case studies – travel insurance

07/1
travel – accidental death benefit – exclusion for ‘hazardous activities’ – whether exclusion brought to insured’s attention.

Mr H took out an annual travel policy for his two adult sons before they went to America in May 1999. The insurer took approximately three weeks to issue the policy and then sent it to Mr H. As he was away at the time, the sons were unable to check – before they set out on their trip – whether the policy was suitable for their needs. In fact, it was not. It restricted cover for individual trips to 30 days, whereas they planned to be away for 74 days, and it did not cover claims arising from hazardous activities, including riding motorcycles over 125cc.

The following April, one of Mr H’s sons went out to Australia. Whilst there, he had a fatal accident riding a 600cc motorcycle. Mr and Mrs H put in a claim for repatriation and funeral expenses and for the accidental death benefit of £30,000.

The insurer explained that, because of the motorcycle exclusion, the policy did not provide any cover. However, it accepted that it had not sold, issued or explained the policy correctly. It therefore met the repatriation and funeral expenses as a gesture of goodwill. Mr and Mrs H did not accept that the motorcycle exclusion was valid, since it had not been drawn to their attention, and they felt they were entitled to the full death benefit.

complaint rejected
Mr H bought the policy specifically for the trip to America and had decided to buy an annual policy because of the length of the trip. The insurer had accepted that the policy had not been properly sold and it confirmed that it would not have relied on the exclusions or restrictions to repudiate any claims arising during the trip to America.

However, by the time of the second trip, the family was aware that the policy did not cover all hazardous activities and the policyholders had had ample opportunity to check whether the policy was appropriate for their needs and to request an amendment if necessary. The policy was, in any event, due to lapse shortly after the son’s departure to Australia yet they had not checked that it would cover the trip or the activities he planned. In these circumstances, we took the view that the insurer’s offer to pay the repatriation and funeral costs was reasonable and that it had no liability for the death claim.

07/2
travel – baggage – temporary loss – meaning of ‘temporary’.

Mr and Mrs N flew to Barcelona to join a cruise and the airline lost Mr N’s baggage. He notified the cruise operator and was advised that the insurer would reimburse emergency purchases. He bought some shirts and, some days later, other clothing. His bag was found fairly quickly and was sent to the ship when it docked at Athens.

Mr N claimed £345 from the insurer. It sent him a cheque for £150, explaining that this was the maximum payable for temporary loss of baggage. The insurer submitted a claim to the airline and in due course received £150, which it regarded as reimbursment of its payment to Mr N.

Mr N argued that his claim should not be limited because the loss was not ‘temporary’. He had restricted his purchases until the ship had left port and had no means of knowing when or if his bag would be found.

Complaint upheld in part
We accepted that a claimant could not know for some time whether the loss of baggage was temporary and that Mr N had taken all reasonable steps to minimise his expenditure. However, he had received his bag within a week and the policy terms made the limited nature of this cover clear. The insurer was justified in limiting its payment to £150.

However, Mr N was entitled to payment from the airline in priority to the insurer’s right to recover its payment to him. We decided the insurer should not have kept the airline’s payment and should send it to Mr N, giving him a total recovery of £300.

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07/3
travel – baggage – theft – exclusion for theft at night from unattended vehicle – whether exclusion onerous.

Miss H went on holiday with her partner to Crete. They left a beach bag containing a camera, two mobile phones, a tape player and some cash, in the locked boot of their hire car. The car was broken into and Miss H claimed for theft of the bag. The insurer rejected the claim on the ground that all the items were within the policy definition of ‘valuables’ and therefore excluded from cover in unattended motor vehicles.

The policy defined ‘valuables’ as ‘photographic and video equipment, camcorders, radios and personal stereo equipment, computers, computer games and associated equipment, hearing aids, mobile telephones, telescopes and binoculars, antiques, jewellery, watches, furs, precious stones and articles made of or containing gold, silver or other precious metals or animal skins or hides’.

Miss H argued that the policy was self-contradictory, in that another exclusion stated that the insurer would not be liable for ‘any theft from motor vehicles left unattended at any time between 10 pm and 8 am’.

Complaint upheld in part
We did not agree that there was a contradiction between the two exclusions; the more onerous exclusion applied only to valuables and meant that they were not covered at any time in an unattended car.

However, that exclusion was unusually onerous and required Miss H to take specific action in order to maintain cover under the policy. The insurer should therefore have drawn it to her attention at the time she bought the insurance. There was no evidence that the insurer had done so.

