Travel Insurance claim advice please

[Broseley]

Hi, sorry, long post!I had to cancel my holiday in July on the day of departure as I woke up with terrible left side groin pain, coupled with a painful right knee which I had had for some time and I could hardly walk, never mind negotiate the trains, buses, plane and 30 steps up to the apartment we had booked. I saw my GP and she discounted an inguinal hernia and thought my knee pain was due to my back and sent me for XRays. My left hip is "preserved" but there are severe arthritic changes in my lumbar sacral vertebrae and facets.

Meanwhile I upped my pred from half mg to 5mg and the next day the pain, including the knee pain, had gone. The GP agreed with me that the hip problem was PMR and said so on the insurance claim.

Now the insurance company want further evidence in the form of my full medical history, which they say I can get from the NHS website. However, I can't see any means of downloading this, plus having looked at it, it gives very little information. For example, under GP consultations, it just records the date but no further details. I want to make sure the GP recorded that the pred worked and that it was therefore my PMR that caused the problem. Also my rheumy had discharged me in June and his letter said all my aches and pains at the time (knees, shoulders) were down to arthritis. I disagreed and stayed on half mg. But his letter stating all this IS on my records! I'm worried that I won't get my holiday money back!

The surgery said they can't send my full history, and that it may take over a month to send a summary.

Any suggestions please?

[SnazzyD]

Just had a look at my GP history. It’s not obvious if you can download it. Have you got back to the insurance company and said that you have not been able to download it? If the insurance company wants to query it, can’t it ask for your medical record from the source? Why can’t the surgery send a full history and if it is so easy for you to download it, why can’t they? Are you speaking to admin staff who deal with communications all the time or receptionists?

Have you tried asking your GP to make sure these details were clearly recorded on your medical record? You can also ask for a copy. Just because the Rheumy said it was arthritis in June doesn’t mean that you didn’t flare in July. Has the GP clearly said that you were incapacitated?

[Broseley in reply to SnazzyD]

Thanks Snazzy. I'm at the surgery now waiting to speak to someone. I can't speak to the GP without making an appointment which has to be a week in advance. I don't want to wait that long. If there are none left you have to try the next day and so on.

[Broseley in reply to SnazzyD]

Further to below, I spoke to a receptionist. They said no admin people were available. She couldn't work out why I couldn't see my notes on the NHS app, just a series of conditions mentioned under each consultation date. Another one came to help. All my permissions are ticked, so they can't understand it. However, she reassured me that the clinical lead is sorting out getting my records to the insurance company and that my GP has continued to record me as having PMR and will continue to prescribe pred.

[SnazzyD in reply to Broseley]

What a palaver. The admin staff at my surgery don’t tend to come out into the daylight and I have to speak on the phone to them. Anyway, I hope they follow through.

[Broseley in reply to SnazzyD]

They are troglodytes!

[SnazzyD in reply to Broseley]

I can see why. I imagine they would spend their whole day dealing with queries in person if they didn’t instead of getting on with sorting out the issues that pass their desk. I do find that it can be exasperating when one has to go through a number of frontline people and opinions in order to get to the solution. I think it started with the insurance company telling you to merely download your history from the NHS app, but perhaps I’m wrong.

[Broseley in reply to SnazzyD]

And the 2 months it took for the GP to fill in her part of the claim form!

[Koalajane]

looking on the NHS app it shows under Health Conditions only one condition diabetic macular oedema. It doesn’t show diabetes t2 (in remission) or even PMR. I have declared my conditions for travel insurance but if asked to download it they would find very little.

[Broseley in reply to Koalajane]

It's a swizz isn't it. We're supposed to be able to see all our records. I used to be able to.

[marionofnorwich in reply to Broseley]

It is the move to apps in all walks of life. Continually updated and often not very well

[Daffodilia]

In similar circumstances my insurance provided a form for the gp to complete. It cost me £36 and took just over a month - had to chase it. I added a note explaining what had happened. Insurance paid up straight away when received form and other documents requested. Don’t give up - I think they make it difficult so we do!

[Decsgran]

I took screenshots of mine for a recent claim. The GP also took 4 weeks to fill in the medical form and charged me £50! I told the insurance company of the delay and they seemed quite happy with that.

