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Jamie-Law
Jamie-Law, Solicitor
Category: Law
Satisfied Customers: 3279
Experience:  Solicitor
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My sister was abroad in Columbia on holiday. She had to go

Customer Question

My sister was abroad in Columbia on holiday. She had to go into hospital whilst out there for treatment related to a pre existing condition she has. She had declared this condition on her holiday insurance and so the costs of her treatment were covered. Her attending doctors out there declared her fit to carry on her holiday. However her insurers then stated that whilst they would continue to cover her for the rest of the trip they would now exclude her pre existing condition. She declared this condition before travelling and paid an extra premium to have this covered for the entire trip. We felt that they shouldn’t have suddenly changed the cover whilst she was away simply because she had made a claim and they should have covered this condition for the entire trip. I contacted a solicitor via this website who took a look at the terms and conditions of her policy and said that it seemed like a breach of contract. We are now preparing to put in a complaint with the financial ombudsman to the effect that curtailment was unnecessary and against medical advice, that she was forced into cutting short her trip by several weeks due to the fact that the insurers refused to carry on insuring her fully despite the fact that she had declared her pre existing condition previously and had paid to be covered for this for the entire trip.Our complaint is that all the attending doctors and the surgeon in Columbia agreed that my sister was well enough to carry on her trip and so the insurers medical team were going against medical advice in curtailing her trip. In agreeing that she can carry on her trip with cover for everything but the pre existing condition was essentially admitting that she is in fact well enough to travel and did not require curtailment home. We believe the reason for their decision is that she was due to fly to LA where medical costs are potentially very high. They state that any further claims would no longer be unforeseen or out of her control but this is why she declared her pre existing condition of crohns disease and paid a very high premium of £477 for the trip, the fact that you have a condition like this means it is more likely that you may have a problem whilst away and why you pay more. So it’s already a possibility and therefore not unforeseen, the fact that she had to make a claim doesn’t change that as it was essentially already the case.Essentially I’m contacting you today as we’d like advice on the best way to approach the ombudsman, which areas we should focus on and how we should set out our case to the best effect.I’ve attached the terms and conditions of her policy along with the email the insurers sent us explaining their decision.Many thanks,Victoria
Submitted: 1 month ago.
Category: Law
Expert:  Nicola-mod replied 1 month ago.
Hello,
I've been working hard to find a Professional to assist you with your question, but sometimes finding the right Professional can take a little longer than expected.
I wonder whether you're ok with continuing to wait for an answer. If you are, please let me know and I will continue my search. If not, feel free to let me know and I will cancel this question for you.
Thank you!
Nicola
Customer: replied 1 month ago.
Hi Nicola,Yes that's fine, I'm happy to wait for an answer.Thanks for letting me know,Victoria
Expert:  Nicola-mod replied 1 month ago.
Hello,
We will continue to look for a Professional to assist you.
Thank you for your patience,
Nicola
Expert:  Nicola-mod replied 1 month ago.
Hello,
I apologise as we have not yet been able to find a Professional to assist you. Do you wish for me to continue to search for someone to assist you or would you like for us to close your question at this time?
Thank you for your patience,
Nicola
Expert:  Nicola-mod replied 1 month ago.
Hello,
Please understand it is rare for us not to be able to find the right Professional to assist our customers. We can close this question and refund your good faith deposit to the original funding source on request, as per our satisfaction guarantee.
Please let me know how you wish to proceed and again I apologize for any inconvenience this may have caused.
I hope you will give JustAnswer a try again in the future,
Nicola
Customer: replied 1 month ago.
Hi,I would like to continue looking for an answer to my question. I'm a little confused as a couple of weeks ago I asked a very similar question which was answered within minutes. I'm wondering if this is because I paid for that question whereas this one was asked on my free trial?Just seems very odd to me that such similar questions have had such different responses.
Expert:  Nicola-mod replied 1 month ago.

Hello,

We will continue to look for a Professional to assist you. It is possible that this question is underpriced, however I have not had any feedback from Experts about this.

Thank you for your patience,

Nicola

Expert:  Jamie-Law replied 1 month ago.

Hello my name is ***** ***** I will help you with this.
What is it you would like to achieve please?

Customer: replied 1 month ago.
Hi Jamie,Essentially we’d like advice on the best way to approach the ombudsman, which areas we should focus on and how we should set out our case to the best effect based on the info I've included and the documents attached.Many thanks,Victoria
Expert:  Jamie-Law replied 1 month ago.

Does the policy say they can change the cover mid way through or after a claim?

Customer: replied 1 month ago.
Not that I can see no, though it's quite dense and in legal speak. I attached the terms of the policy in case you want to double check.
Expert:  Jamie-Law replied 1 month ago.

its 60 pages long and outside the remit of the question.

I can look through it but it will take several hours and sadly an extra cost.

Let me know if you want me to go through it.

Customer: replied 1 month ago.
Ok no problem, don't worry about that. I've had a good look through and nowhere states that they can change the cover midway through or after a claim.
Expert:  Jamie-Law replied 1 month ago.

Ok - if that is the case they can not. The contract is agreed and unless it says otherwise they must provide full cover for the duration of the term.
They can not change their minds mid way through it - that is like BT saying, actually we have changed our mind, we are not going to provide you with a phone service from 3 weeks time!

You should write, make a formal complaint and ask them to investigate.

They will provide a final response and if they do not uphold it, you can then complain to the Financial Ombudsman.

They offer a free, independent service at: www.financial-ombudsman.org.uk

That should resolve the complaint.

Can I clarify anything for you about this today please?

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