The fact that she had been given time to read the policy and the option to cancel it was not sufficient for the insurer to comply with its duty to draw such exclusions to the attention of anyone purchasing the policy. We required the insurer to deal with the claim. However, the policy contained a limit of £200 for all valuables and an excess of £45 for cash. These meant that Miss H and her partner would not be reimbursed for the majority of their losses.

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07/4
travel – cancellation – disability – cause known to policyholder when buying insurance – whether claim valid.

On 28 January 2000, Mr A booked air tickets for his family to travel from Manchester to Saudi Arabia on holiday from 8 to 30 March. On 26 February, he bought insurance to cover their travel. He cancelled the flights on 2 March, stating that Mrs A was suffering from complications of her pregnancy and that travel was inadvisable for her.

The insurer’s investigation established that Mr A had tried unsuccessfully to amend the air tickets on 7 February and that his wife’s GP had made a formal diagnosis a week later. The insurer rejected the claim, explaining that the policy did not include cover for any medical condition which existed when the policy was issued on 26 February. Mr A argued that they had no reason to believe that the trip might have to be cancelled when they bought the tickets and he said the sales operator had told him he would be reimbursed if Mrs A became ill. However, the insurer would only refund the premium, not meet the claim.

complaint rejected
We accepted that Mr and Mrs A did not know that the pregnancy was subject to complications when the flights were booked. However, they had been aware of the problem for two weeks before they bought the insurance. The insurer was therefore fully justified in refusing to meet the claim.

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07/5
travel – cancellation – disability arising after start of insurance – whether insurer liable for cancellation cost.

In January 2000, Mr W and Mrs G arranged to go on a holiday in July. Mrs G’s son was admitted to hospital in April and underwent a series of tests. Mr W and Mrs G paid the balance of the holiday costs on 5 May. The son was discharged in the middle of that month but was referred back to a consultant on 24 May, readmitted to hospital a few days later, and died on 13 June, one day after his illness had been diagnosed.

Mr W and Mrs G claimed reimbursement of the cost of cancelling their holiday, but the insurer refused to make any payment beyond the £200 deposit. It relied on a condition in the policy which required policyholders to notify the insurer’s helpline if an immediate relative was ‘receiving, recovering from, or on a waiting list for, in-patient treatment in a hospital’ or ‘waiting for the results of tests or investigations or referral for an existing medical condition’.

complaint upheld
We interpreted the requirement as applying only at the time the policy was issued in January 2000, as is usual with this type of wording. If the insurer had intended this requirement to cover the whole period until the date of departure, that would be an onerous obligation and the insurer would have had to have made it much clearer in its documentation, as well as drawing it to the attention of potential policyholders.

Moreover, even if we considered it reasonable to treat the condition as if it applied when the balance of the money was paid, the claim would still be valid. Although Mr G was in hospital when the payment was made on 5 May, the insurer accepted that it would have provided full cover after his discharge from hospital in mid-May. He would therefore not have come within the terms of the condition when he saw the consultant on 24 May or was readmitted to hospital on 28 May. The insurer agreed to pay the balance of the holiday cost, which the couple had forfeited when they cancelled.

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07/6
travel – cancellation – disability arising after start of insurance – whether insurer liable for full cancellation charge.

In February 2000, Mr and Mrs T booked a holiday in Florida for May and paid a deposit. On 17 March, Mrs T fell off a ladder, breaking bones in her foot.

The foot did not heal well and, when the balance of the holiday cost was due to be paid, Mr T telephoned the insurer for advice.

The insurer would not take responsibility for deciding whether the couple should go ahead with the holiday. It told Mr T that if they went ahead and then found Mrs T was not well enough to travel in May, it would only reimburse the deposit, not the balance of the holiday cost. Mrs T’s foot was not sufficiently recovered before departure and they cancelled the holiday. Mr and Mrs T claimed the full cost of the holiday, but the insurer refused to pay more than the deposit.

complaint rejected
It was Mr T’s decision to pay the remaining balance, trusting that his wife’s foot would have recovered before the holiday started. We were satisfied that the additional expenditure he incurred when paying the balance of the cost of the holiday was a risk he had personally agreed to take. In these unusual circumstances, the insurer was justified in refusing to indemnify him.

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07/7
travel – cancellation – event leading to cancellation pre-dating insurance – policyholder choosing date of departure as start date of policy – whether insurer liable for cancellation due to event occurring after insurance bought but before start date.

