they draw it to the attention of policyholders. However, you may wish to consider whether you want to take the risk of having to fight if you did need to make a claim for medical expenses relating to those conditions.
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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They certainly can't enforce something which is not obvious and that they haven't told you about.
They may have included it as an endorsement on the schedule though, rather than in the main policy.
And of course, now that you have been told (and they will have a record of that), they will be able to enforce it against you if any of those apply, even if they couldn't enforce it against anybodye else..
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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?
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There is no endorsement or schedule, because this is a policy that comes with a bank package, so you are covered as long as you have the bank account. I agree that they would have a better chance of enforcing it against me. So I'm going to have to get a different policy to cover my skiing. Or maybe cancel this policy altogether.
For anyone they haven't told about this, I guess they need to decide if they are prepared to suffer the stress of having a claim declined, having to pay their medical costs themselves, and then fighting to force them to pay up.
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You need to Login to know who's really who.
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@koru, although it no longer applies to you since you specifically asked about it, their general approach of seeking to apply restrictions which are not mentioned in their policy schedule or subsequent communications is certainly one which I don't think would stand up in any legal dispute.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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@koru, your word of warning might better be directed at anyone considering going skiing with 'osteoporosis, osteopaenia, thinning bones, fragile bones'. Regardless of who you are insured with you have a duty to mitigate loss. Going skiing with fragile bones is deliberately putting yourself in harms way. In other words, no policy would technically cover it.
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You'll need to Register first of course.
You'll need to Register first of course.
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| Phantom Phil wrote: |
| Going skiing with fragile bones is deliberately putting yourself in harms way. In other words, no policy would technically cover it. |
I am sure there are policies that would cover it - they just might be rather expensive.
And technically, going skiing at all is deliberately putting yourself in harms way, it is just the likelihood of that harm is increased with certain conditions. And so insurers will charge more if you have any of those. Some insurers just won't cover you at all, others will charge higher premiums but will cover you.
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VM (an insurance intermediary) changed their insurer this year, probably a cheaper one who will pay them more but payout less. I would agree that unless the policyholder's documents disclose the new exclusions they wont have a (fractured) leg to stand on.
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@alex_heney, there is obviously an element of risk to everything - if there were no risks there would be no such thing as insurance. Statistically, the sport of skiing is very safe when you look at number of skier days v the incidence of injuries. However, people do get injured in ways that are unforeseen and the premium you pay reflects the costs associated per injury and that incidence rate. That is very different from someone knowing they have a medical condition that will almost certainly result in a claim. I'd say 'fragile bones' is a material fact if you are going skiing!
My training in insurance law (it's rusty but you never forget) and the seven principles of insurance informs me that Principle 1 - Utmost Good Faith, and maybe, to a lesser extent, Principle 7 - Loss Minimisation, are in play here. Principle 1 means disclosing all material facts relevant to the insurance contract and Principle 7 means taking steps to mitigate claims, although that's normally about what you do after an insured event occurs to minimise the loss. The UK Insurance Act 2015 introduced a Duty of Disclosure - it compels YOU and your insurer to reveal all relevant facts pertaining to your insurance. VM have made disclosure "the following medical conditions will not be covered under the medical expenses benefit of the policy while participating in winter sports etc etc............" But it sounds like it isn't in the actual contract (yet). Nevertheless, they have informed the customer as they are meant to. VM will have a compliance team and my opinion is that they are on safe ground.
@NJ, most of the insurance brands in the market are intermediaries. Contracts are normally for 3 years and then firms go to market, so not surprising at all that VM have switched underwriters. If they didn't test the market for the best deal we'd all be paying more.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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| Phantom Phil wrote: |
My training in insurance law (it's rusty but you never forget) and the seven principles of insurance informs me that Principle 1 - Utmost Good Faith, and maybe, to a lesser extent, Principle 7 - Loss Minimisation, are in play here. Principle 1 means disclosing all material facts relevant to the insurance contract and Principle 7 means taking steps to mitigate claims, although that's normally about what you do after an insured event occurs to minimise the loss. The UK Insurance Act 2015 introduced a Duty of Disclosure - it compels YOU and your insurer to reveal all relevant facts pertaining to your insurance. VM have made disclosure "the following medical conditions will not be covered under the medical expenses benefit of the policy while participating in winter sports etc etc............" But it sounds like it isn't in the actual contract (yet). Nevertheless, they have informed the customer as they are meant to. VM will have a compliance team and my opinion is that they are on safe ground.
