Travel insurance: a cautionary tale
by
Graham Davies

Updated 27 December 2011

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, that need treatment while they are abroad or that cause them to cut their holiday short and return home.

In November 2005 my wife and I booked a holiday in Barbados in order to be able to attend our daughter's wedding in May 2006. Unfortunately, I had to cancel the holiday as a massive tumour was identified in my abdomen in January 2006 and had to go into hospital for major surgery in March 2006. I therefore submitted a claim to American Express, with whom I have whole-year family 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."

I disputed AXA's reason for rejecting the claim on the grounds that I had no idea that I had a pre-existing medical condition. 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 August 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 at regular intervals, so I asked American Express what would happen if I claimed, say, for lost luggage or treatment for a broken leg or illness that had 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 usually 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. However, medical insurance cover for myself and my wife will cease to be offered by American Express when we reach the age of 70 in 2012 and 2013, so we will have to hunt around for another company to cover us for medical treatment. Loss of baggage etc is still covered by American Express.

In September 2006 my wife Sally and I had planned a visit to Switzerland and I was anxious to cover both of us adequately. At that time Switzerland (which is outside the EU) was not a member of the European Health Insurance scheme, and my EHIC card would therefore not have been valid. 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.

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.

In March and August 2010 I had two CT scans, which showed that I had a recurrence of PMP. Both showed evidence of new growth, but not at an alarming rate. A laparoscopy performed on 8 October 2010 provided my consultant surgeon with more details, and his decision was not to offer further major surgery but to continue keep a watchful eye on me. I appeared to be asymptomatic, he said (i.e. not in pain or discomfort and apparently very fit), and the PMP was very slow-growing. A CT scan was therefore scheduled for April 2011, and then the situation would be reviewed. I could go on for years like this, my surgeon said.

My wife and I decided that we would like to go to Canada (where she has relatives) in May 2011, so I checked on the situation regarding travel insurance. It was not good. I contacted three companies that specialised in insuring people with pre-existing medical conditions: SAGA, MIA and ItsSoEasy. SAGA and MIA turned me down flat. Insuring me for a holiday in Canada (or the USA) would be out of the question, they said, due to the enormous costs of medical treatment in these two countries and the high rate of claims by people with pre-existing medical conditions. ItsSoEasy was prepared to insure me, but for a premium of £2750 pounds (US$4000) for two weeks! Oh well, that restricts my travel plans for the foreseeable future. I could take a chance and travel without taking out additional insurance, I suppose, but travel insurance for Europe is still affordable and there are so many nice places to visit. Interestingly, I could get insurance for Australia at a reasonable price, as Australia has a reciprocal agreement with the UK with regard to treatment under its national health service.

Feedback welcomed. Please use my contact form if you wish to email me: Contact Form.

© Graham Davies 2011. This work is licensed under a
Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

Creative Commons Licence