When an insurance wont pay for holiday accident.....anyone had experience?

[Dave7]

Situation is......
An elderly (82 yrs) relative has had a fall while in Spain.
She has full insurance and declared all medical probs INCLUDING blood thinners.
The hospital was due to operate today when suddenly the insurance Co have said....hang on, the blood thinners might have made her dizzy and lose balance. They are now refusing to pay out with the obvious family problems.
So.......does anyone KNOW FOR SURE what can be done ie best guesses are not really helpful.
NB
AI says the insurance Co cannot do this, but they have.

 

[Drago]

Insurance Ombudsman.

The only downside is thats liable to take some time, although if everything was declared as you say and they still provided cover there's a good chance of success.

Theres one final argument you might try direct with the insurer. The blood thinners were declared, and they dant just assume thats what made her dizzy. Theres has to be some actual evidence thar is the case - if theyre declining on ther basis the evidential burden calls upon them to prove it, not you to prove otherwise.

Theres a good chance theyre just being chumps as insurers are wont to do and are ultimately on a hiding to nothing, but resolving the matter expeditiously might be difficult, even if in the long run you may prevail.

Best of luck.

 

[SpokeyDokey]

Insurance Ombudsman.

The only downside is thats liable to take some time, although if everything was declared as you say and they still provided cover there's a good chance of success.

Theres one final argument you might try direct with the insurer. The blood thinners were declared, and they dant just assume thats what made her dizzy. Theres has to be some actual evidence thar is the case - if theyre declining on ther basis the evidential burden calls upon them to prove it, not you to prove otherwise.

Theres a good chance theyre just being chumps as insurers are wont to do and are ultimately on a hiding to nothing, but resolving the matter expeditiously might be difficult, even if in the long run you may prevail.

Best of luck.

Good advice.

 

[Drago]

Good advice.

Thats a first from me!

 

[presta]

If anticoagulants invalidated her insurance, the time to tell her that was when she took out the policy, not when she makes a claim.

 

[fossyant]

They/or a relative will need to argue the point as this could now get very costly, and it's a big problem with insurers doing this. It's all declared then they have accepted the risk - double check its on the policy though !


I phoned my insurer when I 'hurt my leg' last year asking was I OK to go away as the hospital said I was OK, nothing broken, but would need assistance. Should I have fallen ill (like a blood clot) then I expect I'd have had a battle when I actually had a broken pelvis and hip socket, not a torn muscle.

It's becoming increasingly common for them to pull cover.

It's a bit like folk taking out a scooter or doing a quad bike 'explore' - have an accident, you aren't covered.

 

[Bonefish Blues]

Anyone in the family a member of Which? by any chance? They have useful helplines.

 

[tom73]

Drago has said it all really. Another option is go to press, they love this sort of stuff. Be surprised what a bit of bad publicly can do. To change things round.
Mrs73 says no way do her meds make you dizzy. If it was blood pressure meds then maybe.

 

[Emanresu]

Have you a copy of the policy? There is a well established principle that any contract (insurance being a contract) is bound by whatever is on the page at the point of payment. As mentioned above, they can't rely on it later. See if you can get the wording.

Also if you are comfortable doing it, run the wording through an AI like Claude or Gemini. They are very good with issues that turn on wording - as courts are finding out now.

 

[icowden]

Situation is......
An elderly (82 yrs) relative has had a fall while in Spain.
She has full insurance and declared all medical probs INCLUDING blood thinners.
The hospital was due to operate today when suddenly the insurance Co have said....hang on, the blood thinners might have made her dizzy and lose balance. They are now refusing to pay out with the obvious family problems.
So.......does anyone KNOW FOR SURE what can be done ie best guesses are not really helpful.
NB
AI says the insurance Co cannot do this, but they have.

Find a local solicitor who specialises in medico-legal. Get them to review the policy and the information from the insurer. They will be able to tell you if there is an actionable case. Of course, there will be some attendant cost...

 

[Dave7]

Thanks for all the comments.
I am on the periphery, my SiL is doing the donkey work. His brother has flown out to fight from that end.
SiL has spoken to the consulate. Apparently there is what I call a legal scam where, in the event of an accident the private ambulance/hospitals try to get there before the standard ones. Once 'they' have started treatment its illegal to stop procedures without paying (my words).
Her doctor cannot disclose info without written consent so the family are in the throes of getting the patient to 'sign' consent.
My daughter and SiL are flying out Thursday and may resort to bringing the lady home via hire car/ferry/hire car.
As I say, I am on the periphery doing my little bit.
Thanks again......I will hopefully know more by Friday.

 

[Cirrus]

If she has her GHIC (Global health insurance card) then Spanish hospital should be able to bill the NHS directly https://www.nhs.uk/using-the-nhs/he...-a-free-uk-global-health-insurance-card-ghic/

 

[Dorset Boy]

I was going to mention the GHIC.
With regards to the policy, you may declare something and they may then exclude cover for related incidents, but that should be clear from the exclusions section of the policy.

What a difficult situation made much more stressful than it really should be.

Who is the insurer?

 

[Dave7]

Who is the insurer?

I really have no idea.
I am just trying to help by digging, hence my question on here
Thanks