While on holiday in Lanzarote in May last year, I fell ill and passed out. I was taken to hospital where over the following three days I went from intensive care to having a pacemaker fitted, before being discharged.
The day after, I contacted Insure and Go, my travel insurer, to tell them what had happened and was told not to worry and to complete my claim when I returned home. Nine months later and now its underwriter Zurich is refusing to pay the €10,000 (£8,542) hospital bill because I didn’t contact them soon enough after falling ill. Please can you help? S.B., Kent.
Declined: Zurich won’t pay my £8,542 hospital bill because I didn’t contact them soon enough
Sally Hamilton replies: You forwarded me a copy of the email you received from Zurich Assist, which was handling your claim. I imagine its contents put your pacemaker to the test as soon as you read it.
Sent to you in January, the claims handler confirmed that on reviewing your claim — which had involved looking at your GP records and paperwork from the hospital in Lanzarote — that it would pay you £30 in hospital benefit (a cash benefit of £10 for each night you spent as an inpatient) and £500 towards the €10,000 bill for your hospital treatment.
It stated: ‘Having looked at your medical report we note that you were unwell for three days and could have contacted the medical assistance team within those days. Therefore, the underwriters have advised that your claim settlement will be limited to £500 as you did not contact the assistance team as per your policy terms and conditions.’
You were referred to page four of your policy document, which says you must contact the company immediately on going into hospital — or risk having any claim limited to £500. It asked you to pay the outstanding balance to the hospital — and send evidence you had done so — before it would reimburse the £500. You were furious and upset and so contacted me.
You told me the policy schedule you had taken with you on the trip clearly stated that you should contact the insurer ‘as soon as possible’. To your mind, and mine, you made contact the moment you were out of danger after being treated for an irregular heart rhythm and having the pacemaker fitted. Surely that was soon enough.
A policy schedule is a shortened version of the full terms and conditions. I thought your reading of the schedule was correct and that Zurich should not have declined your claim over a three-day time lapse. If the insurer wants to enforce such a restrictive condition, it should be emphasised clearly on the schedule.
However, I think the requirement to get in touch ‘immediately’ was out of order in your case as you had been taken seriously ill. You told me you were barely conscious during the three days in question — nor did you have your phone or insurance documents with you.
I told Zurich what I thought, and it agreed to investigate. After reassessing your case, the insurer decided an error had been made. As a result, it concluded you will not only have the €10,000 medical bills met but be paid extra as an apology for the distress caused.
A Zurich spokesman says: ‘We are very sorry for the challenges and the delays that our customer faced when trying to make a claim on her travel insurance policy. We have now carried out a full investigation and can confirm she was incorrectly informed that she did not have a valid claim. This was due to a miscommunication between claims handlers.’
He adds: ‘We have now spoken to her to confirm that we will make a full settlement as soon as possible and provide £850 in compensation for the inconvenience caused. We strive to maintain a high standard of customer service and on this occasion we have fallen short. We will conduct a full review of how this claim was handled to ascertain the lessons learned and prevent this from happening again.’
Train delay claim
I have reached a brick wall with Great Western Railways (GWR) regarding a claim for delays and cancellations affecting my journey from Truro to Poulton-le-Fylde in Lancashire last August that caused me considerable discomfort.
I am 84 and arrived home with a trapped sciatic nerve caused by sitting on draughty platforms and waiting rooms that day while staff found me alternative trains along the way.
I arrived home after midnight, 14 hours after the start of my journey. It was supposed to take six hours. I complained to GWR, but it refused a claim for reimbursement or compensation.
C.C., Preston, Lancashire.
Sally Hamilton replies: I have endured a few delayed train journeys in my time, but the bitter pill is usually sweetened by the railway company refunding the ticket price, whether partially or in full. Your tale of travel woe and denied refund defies belief. On its website, GWR states: ‘If you arrive at your destination 15 or more minutes late because your GWR train was delayed or cancelled, you can claim delay repay compensation.’
The amounts paid back to travellers vary, but a delay of 120 minutes entitles the traveller to 100 per cent refund for the full cost (outward and return).
Since your ticket cost you £152.30 return, you should have automatically received £152.30.
You submitted copies of your tickets, as required, but your claim was rejected on the grounds the rail company could not find a timetabled journey to match the first leg of your claim.
You sent me a copy of the ticket. It clearly stated it was due to leave Truro for Taunton, at 11.50am. This train was cancelled, and you were shunted on to a train leaving Truro at 13.30 instead. After that everything went awry, with all your seat reservations lost as well as the pre-booked assistance you had requested for particular trains.
You had to seek ad hoc help from staff at each of four stations. By the time you reached Preston, you had to terminate the journey 16 miles short of your destination as it was so late no more trains were running from there to Poulton le Fylde. You had to phone a friend who kindly picked you up and drove you home.
I asked GWR to put things right. This prodded its customer service operation to contact you and confirm you would receive your refund after all. Sadly, its apology did not extend to expressing regret for the five-month delay in delivering your refund.
This post first appeared on Dailymail.co.uk