On 9 February 2000, Miss S bought insurance to cover her holiday, which was to begin on 20 February. On 17 February, she injured her back and had to postpone the holiday. A month later, she gave up hope of being fit to travel and cancelled the holiday. She submitted a claim for the cancellation cost, but the insurer refused to make any payment. It explained that she had asked for the policy to come into force on 20 February, which was after her injury had occurred. Even though the cancellation date was after the policy’s start date, the insurer considered that the event leading to cancellation had pre-dated the insurance.

complaint upheld
It is normal practice for policyholders to ask for their insurance to start on the date they book a holiday so that cancellation cover operates immediately. Miss S had bought the policy from her travel agent, but he had apparently not given her any advice as to how she should complete the application form. She had not intentionally inserted an incorrect date for the policy to start, but it was not the insurer’s fault that she had asked for cover to begin only on the date of departure. On a strict interpretation, Miss S was not entitled to reimbursement of the cancellation charges. However, owing to the unusual circumstances, we asked the insurer to meet the claim without admitting liability and it agreed to do so. We could not agree that Miss S was also entitled to interest, or to reimbursement of the fee her GP charged for completing her claim form.

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07/8
travel – cancellation – exclusion for pre-existing medical conditions – need for exclusion to be drawn to policyholder’s attention.

Mr R booked a week’s holiday in January 2000, with a departure date of 12 May. He knew he was due to undergo surgery for his hernia and the operation was scheduled for June. When Mr R was told the operation would be performed in April, his daughter asked the travel agent what alternatives were available. The travel agent said that the insurer would meet the cost of cancelling the holiday.

However, when Mr R cancelled, the insurer said it was not liable to make any payment, since Mr R had known about his operation since October 1999. The policy excluded any claim arising out of a medical condition which the policyholder was aware of before buying the insurance. Mr R contended that he had not had any reason to expect the surgery would interfere with his holiday. He also said that, had the travel agent not misled his daughter, he would have rearranged the holiday or transferred it to someone else.

complaint upheld
Mr R could not have been expected to disclose his operation to the insurer unless the travel agent had made him aware of the need to do so, and had explained that the insurer would not otherwise cover any claim resulting from his medical condition. The insurer did not comply sufficiently with the industry selling code by simply requiring the person applying for the insurance to sign a declaration that they had read and understood the policy terms.

Unless there was evidence that the exclusion for pre-existing medical conditions had been drawn to Mr R’s attention before he bought the insurance, we considered that the insurer had to meet the cancellation claim. It accepted our view.

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07/09
travel – cancellation – exclusion for pre-existing medical conditions – whether complications of surgery a pre-existing medical condition.

Mr D booked a holiday for himself, his wife and daughter to start in August 1999. In June, his daughter underwent a kidney transplant and suffered complications, Mr D cancelled the holiday and claimed reimbursement of the cost.

The insurer rejected the claim because Mr D’s daughter had suffered from kidney problems and been on dialysis for some years.

Mr D argued that they had not cancelled because of his daughter’s kidney problems but because of complications that had arisen after her operation. The operation had not been planned when they booked the holiday, but was a one-off life-saving opportunity that they could not pass up.

complaint rejected
The policy excluded any condition ‘which [they] knew about at the time [they] bought the insurance … unless [the insurer] agreed to cover it in writing’. This clearly excluded liability for the claim, even though we acknowledged that the reason for cancelling the holiday was because of deterioration in Miss D’s condition.

Although Mr D denied that this exclusion had been discussed with him, he had signed a declaration that he was aware of it. There was clear advice to call the insurer’s helpline to arrange cover for any pre-existing condition. However, Mr D had not done so. We considered that the insurer’s rejection of the claim was fully justified.

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07/10
travel – cancellation – illness of relative – definition of ‘relative’ – whether illness of next of kin covered.

Mrs and Miss M were due to fly to Rome on 6 August 2000. In July, their parish priest was admitted to hospital as an emergency case and put in intensive care. Mrs M cancelled her holiday to stay by his bedside. The insurer rejected her claim for the cost of cancelling the holiday since the policy stated that benefit would be paid for cancellation ‘because of the death, injury or illness of a relative, travelling companion or a business colleague’, and the priest did not come into any of these categories. The policy definition of ‘relative’ listed various blood relations. Although the priest was not a blood relation, Mrs M produced proof that she was specifically named as his next of kin.

complaint upheld
Although the policy definition of ‘relative’ was clear and the priest did not come within it, the situation was highly unusual and not one which a policy could be expected to mention. In the circumstances, we considered that anyone who is named as ‘next of kin’ for someone hospitalised on an emergency basis should be treated as a ‘relative’ of that person. We required the insurer to meet the claim in full.

