There are occasions when you need to make a travel insurance claim for some lost baggage, delayed flight or claim medical expenses if you should fall ill whilst abroad. 9 out of 10 times these claims are legitimate and are approved by the insurer.
But there are occasions where the claims have been rejected. This can be due to multiple reasons for example not being given enough evidence to support a claim, the claimant hasn’t purchased the correct insurance policy or is found to be negligent, making their claim invalid, and in turn the claim gets rejected by the insurer.
When the claims have been rejected, the claimant has the right to contest the decision with the Financial Ombudsman Service (FOS) if they feel that their claim has been unfairly rejected.
So, who are the Financial Ombudsman Service?
Set up by Parliament, the Financial Ombudsman Service is the UK’s official expert in sorting out problems with financial services.
If a business and a customer can’t resolve a complaint themselves, the Financial Ombudsman Service can give an unbiased answer about what’s happened. If they decide someone’s been treated unfairly, they have legal powers to put things right.
Example of upheld cases from Financial Ombudsman Service
Not covered for business travel
Mr S complained that his travel insurer declined his delayed baggage claim under his travel insurance policy.
He travelled to India to attend a conference, at which he was a speaker, and to visit his parents. When he arrived in India, his baggage was missing and wasn’t returned to him for three days. As his baggage was missing, Mr S needed to buy emergency clothing, including clothes for the conference. His claim on his travel insurance policy was declined by his insurer as they concluded that the main purpose of Mr S’s trip was to attend the conference and as his policy excludes cover for business travel, he couldn’t claim for his delayed baggage.
Mr S was dissatisfied and went to the Financial Ombudsman Service to complain that his claim was rejected. He stated that main purpose of his visit to India was to visit his parents, and while he was there he attended a medical conference. The insurer told Mr S it wasn’t prepared to change its decision, as the main purpose of his trip was to attend the conference and cover for business travel was excluded.
The Financial Ombudsman Service said: “We have looked at the terms and conditions of Mr S’s policy and these clearly states cover for business travel is excluded. What the terms and conditions don’t state is the position when a trip combines business with other travel which would be covered under the policy.
In this situation we need to look at the details of the trip to decide whether the main purpose of the trip was business. Mr S has provided details of the conference he attended and details of his flights. But, Mr S was a speaker at the conference, and the information he has provided states abstracts must be submitted by the end of April 2016 and the last date for notifying a change of speaker is the end of June 2016.
So, by this date Mr S was going to attend the conference. Mr S booked his flights in late September 2016. He flew from England to the location of the conference and then he flew on to visit his parents. His baggage was delayed on the flight from England to the conference. And the replacement items Mr S bought were for business purposes. As the purpose of this part of his journey was business, I think the insurer acted reasonably when it applied the business travel exclusion on Mr S’s policy and I think it applied this fairly.”
Final decision: Mr S’s complaint not upheld
Deciding to cancel a trip
Mr W booked a family holiday in early 2017 but he came across a news item which said there had been an outbreak of Dengue Fever in the country where he and his family were due to visit. As Mr W had contracted Dengue Fever when he visited the country before, he was concerned he could be prone to more serious symptoms if he contracted it again. To reduce his chances of contracting it again, he obtained a doctor’s note from his GP and decided to change the holiday from August 2017 to December 2017 and notified the insurer to make a cancellation claim.
His insurer declined the claim because it determined the outbreak as an ‘anticipated event.’ He then raised the matter further with the Financial Ombudsman Service who said: “Our investigator didn’t think the insurer had acted unfairly in declining his claim. She thought it’d acted in line with the policy terms and conditions. She also said outbreaks of Dengue Fever in Mr W’s holiday destination had been reported as early as 2016. And, as Mr W had contracted Dengue Fever in the same country previously – he would’ve likely been aware of the risk of this happening again.”
Unsatisfied with the finding, Mr W took the matter further and a senior officer of the FOS dealt with his claim.
The officer said: “We will not be upholding the complaint as the insurer declined the claim as it thinks the outbreak of Dengue Fever in the country he’s travelling to be an anticipated event. The policy can offer reimbursement up to £5,000 per insured person for journey deposits and costs which you cannot recover from any other source as a result of a variety of reasons listed in the policy documentation. But reimbursement for cancellation as a result of an ‘anticipated event’ is excluded under the policy.”
The policy definition of an anticipated event is ‘Any event or occurrence which you or your immediate family knew would occur or could have reasonably have expected to occur and which you and your family were aware of at the time of booking your trip, when you became eligible for cover or when purchasing an upgrade.’
Mr W had contracted Dengue Fever when he visited the same country previously. He would’ve been more aware of the risks of contracting this type of illness if visiting again and his insurer are correct in saying that the government website talks about the outbreak figures as detailed above. But it also states that all regions of Mr W’s holiday destination experience outbreaks of the mosquito-borne Dengue Fever.
The use of the term ‘outbreaks’ seems to suggest this is a regular occurrence in this country and something that’s happened more than once. The World Health Organisation (WHO) says Dengue Fever is endemic in Mr W’s travel destination and occurs every year, usually soon after rainfall as this is optimal for mosquito breeding.
Although it was understandable that Mr W wanted to cancel his trip, the Financial Ombudsman Service do not think it is fair that the insurer covers the costs of his decision to do this. Mr W’s doctor didn’t seem to advise against him travelling, so there was no official advice instructing him to do so. Mr W’s policy also doesn’t cover him for a disinclination to travel.
Final decision: Mr W’s complaint not upheld