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While on holiday in Lanzarote in May last year, I fell ill and fainted. I was taken to hospital, where over the next three days I went from intensive care to having a pacemaker fitted, before being discharged.
The next day I contacted Insure and Go, my travel insurer, to tell them what had happened and they told me not to worry and to complete my claim when I returned home. Nine months later, and now my insurer Zurich is refusing to pay my €10,000 (£8,542) hospital bill because I didn’t contact them soon enough after falling ill. Can you please help? S.B., Kent.
Rejected: Zurich won’t pay my £8,542 hospital bill because I didn’t contact them soon enough
Sally Hamilton responds: You sent me a copy of the email you received from Zurich Assist, which was handling your claim. I imagine that its content will test your pacemaker as soon as you read it.
Sent to you in January, the claims manager confirmed that upon reviewing your claim, which involved looking at your GP records and Lanzarote hospital documentation, it would pay you £30 in hospital benefits (a cash benefit of £10 for each night spent as an inpatient) and £500 towards the €10,000 bill for his hospital treatment.
It said: ‘After examining his medical report, we observed that he was unwell for three days and could have contacted the healthcare team during those days. Therefore, the insurers have informed her that her claim settlement will be limited to £500 as she did not contact the support team in accordance with the terms and conditions of her policy.’
He was referred to page four of his policy document, which says he must contact the company immediately upon admission to hospital, or risk having any claim limited to £500. He asked her to pay the outstanding balance to the hospital (and send evidence that he had done so) before repaying the £500. You were angry and upset and then you contacted me.
You told me that the policy schedule you had brought with you on the trip clearly indicated that you should contact the insurer “as soon as possible.” In her opinion, and in mine, you made contact the moment you were out of danger after being treated for an irregular heart rhythm and having your pacemaker inserted. It was probably pretty early.
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 rejected your claim within three days. If the insurer wants to enforce such a restrictive condition, it must clearly indicate this in the schedule.
However, I believe that the requirement to contact “immediately” is not valid in his case, since he was seriously ill. You told me that you were barely conscious during the three days in question and that you were also not carrying your phone or insurance documents.
I told Zurich what I thought and they agreed to investigate. After reevaluating his case, the insurer decided that a mistake had been made. As a result, she concluded that she will not only cover the medical bills of 10,000 euros, but she will also receive an additional payment as an apology for the distress caused.
A spokesperson for Zurich says: ‘We are very sorry for the challenges and delays our client faced when trying to make a claim on her travel insurance policy. We have now conducted a full investigation and can confirm that she was incorrectly informed that she did not have a valid claim. This was due to a lack of communication between claims handlers.’
He added: “We have spoken to her to confirm that we will reach a full settlement as soon as possible and provide her with £850 in compensation for the inconvenience caused.” We strive to maintain a high level of customer service and on this occasion we have fallen short. “We will conduct a full review of how this claim was handled to determine lessons learned and prevent this from happening again.”
Train delay claim
I have hit a brick wall with Great Western Railways (GWR) regarding a claim for delays and cancellations which affected my journey from Truro to Poulton-le-Fylde in Lancashire last August and which caused me considerable distress.
I am 84 years old and came home with a trapped sciatic nerve caused by sitting on drafty 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 trip. It was supposed to take six hours. I complained to GWR but they rejected a claim for refund or compensation.
CC, Preston, Lancashire.
Sally Hamilton responds: I have experienced some delays on train travel in my life, but the bitter pill is usually sweetened by a full or partial refund of the ticket price from the railway company. His story of travel problems and denied refund defies credibility. On its website, GWR states: “If you arrive at your destination 15 minutes or more late because your GWR train has been delayed or cancelled, you can claim compensation for the delay.”
The amounts refunded to travelers vary, but a delay of 120 minutes entitles the traveler to a 100 percent refund of the total cost (round trip).
Since his ticket cost him £152.30 return, he should have automatically received £152.30.
He submitted copies of his tickets, as required, but his claim was denied because the railroad company could not find a scheduled trip that matched the first leg of his claim.
You sent me a copy of the ticket. It clearly stated that you were due to leave Truro for Taunton, at 11.50am. This train was canceled and you were transferred to a train leaving Truro at 1.30pm. After that, everything went wrong: all of his seat reservations were lost, as well as the pre-booked assistance he had requested for certain trains.
Ad hoc help had to be sought from staff at each of the four stations. When he arrived at Preston, he had to end the journey 16 miles from his destination because it was too late and there were no more trains running from there to Poulton le Fylde. You had to call a friend who kindly picked you up and took you home.
I asked GWR to put things right. This prompted their customer service operation to contact you and confirm that you would receive your refund after all. Unfortunately, his apology stopped short of expressing regret for the five-month delay in providing his refund.
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