Medical expenses and repatriation

Most travel insurance policies ask you to contact your insurer before you get medical help.

Some policies say you don’t need to do this for minor ailments or where expenses are likely to be less than a specified amount, for example £250.

Insurers usually ask you to contact them so that they can ask their agent based in the country you want to be treated in to:

• agree the medical expenses
• decide you or the injured or ill person is fit enough to travel (‘fit to fly’ or ‘ftf’)
• decide whether you or the injured or ill person should be repatriated (returned home) or evacuated to the nearest suitable place for treatment

We don’t think your claim should automatically fail just because you didn’t contact them first. We’d look at:

• what your reasons were for not contacting them
• whether your medical expenses were necessary and reasonable – a lot of complaints involve treatment at private hospitals, but most travel policies exclude these costs and cover treatment in public hospitals only
• what they would have done if you’d contacted them first

You won’t be able to return to the UK until you have a fit to fly (ftf) certificate from the treating doctor. We often see complaints where the treating doctor and the insurer disagree about:

• when you can be safely repatriated
• the transport which is suitable for repatriation

We’d expect your insurer to take account of the recommendations and advice of the treating doctor. It’s our view that your insurer’s medical team have the necessary expertise and experience to assess your repatriation needs.

Your insurer will make a decision on what’s medically appropriate. It’s not necessarily unfair for your insurer to insist on the cheapest option, even if it does take a little longer – as long as it doesn’t have a significant impact on you.

Most travel insurance policies only cover the cost of private treatment in very limited circumstances. If your claim for medical expenses has been turned down because private treatment isn’t covered, we’ll look at whether:

• you were told that private treatment wasn’t covered when you contacted your insurance company
• you chose to go ahead knowing private treatment might not be covered
• you were offered any help to move to a public hospital
• we think your actions were reasonable in the circumstances

We might think it was reasonable for you to use a private hospital if:

• you needed emergency treatment that couldn’t wait
• you were taken to a private hospital without being able to check first to see if this would be covered under your policy
• your treatment wasn’t available in any public hospital within a reasonable distance from you
• the standard of care at a public hospital was so unacceptable that it wouldn’t have been reasonable to expect you to remain there for treatment

The standard of medical care varies from country to country. Although we’d expect your insurance company to look into any concerns you raise, there’s often little they can do about these concerns.

If your claim was delayed, we’ll look at:

• how long the delays were
• what caused the delays
• whether your insurance company could have reasonably done more to prevent or reduce the delay
• whether you got regular updates from your insurance company
• how you were affected by the delay