Most people take out travel insurance before they go on holiday in order to cover unforeseen events such as loss of baggage, theft of valuables, and accidents and illnesses that might prevent them from going on holiday or cause them to cut their holiday short and return home. I always take out travel insurance. As I travel a lot I have a whole-year policy.
In November 2005 I booked a holiday in Barbados in order to be able to attend my daughter's wedding in May 2006. In February 2006 I had to cancel the holiday as a massive tumour had been identified in my abdomen and had to go into hospital for major surgery. I therefore submitted a claim to American Express, with whom I have whole-year travel insurance underwritten by AXA. The claim was for the reimbursement of the £240 deposit I had paid for the holiday, but it was rejected on the grounds that I had a pre-existing medical condition at the time of booking the holiday. AXA quoted the relevant exclusion clause in the travel insurance policy document, which stated:
"Pre-existing medical conditions known to you prior to booking your trip, for which you are awaiting test results or on a waiting list for an operation, consultation or investigation."
In August 2005 I developed a bladder infection and went to see my GP for treatment. I was prescribed a course of antibiotics which cleared up the infection within a week, but my GP decided to arrange for an immediate ultrasound scan and to refer me to a consultant urologist just to be sure. The ultrasound scan did not reveal a great deal, only that I had a urine retention problem. I finally got to see the urologist in early December 2005, who said he could feel cysts around the area of my bladder. There followed a series of tests and scans over a period of three weeks, and finally I was told by the urologist in January 2006 that I had a massive, probably malignant, abdominal tumour that would have to be removed by surgery. This came as a complete shock to me, as I had not suffered any pain or other symptoms since I first visited my GP for advice in September 2005. The operation was scheduled for 1 March 2006, and it was only after the tumour had been removed that it was identified as a very rare form of cancer, a mucinous adenocarcinoma of the urachus, one of a group of cancers known as Pseudomyxoma Peritonei (PMP) that affects around one in a million people. See my full story here: PMP: a survivor's story
When AXA rejected my claim on the grounds that it was a "known" pre-existing condition I pointed out that it was not known to me at the time of booking my holiday - indeed it could not have been known to me as the condition was so unusual and unsuspected - and that therefore I had a valid claim. I stressed that I appeared to be fit and well at the time of booking my holiday in November 2005, which was confirmed by my GP, and I had no reason to suspect that I would require major surgery. An exchange of around a dozen letters between AXA and myself over a period of five months got me nowhere. AXA flatly refused to accept my claim and were extremely unhelpful. I had the feeling I was banging my head against a wall. Each reply from AXA was signed by a different person, and the exotic names at the foot of the letters led me to suspect that I was probably dealing with a team of people in a far-flung outsource unit who did not fully understand what I was trying to convey to them and who were just copying and pasting standard responses into their letters to me.
Finally, I went back to the UK branch of American Express Customer Services, pointing out that I was a long-standing American Express cardholder and that I was displeased with AXA's refusal to honour my claim. Customer Services were much more sympathetic and I was awarded an ex gratia payment of £240, the amount that I had originally claimed. So my claim was not actually accepted, but my persistence in arguing over the interpretation of the word "known" in the relevant exclusion clause paid off.
The current American Express Summary of Benefits booklet relating to travel insurance states that if you require a medical, surgical or psychiatric check-up every 12 months or more frequently then they won't pay up up if you make a claim for anything relating to a pre-existing condition, e.g. emergency treatment while on holiday or cancellation of a trip due to a deterioration in your condition. I have a CT scan and a blood test every year, so I asked American Express what would happen if I claimed, say, for lost luggage or treatment for a broken leg - which has nothing to do with my pre-existing medical condition. In June 2007 they wrote back as follows:
"Any claims which are not as a result of your pre-existing medical condition will be considered according to the Summary of Benefits [of your policy]."
This is reassuring. I still have an American Express travel insurance policy, and I don't take out additional insurance when travelling in the European Union as it is highly unlikely that I would require emergency treatment for my existing condition. It's not that kind of disease, i.e. it's currently stable and it does not suddenly flare up, and the EHIC (European Health Insurance Card) covers most emergencies. In any case the travel cover I get from American Express is good value for money as it extends to my wife, two daughters, two sons-in-law and three grandchildren - all for £300 per year and for multiple trips, including skiing holidays.
If I needed to travel outside the EU, particularly to Canada or the USA (which charge frightening fees for medical treatment), I would definitely look for another travel insurance company. In September 2006 my wife Sally and I had planned a visit to Switzerland and I was anxious to cover both of us adequately. SAGA kept coming up in my searches for suitable travel insurance policies, and they said they were prepared to insure Sally and me. SAGA allows policyholders to specify medical conditions which they already have or which are under investigation, and then the premium is adjusted accordingly. Their insurance policy was not cheap, however - probably because the dates of travelling were just six months after I had undergone major surgery. I had to pay around £110 for each of us for the two-week holiday. SAGA's policy includes an exclusion clause that is similar to AXA's exclusion clause as quoted above, except that the phrase diagnosed or undiagnosed appears in place of the word known, which is much clearer, and then they allow you to specify an existing medical condition and to override the exclusion clause for an additional premium: http://www.saga.co.uk
There is another company called MIA (Medical Insurance Anywhere) that will cover people with pre-existing conditions. I have read favourable reports about MIA in forums and blogs relating to my medical condition: http://www.miaonline.co.uk
The moral of this story is that you need to read exclusion clauses in travel insurance policies very carefully if you have a pre-existing medical condition and you need to shop around for a suitable policy.
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Updated 12 November 2009
© Graham Davies 2009 under a Creative Commons Attribution-Noncommercial-No Derivative Works 2.0 UK, England & Wales Licence.
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