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07/11
travel – cancellation – missed departure – failure or disruption of pre-booked public transport – ‘additional expenses’ – whether cancellation claim valid – whether cost of taxi to and from airport ‘additional expenses’.

Mr D booked a flight to Malta for a week’s holiday and arranged for a car to take him to the airport. A motorway accident, causing serious congestion and tailbacks, meant that he missed the plane. The next flight was not for more than 25 hours and would have cost a further £115, so Mr D decided to give up his holiday and return home.

The insurer refused to reimburse the cost of the flight (£173) because the policy only covered cancellation in the event of ‘failure or disruption of the pre-booked public transport service in which the insured is due to depart from the UK’. As the flight had not failed or been disrupted, Mr D’s claim was not covered.

Mr D then contended that the insurer should reimburse the cost of the car taking him to the airport as ‘additional expenses’ for missed departure due to failure of his ‘pre-booked connecting public transport’. He produced a taxi receipt for £90 for the return trip.

complaint rejected
The insurer correctly rejected the cancellation claim. However, Mr D’s claim for missing the plane’s departure would have been valid, if he could have proved he had incurred additional expenses.

Mr D had not mentioned the costs of the ‘taxi’ until three months after his claim had been rejected, having previously indicated that a friend drove him to the airport as a favour. And despite the receipt, we were not persuaded that he had actually made any payment.

In any event, we considered that Mr D had not proved that he had incurred any ‘additional’ expenses as a result of missing the flight. He would have had to meet the cost of travel to and from the airport, even if we accepted that he had agreed to pay the driver. We therefore rejected the complaint.

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07/12
travel – exclusion for unattended baggage – policyholder sitting next to bag but distracted by thief – whether bag ‘unattended’.

Mr N was on holiday in New York. While he was sitting on a subway platform bench waiting for a train, another traveller started a conversation with him. When Mr N looked around a minute or two later, he found his rucksack had been taken from the seat beside him. He claimed for theft of £2,000 of personal belongings and about £400 cash. The insurer rejected the claim on the ground that the rucksack was ‘unattended’ and therefore specifically excluded from cover.

complaint upheld
It could not be said that the bag was unattended when Mr N was in reasonable proximity at the time. Indeed, this was borne out by the circumstances of the theft. There would have been no need for one of the thieves to distract Mr N by engaging him in conversation if the bag had been unattended: the thieves could just have taken it.

The mere fact that a theft had occurred did not prove that property was ‘unattended’. If there had been any indication that Mr N had walked away from his bag and returned to find it stolen, it would have been different. The insurer accepted our view that it should meet the claim, subject to the policy limits of £1,500 per bag and £400 total cash, less the policy excess.

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07/13
travel – fraud – burden of proof.

Mrs B’s handbag was stolen when she was on holiday in Spain. She claimed for the bag and contents, including a neck pendant. The insurer asked her to provide receipts and the receipt for the pendant showed a price of £474. After making enquiries, the insurer established that the receipt had been altered. The true cost was £74.

The insurer rejected the claim in full, quoting the policy provision that it would not pay for any claim ‘if it is either in whole or in any part fraudulent’. Mrs B asserted that she had bought the pendant from a friend and had not altered the receipt, although her friend might have done. The insurer was unable to make contact with the friend and Mrs B could not produce anything from him to support her story. complaint rejected There was no evidence or other information to support Mrs B’s assertion. Although she alleged that her friend had defrauded her, there was no evidence she had bought the necklace from the friend and she had not initiated any legal action against her friend. Whilst she might be entirely innocent of any attempt to defraud the insurer, our informal procedures were not suitable for the full examination of witnesses that would be necessary to try and establish all the facts of the case. We recommended Mrs B to consider pursuing her claim through the courts, where witnesses could be compelled to attend and undergo a thorough cross-examination.

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07/14
travel – loss – proof – policyholder failing to provide police report – whether insurer liable for claim.

Miss K left her wash bag in the aeroplane toilet when travelling to Spain. She submitted a claim for make-up and jewellery valued at £3,200. The insurer rejected her claim on the ground that she had not obtained a written police report of the loss, as required by the travel policy terms. She argued that a report was unnecessary since the police would not be interested, but she stated that she had informed the police.

This statement was contradicted by the claim form, in which she said only that she had told the airline crew and ground staff. The insurer made enquiries with the Spanish police. However, they did not recognise the police reference number Miss K had quoted and there was no mention of Miss K in the police records. Nevertheless, the insurer agreed to reconsider the claim if Miss K could provide any evidence that she had reported the loss to anyone.

complaint rejected
The burden of proving a loss which is covered by the policy rests with the claimant in the first place. We could not say the insurer was unreasonable in refusing to accept Miss K’s account without independent verification. It was somewhat unusual that she had no other insurance, such as a household policy, to protect such valuable items, and her word alone was not sufficient to validate the claim.

