Carl complained when his insurer rejected his claim to help arrange a flight home when he was taken seriously ill on a holiday.
Carl was taken seriously ill while on holiday in West Africa. It was clear that he’d need major surgery and probably a blood transfusion.
The treating doctor thought Carl should be flown home to the UK for the operation, despite the risk that he might suffer further problems either before or during the flight itself.
Carl contacted his insurer to explain his situation. He asked for help in arranging his flight home but the insurer said that flying was too risky for him.
The doctor treating Carl had provided a verbal assurance that he was fit to fly. He’d also explained why repatriation was in Carl’s best interests. But the insurer said it would need a written report to confirm this before it could reconsider.
Carl argued the insurer's insistence on a written report was unreasonable as the doctor's view was that it was in his best interests to be repatriated. Anxious not to delay matters any longer, Carl paid for the flight home himself.
Once Carl had recovered from his operation, he complained to the insurer about its handling of the matter. Carl felt it was unfair that his insurer rejected his complaint, arguing that its representative had acted in Carl's best interests. Unhappy with its response, Carl referred his complaint to us.
What we said
The evidence of the treating doctor is usually very persuasive because the doctor is generally best placed to assess their patient's situation. In this case, we agreed with the treating doctor's assessment of the risks in flying Carl home, set against the risks associated with carrying out his operation in West Africa.
The doctor who operated on Carl in the UK confirmed that, in the circumstances, it had been the best course of action for Carl to return home for surgery.
We felt that in this particular case the insurer's insistence on a written report had been unreasonable. Since the treating doctor in Africa had given an assurance that repatriation was in Carl's best interests, we didn’t think it was relevant that Carl hadn’t provided the insurer with a written report.
We upheld the complaint and asked the insurer to pay Carl for his expenses in returning to the UK. We also said it should pay him compensation for the distress and inconvenience he’d experienced because of its refusal to help with his repatriation.
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