Medical expenses and repatriation

What are medical expenses and repatriation?

This is the section of your travel insurance policy that covers medical costs for illness or injury while you’re on holiday. It will also usually cover the cost of getting you back to the UK. In your policy this is called repatriation.

Types of complaints we see

We see customers unhappy that:

• the insurer took too long to confirm cover
• the standard of medical care wasn’t good enough
• they should have been repatriated sooner – or in a different way
• they shouldn't have been repatriated

Common reasons given by the insurer for rejecting a claim are:

• the situation wasn’t a medical emergency – and treatment wasn’t necessary
• the claim isn't covered because it's linked to a pre-existing medical condition

What we look at

We look at the events surrounding the claim as well as your policy to decide whether we think your claim should succeed or not.

How a medical expenses claim works

1. You let the insurer know that you need medical treatment – this is usually by calling the insurer’s medical assistance company directly.
2. The assistance company gets a medical report from the hospital and speaks to the treating doctor if necessary.
3. The assistance company asks for your medical history from your GP – your insurer is entitled to make sure the claim is covered and will want to find out if the expenses relate to a pre-existing medical condition.
4. Your insurer’s medical assistance company decides whether it thinks the treatment is medically necessary – travel insurance policies only cover treatment that can’t wait until the patient returns to UK.
5. The assistance company confirms cover and gives a guarantee of payment to the hospital – you might be asked to pay your policy excess directly to the hospital.
6. The insurer’s medical assistance company assesses if repatriation is needed.
7. If so, the insurer will ask for a fit to fly (ftf) certificate from the treating doctor.
8. The insurer will then make arrangements for you to get home.

Making contact before incurring medical expenses

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

When the insurer and the treating doctor disagree about repatriation arrangements

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.

You’ve used a private hospital when the policy only covers public hospitals

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

Complaints about the standard of medical care

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.

Delays in accepting the claim

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

How to complain

Talk to your insurer first. They need to have the chance to put things right. They have to give you their final response within eight weeks for most types of complaint.

If you’re unhappy with their response, or if they don’t respond, let us know. We’ll check your complaint is something we can deal with, and if it is, we’ll investigate to understand what happened and what went wrong.

Find out more about how to complain.

Putting things right

If we feel your insurance company has turned down a claim unfairly, we’ll do what we can to put things right.

Find out more about how we put things right for customers who’ve made a complaint about their travel insurance claim.