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I'm sure that's correct regarding the original poster @koru as having emailed the insurance company regarding a query they informed him of the new exclusions. However if (as seems likely since they only informed him after he'd raised a query) they haven't as yet emailed all their other customers to similarly inform them of the new exclusions then presumably they are not on safe ground?
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@Alastair Pink, it will depend on what their terms say. (And there will be some, even for "free" policies included with bank accounts).
If they require you to inform them before travel of, say, any medical condition you know about that would give an increased risk of a claim, then they are probably safe. Policyholders would only be fully covered if they are unaware they have osteoporosis or whatever.
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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If you have a diagnosed medical condition, surely you are required to declare it for it to be covered (or not covered) under your policy. You answer their medical screening questions and they decide if they can cover it or not? So if you have osteoporosis, or osteopenia you should have declared it already.
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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.
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| Hells Bells wrote: |
| If you have a diagnosed medical condition, surely you are required to declare it for it to be covered (or not covered) under your policy. You answer their medical screening questions and they decide if they can cover it or not? So if you have osteoporosis, or osteopenia you should have declared it already. |
It depends on the policy wording. This particular one only requires disclosure of certain named serious conditions such as cancer or if in the last 12 months you have:
a. Been referred to see a specialist, or been added to a waiting list to see one?
b. Been referred to or visited a hospital for any tests or treatments? This includes if you’re on the waiting list to visit a hospital.
c. Seen a medical practitioner more than once for the same condition?
d. Been prescribed two or more medications?
e. Changed any medication you’ve been taking?
So, if you were diagnosed with osteopenia 12 months before taking out a VM Club M account, it is possible that it would not be disclosable.
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| Phantom Phil wrote: |
| @koru, your word of warning might better be directed at anyone considering going skiing with 'osteoporosis, osteopaenia, thinning bones, fragile bones'. Regardless of who you are insured with you have a duty to mitigate loss. Going skiing with fragile bones is deliberately putting yourself in harms way. In other words, no policy would technically cover it. |
I disclosed osteopenia to HolidaySafe, who told me it is covered with no extra premium. I agree that skiing with more severe bone weakness would be foolhardy, though whether it would necessarily not be covered I'm not sure.
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You know it makes sense.
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So, for example, if I was diagnosed with high blood pressure, was only one one medication, and my diagnosis was more than 12 months ago, it is OK not to declare it?. That is very unusual. It usually still needs a declaration even if it is covered with no charge. Osteopenia can deteriorate into osteoporosis.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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Maybe they are trying to avoid people claiming to get those conditions treated "privately" when abroad instead of coming back to the UK and using the NHS.
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Poster: A snowHead
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| Hells Bells wrote: |
| So, for example, if I was diagnosed with high blood pressure, was only one one medication, and my diagnosis was more than 12 months ago, it is OK not to declare it?. That is very unusual. It usually still needs a declaration even if it is covered with no charge. Osteopenia can deteriorate into osteoporosis. |
I would say that your example would not need disclosure. It is one of the reasons I liked this policy until the new rule about osteopenia.
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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| koru wrote: |
| So, if you were diagnosed with osteopenia 12 months before taking out a VM Club M account, it is possible that it would not be disclosable. |
If you stopped receiving treatment over 12 months ago the chances are you have been signed off. If you are just living with the condition and not continuing treatment then it would be a material fact.
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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?
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| Hells Bells wrote: |
| So, for example, if I was diagnosed with high blood pressure, was only one one medication, and my diagnosis was more than 12 months ago, it is OK not to declare it?. That is very unusual. It usually still needs a declaration even if it is covered with no charge. Osteopenia can deteriorate into osteoporosis. |
Yes, definitely disclose. They might be ok with it, they might not. Then you have a record it was disclosed. If in doubt, tell 'em.
