The trip is booked
Renee and Raymond booked a trip to go to Fiji on 23 June 2014 through their local travel agent. They were due to leave New Zealand for Fiji on 9 August 2014.
Renee and Raymond called their travel insurance company, Let’s Go Travel on 23 June 2014 to seek travel insurance and as part of that process disclosed information about their health. Renee said she told Let’s Go Travel she was awaiting an appointment time to go to her local hospital to meet with a specialist about some problems she had been having with her breathing.
Renee sees the specialist
On 23 July 2014, Renee attended her hospital appointment and was advised by the specialist not to travel on 9 August. The specialist was concerned that Renee may have blocked arteries and she needed to have an angiogram. Renee and Raymond cancelled their trip and claimed for the cancellation costs- $6,500.
It transpired that Renee did not have blocked arteries; she had angina which could have been controlled by pills, and Renee and Raymond could have taken their trip. However, by the time she and her doctors knew this, it was too late to take the trip.
The claim is declined
Let’s Go Travel declined Renee and Raymond’s claim on the basis that Renee had a pre-existing medical condition. The insurance policy definition of a pre-existing medical condition included any signs or symptoms a person is currently aware of, and is awaiting a specialist opinion about.
Let’s Go Travel also referred to Renee’s medical notes showing that her GP was first made aware of her chest pain on 22 May 2014 and she was referred to the chest pain clinic on 27 May 2014 (that is, before the insurance policy was purchased).
Also, the specialist’s report said that Renee had a one year history of increased chest tightness and breathlessness. Overall, because Renee was under investigation for the chest pain prior to the purchase of the insurance policy, Let’s Go Travel declined the claim.
Renee and Raymond said they would never have booked the trip if they thought that it might be affected as a result of seeing the specialist.
Also, Renee and Raymond said they had received two letters from Let’s Go Travel declining their claim; the latest in time was dated 22 November 2014. Renee said she replied to this letter saying they were unhappy with the decision, but had not received a reply.
We asked Let’s Go Travel for a report on the complaint, including the copy of the telephone call Renee and Raymond made to Let’s Go Travel when they purchased the insurance policy.
The call recording showed that Renee had told Let’s Go Travel she was awaiting a specialist appointment at her local hospital. Let’s Go Travel’s staff member had clearly told Renee during the call that there was no cover for anything in relation to the symptoms she was awaiting the specialist’s opinion on.
Let’s Go Travel also said it did not receive Renee’s reply to its letter dated 22 November 2014.
We sent the insurance company’s report to Renee and Raymond including the telephone call recording. We pointed out that Let’s Go Travel’s staff member said that Renee would not be covered for symptoms awaiting investigation by the hospital and referred to the medical notes which indicated Renee had been suffering angina symptoms since May 2014.
After reviewing the information, Renee accepted she had little chance of having cover under the policy. Renee said that she did not know that she had angina when she booked the holiday and thought that when she saw the specialist all that would happen is that she would be prescribed pills. Renee decided to discontinue her complaint.
Lessons to be learned
It is important to remember that travel insurance policies can be widely worded, particularly in relation to the definition of ‘pre-existing medical condition’. If a person is suffering symptoms and awaiting a specialist appointment there may not be cover under the policy. It is also important to ensure that you listen carefully to what you are told if you are seeking travel insurance cover over the telephone. Renee and Raymond had pursued their claim in good faith – they were simply unaware that the policy definition of a pre-existing medical condition was very wide.
We also noted let’s Go Travel had all the information it needed to be able to resolve the complaint directly with Renee and Raymond and the complaint should not have had to come to FSCL.
A complaint is ‘any expression of dissatisfaction where it is explicitly or implicitly expected that action will be taken’. Perhaps if Let’s Go Travel had written back to Renee and Raymond after receiving the 22 November 2014 letter, sent them a copy or transcript of the telephone recording and explained in some more detail why the insurance policy did not provide cover, the complaint would not have escalated to FSCL.