[Pixix]

I had to cancel 4 holidays this year (two with insurance & two UK ones which I didn’t have insurance for!) I’m a bit confused because if you gave to cancel due to one of the pre-announced, & therefore covered, medical problems, then it should be OK! My insurance Company wanted hospital discharge papers, which gave diagnoses, for one, & the other a Dr’s letter to say it was cancelled due to the illness which I have previously announced, & was covered!! So, as long as you said you had PMR before you paid for the insurance you should be fine. It looks like they are wondering if all your symptoms were for ongoing medical items that were disclosed when you bought the insurance! If not, then you may not be covered for them. Was every bit of your problems that day due to a pre-disclosed illness? If only one bit& the rest weren’t, then they will want to look more closely. All mine were pre-disclosed, but I still had to pay£30 for a Dr’s letter to endorse it, if you didn’t disclose PMR because the rheumy said you didn’t have it, but now the Dr says you have & that’s the reason for the cancellation, then it’s a difficult one, as you can’t get a specialists letter saying it was due to PMR if the specialist says you don’t have it!!But did you disclose arthritis?? It may be easier to go that route& get a specialists letter saying you have arthritis?? Sorry, in a rush,but can clarify later if the above isn’t clear?!

[PMRpro Ambassador in reply to Pixix]

"It looks like they are wondering if all your symptoms were for ongoing medical items that were disclosed when you bought the insurance!"

That were NOT declared I assume you mean???

[Pixix in reply to PMRpro]

Thanks, PMRPro! Yes, bad morning health wise…bent over to empty the Sainsbury's delivery bin, stood up too fast (he was soaking wet, I was in a hurry), blood pressure dropped too low, too fast & I smashed my face into the corner of the kitchen wall! Frightened the delivery guy!! S x

[DorsetLady PMRGCAuk volunteer in reply to Pixix]

Ouch…plenty of TLC 🌸

[Pixix in reply to DorsetLady]

The stars have just about stopped & the room spinning! I’m scrubbing the bathroom floor tiles (twice), then sealing them today, so not a good day for TLC, ha ha!

[Pixix in reply to Pixix]

But I am wearing my splints to scrub the tiles (still hurts a lot), & the tremor helps the scrubbing bit like a vibration helping the old old dirt to come out of the porous tiles!! I’m useless, really, should take more care, or more painkillers, ha ha!! S xx

[PMRpro Ambassador in reply to Pixix]

HOW old are you????????? Poor guy!

[Pixix in reply to PMRpro]

Oh, I think, generally, about 12, really…never older than 15! It was sad (for the Sainsburys guy) that David was out at the time!

[Pixix in reply to PMRpro]

But I am wearing my arthritis splints to scrub the bathroom tiles, & the tremor actually helps…like a vibration helping the scrubbing! Still hurts a lot, though & know I will pay for it tomorrow!! Ha ha, you just can’t help some folk! S xx

[Broseley in reply to Pixix]

Thanks, that's really helpful. I'll have to check the policy. I definitely said I had PMR as I took the policy out on booking as advised, in January. At the time I hadn't had any XRays, and didn't until I made the claim, apart from the rheumy's assumption that I had arthritis, back in June. He said there was evidence of arthritis in my right knee on examination. But it was the sudden onset left hip pain that caused me to cancel. I had had the knee trouble for a couple of months and felt I was OK to travel with it.

I suppose I should have declared the knee. It never occurred to me, as it wasn't going to affect my travel.

BTW, taking 5mg pred cured all my pain, including that in my knee, and I've had no further trouble with it. XRay showed only mild arthritis, not enough to cause the pains shooting down my calf to my foot. GP thinks it's my back causing the issue, but her referral was forgotten and I've had to chase it. I've had back trouble since my 20s, but not for over 25 years and I've never had any referrals before for it.

[Broseley in reply to Pixix]

Just checked and I hadn't declared arthritis!

[DorsetLady PMRGCAuk volunteer in reply to Broseley]

That is one of the things they are really interested in…..more so than GCA when I still had that…

[Broseley in reply to DorsetLady]

Trouble is, medics are quick to diagnose any aches and pains as arthritis. Personally I'd want it confirming with an XRay. My PMR was misdiagnosed as arthritis in multiple joints. I had never actually seen a GP as it was during covid! I should get this taken off my records!

[Broseley in reply to Pixix]

Thanks to you, Pixix, I have written an email to the insurance company detailing my take on it all. My medical notes do say "degenerative joint disease in multiple joints", but this was noted in 2021 when I was suffering with undiagnosed PMR. No GP examined me, as it was during covid, it was all done over the phone. They all assumed it was arthritis, and it's still on my notes as such! I have explained this in my email.