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You need to Login to know who's really who.
You need to Login to know who's really who.
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| rjs wrote: |
| Maybe they are trying to avoid people claiming to get those conditions treated "privately" when abroad instead of coming back to the UK and using the NHS. |
Medical tourism to places outside UK / EEA / EU is a risk but they can and do detect it. Medical records normally reveal all. The absolute gift for insurers for anyone going to Europe or Australia is the GHIC card. I had to help a friend in Switzerland recently and the GHIC card worked like a dream. The insurer was only left with the repatriation and the piste rescue.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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@Phantom Phil, which for the avoidance of any doubt I would have done. It was a completely hypothetical situation.
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You'll need to Register first of course.
You'll need to Register first of course.
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@Phantom Phil, I wasn't thinking of actual medical tourism, just a case where someone tore a knee ligament and thought that they might as well get it fixed immediately in Innsbruck or Lyon.
Excluding ligament damage is wrong to me, there will be a cost of crutches and a brace at least.
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@rjs, I read that OP's article as meaning that you won't be covered (for anything medical) if you have existing ligament damage.
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| ecureuil wrote: |
| @rjs, I read that OP's article as meaning that you won't be covered (for anything medical) if you have existing ligament damage. |
Correct.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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Interesting that the Lloyds Bank Silver package takes a different approach to pre-existing conditions. The policy sets out a long list of conditions that do not require to be disclosed, including osteoporosis, high blood pressure, tendon injury, shoulder injury, dislocations, diabetes, broken bone, arthritis. Full list is on page 43 of the policy here: https://www.lloydsbank.com/assets/media/pdfs/current-accounts/silver_account_welcome_pack.pdf
It is also pretty cheap, at £11.50 pm.
Edit: screening can, however, be triggered by any conditions in the last 6 months that are not on that list and once you are in screening you have to disclose all conditions, even those on the list. This seems like an approach that could easily lead to not being covered.
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| Phantom Phil wrote: |
| Hells Bells wrote: |
| So, for example, if I was diagnosed with high blood pressure, was only one one medication, and my diagnosis was more than 12 months ago, it is OK not to declare it?. That is very unusual. It usually still needs a declaration even if it is covered with no charge. Osteopenia can deteriorate into osteoporosis. |
Yes, definitely disclose. They might be ok with it, they might not. Then you have a record it was disclosed. If in doubt, tell 'em. |
So you are saying you should ignore the wording telling you what to disclose, and disclose it even though it is clearly not included in the list.
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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| Phantom Phil wrote: |
...
... The UK Insurance Act 2015 introduced a Duty of Disclosure - it compels YOU and your insurer to reveal all relevant facts pertaining to your insurance. |
Are you sure this is right?
It is true for Business insurance, but I think that for Personal / Consumer insurance (including travel) the obligation on the potential policyholder is only to correctly answer the questions asked, and to confirm/deny any assumptions made, by the insurer. That would make a big difference to a lot of what you have written above, as it means you don't have to voluntarily disclose other information.
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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.
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It would be interesting to see what answers someone else gets who holds the same insurance cover. I know I have had conversations with insurance call centre staff that has been very different to someone else calling them.
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| ecureuil wrote: |
| Phantom Phil wrote: |
...
... The UK Insurance Act 2015 introduced a Duty of Disclosure - it compels YOU and your insurer to reveal all relevant facts pertaining to your insurance. |
Are you sure this is right?
It is true for Business insurance, but I think that for Personal / Consumer insurance (including travel) the obligation on the potential policyholder is only to correctly answer the questions asked, and to confirm/deny any assumptions made, by the insurer. That would make a big difference to a lot of what you have written above, as it means you don't have to voluntarily disclose other information. |
Yes, you are correct, Phantom Phil is wrong here. The parts requiring that type of disclosure (Part 2 of the 2015 Act) only apply to non-consumer insurance contracts.
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