Heather's insurer agreed to pay the cost of any necessary medical treatment Heather received while abroad, but didn’t think there was any 'medical necessity' for her to curtail her holiday.
What happened
During the first part of her holiday on a cruise ship, Heather tripped and badly injured her ankle. She’d been due to leave the ship the next day, when it reached Cyprus, as she’d booked to stay at a hotel there for a week before flying home to the UK.
Because of her injury, Heather felt there was no possibility of continuing her holiday. She was only able to get around by using a wheelchair and she needed assistance to get in or out of the wheelchair. She rang her insurer's helpline and asked for help in getting back home.
The insurer agreed to pay the cost of any necessary medical treatment Heather received while abroad, but didn’t think there was any 'medical necessity' for her to curtail her holiday. So Heather made her own arrangements to return home. She later put in a claim for the expenses she said she’d incurred from injuries that included:
- the cost of cancelling her week's holiday at the hotel in Cyprus
- the cost of her journey back to the UK, including the flight and taxi fares
- compensation for the time she had taken off work in order to have physiotherapy
- the cost of taxi fares to and from her physiotherapy appointments
Heather said the insurer had underestimated the effect of her injury and she asked for compensation for the distress and inconvenience she’d been caused. She said the insurer had let her down badly by its 'failure to provide appropriate assistance' when she rang the helpline. When the insurer refused to meet her claim or to compensate her, Heather complained to us.
What we said
Medical evidence provided by the ship's doctor confirmed that Heather had suffered an ankle ligament rupture. The doctor had recommended 'complete immobilisation of the ankle for 10-14 days'. And he’d thought it necessary 'by medical reason' for her to disembark, cancel her hotel stay in Cyprus and return home.
Heather had been travelling on her own and the hotel had confirmed that it was unable to provide the additional assistance she would have needed for her stay.
We concluded that there had been a need for Heather to curtail her holiday. We asked the insurer to pay for the costs she’d incurred in cancelling her hotel booking and travelling back home. We said the insurer should pay these costs in full, together with interest.
However, we explained to Heather that her travel policy didn’t cover her for the time she needed to take off work, or for any of the other costs she’d claimed once she was back home in the UK.
We agreed with Heather that the insurer should have given her the assistance she was entitled to under the policy, when she asked for help in getting back to the UK. So we said it should pay her £250 in recognition of the distress and inconvenience that its poor service had caused her.