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Joshua
Joshua, Lawyer
Category: Law
Satisfied Customers: 25440
Experience:  LL.B (Hons), Higher Prof. Dip. Law & Practice
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I am fully insured with PruHealth ie Medical and Travel.

Customer Question

I am fully insured with PruHealth ie Medical and Travel. I was on a Tour of South America and incurred serious breathlessness whilst staying at Lake Titicaca in Peru because of the extreme altitude. I left the group, flew to sea level where my breathing immediately improved, and joined up with the group after they had travelled on to Bolivia and then down to sea level at Buenos Aires. I incurred some considerable personal expense in that I paid for two air flights and three nights in hotels whilst awaiting the arrival of the group. PruHealth says this is not covered under `curtailment` I argue that it should be. Barbara Lynn Meadows.
Submitted: 3 years ago.
Category: Law
Expert:  Joshua replied 3 years ago.

Joshua :

Hello and thank you for your question. I will be very pleased to assist you. I'm a practicing lawyer in England with over 10 years experience.

Joshua :

Do you have a link to the insurance policy document please?

Customer:

I cannot do a link to the policy

Joshua :

Would this be the travel insurance policy? If so do you not what level of cover you had?

Joshua :

http://pruhealth.pruhealth.co.uk/mediaonline/PDF/Presales/Advisers/member-literature/slh1771_1110.ashx

Customer:

level 2

Joshua :

Thanks. Would you bear with me for a few moments while I look at the policy...

Joshua :

Thanks for your patience. Did you receive medical advice at Lake Titicaca not to continue with that part of the tour or did you take this decision on your own initiative? if you did obtain medical advice in this respect, do you have a written record of that advice?

Customer:

I took oxygen which didn't help then I decided to descend to sea level and the courier signed a note.

Joshua :

Thanks. So you didn't obtain medical advice either before or after you descended?

Customer:

no but it said in the letter from the tour operators before we left England that `no breathing` at night wasn't uncommon but not dangerous. The only `cure` is to descend.

Joshua :

many thanks. Under the terms of your policy, there is provision for claim in the circumstances. the relevant provision is on page 10 and states (I have emboldened the relevant sections): This applies if you or your insured dependants have to cancel the holiday or business trip , or have to cut it short or change the itinerary after the departure date as a direct and necessary result of any of the following illness or death of an insured person, • close relative or any person you or your insured dependants intend to travel with, stay with or do business with during the holiday or business trip (please note: for claims for cancellation or cutting the trip short due to illness, we require a medical report from the attending GP or specialist)

Joshua :

under the above provision, the insurer will pay resulting expenses to a maximum value of the lesser of £4000 or the cost of the holiday

Customer:

so no go then if I haven't a medical certificate?

Joshua :

the difficulty however is that you will note that under the provision, they require a medical report from a qualified medical practitioner of some kind in order to demonstrate that in this case. however, on strict reading, to my mind there is a weakness in the provision in that if you read it carefully it states that they require a medical report the claims involving cancellation or cutting the trip short due to illness. it is silent on whether a report is required for changes of itinerary due to illness.

Joshua :

clearly, it would have been better had some form of medical report been obtained, however, due to the precise wording of the above condition, it seems to me possible for you to argue that the condition does not require a medical report the changes of itinerary but only specifies that this is required for cancellation or cutting short of a trip. this is a technicality and I do not wish to suggest that this means that there is any guarantee of success but at least the wording does not close the door on the possibility of a claim

Joshua :

if you wish to pursue the issue, ideally, you will have some form of evidence as to the medical difficulties you experienced whether these are statements from fellow travellers or the hotel you are staying at or indeed any third party that cooperates your claim that you experienced medical difficulties due to the altitude. At the same time, you may consider a formal complaint to the insurer that you consider you do have a claim under the above provision and that the provision does not specify that a medical report is required in respect of changes of itinerary and accordingly your claim stands for the various expenses that you incurred as a consequence of your forced to change of itinerary

Joshua :

in the event that you are not satisfied with their response which is a distinct likelihood, you can refer your complaint to the financial ombudsman which as you are likely aware is a freak dispute resolution service that deals with insurance and financial services disputes. They can independently determine your complaint and can award damages to be paid to you where it finds in your favour. The decision is binding upon the insurance company however it is not upon you is that there is a little too lose other than a little time in making the application

Joshua :

http://www.financial-ombudsman.org.uk/consumer/complaints.htm

Joshua :

Is there anything above I can clarify or assist you with any further?

Customer:

ok I`ll think about it thank you. I will be giving you an excellent rating.

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