Has anyone had problems with Insurance companies?

[BTR1963]

3 years ago I had DVT following a knee operation. I was treated and discharged by my local hospital after 6 months and advised to take aspirin as a precautionary measure. I was tested and was positive for anti-cardiolipin and lupus anticoagulant antibodies on two occasions but I was not told that I had APS. I have been in Cyprus on holiday where I was hospitalised with DVT in the other leg. AXA Insurance company are now refusing to pay my medical bills as I had a 'condition' which I didn't disclose and was taking 'prescribed' medication (aspirin!). I was never told I had APS until I saw the specialist in Cyprus. Has anyone else had a similar problem with insurance who could offer advice? I'm facing a hefty bill as I was hospitalised for 4 days and then treated as an out-patient.

[MaryF Administrator]

You would certainly need to contact the insurance ombudsman.financial-ombudsman.org.uk/ start here and see what they say, if you were not told, and you have evidence in writing, also letters etc and there is no mention, I am sure you will have a case. Do get some help, they will advise you of your writes. Sorry your holiday had a blip! Mary F x

[BTR1963]

Mary, thanks. I have already initiated the complaints procedure and if necessary will go to the Ombudsman. I do have the discharge letter from the anti-coagulation clinic which doesn't mention an APS diagnosis. On the plus side I got an extra 11 days in the sun after I was discharged from hospital.

[StevePT]

This is a tricky one.I work in the Insurance(reinsurance) industry and I also have APS so I suppose I should be well qualified to offer an opinion.All travel insurers will ask the question as to whether you have any pre existing conditions and will want to know your medical history before offering cover.They are also very rigid in their stance regarding claims and quite frankly will look to avoid paying any if they are able to find a reason to do so(in their partial defence premiums are usually very competitive these days so they will look to avoid any payouts that they feel they can).It seems to me that the key in your case is not the APS issue but the dvt.I recently tried to get travel insurance from a mainstream company and was deemed okay with one dvt but when I advised that I had a previous undiagnosed at the time(it showed up on the doppler scan i had for the 2nd dvt)dvt I was told that they would not insure that condition.They didn't seem too phased about the APS issue but more the dvt issue.I guess that is their stance in your case i.e that you did not declare the dvt?If you did (and they are declining the claim on an APS issue)then you have a perfect right to take the matter further.You could try the press?No insurer likes their name spread across the travel sections in a negative manner.Did you buy the policy direct from AXA or through a broker or through some other source(credit card etc)?If you used a broker they should be offering more assistance/advice.As to the aspirin being prescribed medication I think they are on very thin ice with that argument.What percentage of the population takes aspirin?Let me know if I can help in any other way with my inside industry knowledge.

[MaryF Administrator in reply to StevePT]

I might have to pick your brains when I next travel. For my summer holiday in Eastern Europe, I had to travel totally uninsured for myself and my children, despite working through the list on our recommended providers..awful! Mary F x

[BTR1963]

Steve,

Thank you very much for your reply.

The policy is via my bank account which is with Lloyds. The policy states that you have to declare any on-going medical conditions and any conditions you have had treatment for within the last 6 months. Despite testing positive for anticardiolipin and lupus anticoagulant antibodies my DVT was written off as a one off brought on by an arthroscopy I had had on my right knee. I was not really aware of the significance of the antibodies and it was only the doctor in Cyprus who told me that technically I had APS. The specialist in England had told me to take aspirin as a precautionary measure and that if I ever needed an operation I had to tell the hospital that I had tested positive for the antibodies and had previously had DVT. I didn't even think to disclose any of this to Axa. The main point they made was that aspirin was 'prescribed' medication and it was only when I argued that it wasn't that they decided I had a medical condition which I hadn't disclosed. I'm not sure what they meant by this, whether it was the previous DVT or they were saying it was APS which I was unaware of. The DVT was diagnosed almost 3 yrs ago, so well outside of the 6 month period.

Brian

[StevePT in reply to BTR1963]

Having read your explanation above I imagine their stance is based on the fact that you are taking the aspirin for the dvt(albeit on a precautionary basis) and therefore are taking "medication" for an ongoing condition.If you had had the dvt and were not taking anything subsequently then it could not be called an ongoing condition.It is a bit tenuous but I imagine that is their position.I still think it is worth a go pursuing them to settle however.Good luck and I would be interested to know how it finally resolves itself.

[YvonneW]

I get my travel insurance through Natwest. I have a charge account I pay £15 a month for (gives free car breakdown, phone insurance and travel insurance). I checked the level of cover for these and have paid an additional £80 per annum for world-wide, annual insurance to cover primary APS - and made sure they wrote the name on the insurance document. I have claimed on it successfully after a holiday in Hawaii. There is also useful travel information on the website hughes-syndrome.org

Good luck.

[BTR1963]

Thanks to everyone for their advice. I was contacted by AXA on Friday and they have now agreed to pay in full. I haven't seen any cash as yet but have a letter stating that the original decision was incorrect and has been overturned. They decided that the aspirin was not being taken on a 'prescription basis' and therefore did not need to be disclosed.

I suspect that they simply expect people to accept their decisions and not kick up a fuss!