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07/15
travel – loss – proof – written police report – whether report essential to validate claim.

Mrs M’s ring was damaged while she was on holiday in Malta. She made a claim for £124, the cost of repairing it and replacing one stone. The insurer refused to make any payment, citing the policy wording which stated that it would not pay ‘for loss or theft of valuables … and any item valued over £100 not reported to the police’. Mrs M argued that the requirement was not appropriate in her case, as the police would not have been prepared to document the damage to her ring.

complaint upheld
The policy defined valuables as ‘items containing precious or semi-precious stones’. Although the ring came within the definition, Mrs M had not lost the ring, only one stone. The estimate for replacing it was less than £100 and therefore it was neither a ‘valuable’ nor ‘any item valued over £100’.

One of the reasons insurers require police reports is to provide independent evidence that a loss has occurred. In addition to submitting an estimate, Mrs M had provided a letter from the holiday group leader confirming that the ring had been damaged. The insurer agreed to meet the cost of replacing the stone and repairing the ring, less the £35 policy excess.

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07/ 16
travel – medical expenses – exclusion for pre-existing medical conditions – policyholder required to obtain permission to travel – whether permission could be given retrospectively.

Mr M went on a long cruise. He was robbed in Singapore and then, two weeks later, became ill with chest pains. He was transferred to a hospital in Jordan, where he was found to be suffering from unstable angina. Subsequently he was repatriated. When the insurer carried out medical enquiries it learnt that Mr M had an extensive history of heart problems. It referred him to the policy conditions and to a declaration he had signed on the policy application form saying he was in good health. These conditions provided that the insurer would not be liable for claims if the policyholder had ‘during the 12 months prior to taking out this policy suffered from any chronic and/or recurring illness of a very serious nature which has necessitated consultation or treatment, and has not obtained permission from their doctor that he/she is fit to travel …’.

The insurer rejected Mr M’s claims for medical expenses and curtailment of his holiday. Mr M acknowledged that he had had cardiac problems for many years, but asserted that he was in good health when he embarked on the cruise. He provided letters from his consultants to confirm this.

complaint upheld
The wording of the application form did not require Mr M to inform the insurer or the intermediary of his pre-existing medical history, as the insurer had argued. It simply required him to obtain permission to travel from his doctor. The policy document contained similar wording. The exclusion stated that the insurer would not meet a claim from someone who had suffered from a chronic or serious condition in the previous 12 months unless the person’s doctor had given them permission to travel. There was no requirement that this permission had to be in writing or presented to the insurer before the holiday.

It was clear that Mr M had seen his GP a week before his cruise. Although it was not clear that Mr M’s reason for visiting his GP was to obtain permission to go on the holiday, his GP was certainly of the opinion that Mr M had been fit to undertake the holiday. In the circumstances, we considered Mr M had satisfied both the policy condition and the declaration he had signed on the application form. The insurer accepted our view and agreed to meet both the medical expenses and curtailment claims.

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07/17
travel – non-disclosure – pre-existing condition – insurer repudiating liability for medical expenses – delay in communicating repudiation – whether insurer liable for expenses despite non-disclosure.

Ms S and Mr C were on holiday in America when Mr C injured his leg. He was hospitalised with deep vein thrombosis, but his condition was exacerbated by liver cirrhosis, hepatitis and alcoholism. Ms S notified the insurer, but after several days it refused indemnity.

Ms S argued that the insurer’s delay had resulted in large medical bills. She said that if it had notified them of its decision more quickly, she could have given Mr C an alcoholic drink and his withdrawal symptoms would have stopped. They could then have taken their flight home.

complaint rejected
It was clear from Mr C’s medical notes that he had a long history of alcoholism, fairly severe liver disease and thrombocytopenia. His GP had only reluctantly agreed that Mr C was fit to travel and had advised him to declare his medical history to the insurer. Despite plain warnings in the policy, Mr C had not done so. We considered that he had accepted responsibility for the risk of travelling.

We did not agree that stopping treatment and giving Mr C a drink would have been acceptable. Mr C was not fit to fly and no doctor would have certified him as fit. There was no unreasonable delay on the insurer’s part in deciding whether to accept the claim. It had made the necessary enquiries as quickly as possible. In any event, the seriousness of his illness meant that Mr C could not have flown home as quickly as Ms S later suggested, regardless of the insurer’s decision.

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