Travel insurance policies usually provide cover for a policyholder to cut short their holiday for 'insured events' like illness, injury or death. This is known as ‘curtailment’.
Types of complaints we see
The most common complaints are from customers who tell us they fell ill on holiday:
- and came home early – but the insurer won’t pay the claim as they weren’t contacted first
- and came home early – but the insurer won’t pay the claim as it doesn’t think it was medically necessary to cut the holiday short
- but didn’t come home – we call this ‘effective curtailment’, as in effect the customer’s holiday has been cut short
What we look at
The situations in which a policyholder can claim for cutting short a holiday are usually limited. But each policy is different so we’ll always ask for the terms and conditions in every case.
When your customer didn’t contact you before curtailing
Most travel insurance policies ask the customer to contact the insurer before they decide to cut their trip short.
But some travellers return home without contacting the insurer first – either because they didn’t realise they needed to, or because they made their own arrangements to come back.
We don’t think a customer’s claim should automatically fail just because they didn’t contact you first. We need to look at the circumstances in each case to see whether the customer needed to end the holiday and return home when they did.
We’d want to know:
- if there’s medical evidence to show it was necessary for the customer to come home
- whether it’s a condition of your policy that the customer needed to contact you first
- what the customer’s reasons were for not contacting you first
- what you would have done if the customer had contacted you first
Whether curtailment is medically necessary
Limited medical evidence
We see cases where there is limited evidence to show it was medically necessary for the customer to cut short their trip. Usually, the customer needs to provide some medical evidence to support what they’re saying before we’d uphold their complaint.
If there’s a good reason why there’s no medical evidence available from the treating doctor abroad, we might accept medical evidence from a UK doctor saying that curtailment was necessary and would have been recommended.
When you don’t think curtailment is necessary
In these cases, we’d consider the medical evidence provided and your claims notes. We’d want to know if you were in regular contact with the treating hospital, and we’d expect you to take into account the recommendations and advice of the treating doctor. You’ll also need to provide evidence from your Chief Medical Officer (CMO) in support of your position that curtailment wasn’t medically necessary.
We’ll look at this evidence and any evidence from the treating doctor to decide whether we think curtailment was medically necessary, without the benefit of hindsight.
The informed opinion of your CMO is valid medical evidence, but the treating doctor will have seen the patient at the time – so might be better placed to comment on your customer’s condition.
We often see complaints where a customer hasn't actually returned home early – but has been confined to a hospital, their hotel room or ship’s cabin because of illness or injury.
Usually, if your customer has been admitted to hospital and remained there, we'd consider their trip had been effectively cut short at that point. So we'd expect you to pay curtailment benefit from that date onwards.
It can be less clear-cut when a customer says they were confined to their resort, hotel room or cabin.
We need to think about whether there is medical evidence to support what the customer is saying – but we also need to think about whether the customer still got some benefit out of their trip.
Travel insurance policies don’t cover loss of enjoyment – so if your customer was unable to swim because of a cast but could still use other facilities and sit by the pool – we’re unlikely to think their holiday has been effectively curtailed.
But, the situation might be different where there was a very specific purpose to the trip – such as diving or hiking and they couldn’t do that activity. But the specific purpose would need to be the dominant purpose of the trip.
Sometimes customers fall ill part-way through their holiday. They could be admitted to hospital from days 4 to 7 of a 14-day trip, but they'll then be able to continue their holiday as normal from days 8 to 14. There might be some limited situations where we’d think it’s fair and reasonable for you to pay effective curtailment for days 4 to 7. But, in the majority of cases, we wouldn’t usually ask you to do this.
But the situation might be different if a customer has lost a large percentage of their trip to illness or injury.
Other travellers and effective curtailment
Usually, we'd only expect you to pay effective curtailment benefit for the sick or injured customer.
But, in some cases, we might think a travelling companion's holiday was also cut short – where the customer needed their travelling companion to stay with them. We’d need to see evidence that this was medically necessary.
Putting things right
Usually the policy will cover travel and accommodation costs – and other payments for things like excursions – that the policyholder hasn’t been able to use, and that they haven’t been able to reclaim from anywhere else.
If your customer has used their original flight to come home by rescheduling it for a different date, this flight is used so we wouldn't expect you to pay for this. If your customer had to pay an amendment fee to move their original flight, we might expect you to pay for this depending on what the policy terms and conditions say.
If you arranged for your customer to come home (you repatriated your customer), then the original return flight is 'unused'. So this might be covered, unless you have a policy exclusion to say you won’t pay for an unused return flight if you’ve paid to repatriate your customer.
If your customer bought a package holiday and it's not clear how much the flights cost, we'd usually recommend that you pay a proportion of the total holiday cost from the date the customer cut short their trip. If you don’t agree then we’d expect you to provide evidence to show what part of the total overall cost you think was taken up by travel and accommodation costs that have already been used.
My insurer didn't think there was a "medical necessity" to cut short my holiday