Norris and Lina contacted us to complain about their insurance claim after they cancelled their holiday because Lina was taken ill.
What happened
Norris and Lina cancelled their holiday because Lina became ill shortly before the start of their trip. The couple had bought a travel policy from their travel agent at the time they booked the holiday. They put in a claim for the cost of cancelling it.
The insurer asked why they’d cancelled their holiday, and they described the symptoms of Lina’s illness. The symptoms suggested to the insurer Lina had a digestive disorder called diverticulitis.
The insurer asked for details of Lina’s medical history. Her GP confirmed that she’d been diagnosed with diverticulitis five years ago. She’d also seen her GP about the condition six months before the couple had booked their holiday and bought the policy.
The insurer turned down the claim on the grounds that the policy excluded claims relating to pre-existing conditions or medical symptoms a policyholder should reasonably have known about before buying their policy.
Norris and Lina complained that the insurer was being unreasonable. They said Lina had been in good health at the time they took out the policy and they weren’t aware that she’d been diagnosed with diverticulitis.
Unhappy with the outcome, Norris and Lina contacted us to make a complaint.
What we said
It was clear from the medical evidence that Lina had been diagnosed with diverticulitis five years before she’d bought the policy. She’d also been to her local hospital several times since then to have tests and see a consultant about the condition.
We thought that even if the couple didn’t understand the medical terms relating to the condition, they would have known Lina sometimes had symptoms that were serious enough to need hospital treatment.
The couple confirmed that when they’d bought the policy the travel agent asked both of them some questions about their health. We were unable to establish whether the agent had also explained the significance of the policy exclusion for pre-existing medical conditions. However, we noted that there was a clearly worded statement about the exclusion on the front page of the couple's policy document.
We explained to Norris and Lina that weren’t upholding their complaint, because we didn’t think the insurer had acted unfairly by declining their claim.