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 complaint 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
Handling a complaint like this
As with any complaint, we’ll expect you to work with your customer to get to the bottom of what happened, investigate fairly whether anything went wrong, and – where appropriate – take steps to put things right.
If you don’t reply within the time limits for responding to a complaint, or the customer disagrees with your response, they can bring their complaint to us. We’ll check it’s something we can deal with, and if it is, we’ll investigate.
Read more about resolving complaints.
Information we will ask for when we receive a complaint
Once a complaint has been referred to us, we will ask you to provide information about your side of events.
The typical information we would normally expect to see about this type of complaint includes:
- policy schedule
- policy certificate
- full policy terms
- a copy of the claims notes
- a copy of the medical assistance company notes.
- if the complaint is about the customer failing to contact you before curtailing, we’d need to see information about what you would have done had you been contacted at the time
- any medical evidence (in English)
- the customer’s account of what happened when they contacted you
We may ask for further information or documents, depending on the circumstances of the case.
Read more about how we handle complaints.
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.
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
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 curtailment benefit 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 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
If we think you have made a mistake or treated a consumer unfairly, we'll ask you to put things right. Our general approach is that the customer should be put back in the position they would have been in if the problem hadn't happened.
The exact details of how we'll ask you to put things right will depend on the complaint, and how the customer lost out. In some cases, we may also ask you to compensate the customer for any distress or inconvenience they've experienced as a result of the problem.
Business Support Hub
If you want to talk informally about a complaint you've received, you can speak to our Business Support Hub. They can give general information on how the Financial Ombudsman might look at a particular complaint. We also offer guidance on our rules and how we work.
Find out how to contact the Business Support Hub.
My insurer didn't think there was a "medical necessity" to cut short my holiday
Travel Insurance Distress and inconvenience Up to £300