[PMRpro Ambassador in reply to Broseley]

It is so infuriating - I was told it was OA causing knee pain and that is what would appear on UK notes but in fact the only degenerative disease I have is in my spine - knees are fine! I'm sort of hoping I have no UK notes any more after 15 years out of the country!!!

[Pixix in reply to Broseley]

Well done. Sadly, a bit of a sticky wicket. If the consultant hadn’t said you don’t have PMR,nit would be easier. But if your notes say that I’m not sure if you will win, I do hope so. But basically they could say that your notes show that degenerative joint disease (which is definitely not a description of PMR I don’t think), but you didn’t declare “degenerative joint disease in multiple joints” then they may have a point here. I have to declare 12 things…but when I checked my medical notes before last holiday I found ‘asthma’!! I only get it when I get a chest infection, so I hadn’t been declaring it…but it’s written on my medical notes! Fortunately, the dearest holiday cancellation was due to hubby being hospitalised with pneumonia!! It takes me 40 minutes to get a quote these days, but I now know how closely they look at your notes when you cancel! Whatever is diagnosed must be covered, however good it is on the day!! Good luck, S x

[Broseley in reply to Pixix]

Thanks, the surgery didn't tell me about the degenerative disease in multiple joints. It just appeared on my notes and I have only just seen it yesterday when I was going through the app. Of course it is wrong, but I guess I'd have to see the GP to get it corrected.

[Pixix in reply to Broseley]

But see my latest reply…it seems, to an outsider, that the Rheumy told you in June it was arthritis & you cancelled July holiday, but hadn’t included it in insurance cover. I realise you disagree with the consultants diagnosis…but unless you do it formally & get the consultant to retract that…then from an outsiders point of view, they believe the consultant & that you do have arthritis!!

[Pixix in reply to Broseley]

Hm…just reread your post with knowledge from your replies, & the bare bones seem to be that the rheumy told you you have arthritis (& wrote it in your notes) in JUNE, & then you cancelled your holiday in JULY without having updated your travel insurance to include arthritis. I put the months in capitals as they are important. If that’s right, then, sadly, it’s your mistake, & the 2021 bit wouldn’t even need to be seen. So sorry, & I hope I’m wrong, I really do, hugs, S xx

[PMRpro Ambassador in reply to Pixix]

Depends when the insurance was taken out. Conditions developing/diagnosed AFTER the insurance is taken out are covered.

[Pixix in reply to PMRpro]

Yes, but then there’s the issue of the 2021 diagnosis which would still count, sadly. I had a diagnosis over the phone during Covid, well, two, actually, & they are on my notes as definite diagnoses. The insurance we had recently…I took it out a month before we went, when we booked everything, & it carried a reminder to phone in any new medical diagnosis…& that if I didn’t it would all be null & void, even if that wasn’t the item that made me cancel. You’re expected to update it before you go, & yes, pay an 3xtra premium, if necessary.

[Broseley in reply to Pixix]

I was not aware of the 2021 (mis)diagnosis and I have asked surgery to change it.

The rheumy's diagnosis was backed up by an XRay which showed only mild arthritis, but was not what caused me to cancel my holiday, the hip was. Plus the fact that the pred cured me of all pain, not just the hip. Would the rheumys diagnosis still matter? I took the policy out in January, saw rheumy in June, X Ray results came through the week before our holiday but were never sent to my GP. Rheumys letter stating the arthritis came on 15th July. Our holiday was w/b 5th July.

[Pixix in reply to Broseley]

That’s good news!! Not sure. It depends if they take it to the consultants level, I think.nif they just deal with your GP & he says the whole cancellation as due to PMR, then you could be OK. But the rheumy said you don’t have PMR, so that’s tricky. With that timing of dates you may have a get out clause…how do you know the date the x-Ray results came out…did you see them, or did the rheumy? It’s looking like if the rheumy isn’t involved you may get away with it (but it does look…I’m on your side, but see me as an outsider investigating this…as if you knew you had arthritis. I don’t know how much money is involved here. It shouldn’t make a difference, but they are likely to look harder if it’s mega bucks, as they say! I was surprised how detailed my investigation was…& my husband was still in hospital when we were due to travel!! I ended up with paperwork an inch thick, & had to wait two weeks without knowing if I’d get it all back. But I guess they are only doing their job. Sorry, but I think an outsider would say a consultant’s diagnosis carries more weight than a GP…! Let me know, please, how you get on. Feel free to ask any more questions…& do take it to a private chat…but only if you want to! I’m happy either way! The other thing I need to make you aware of…when I was booking our holiday, my hubby had a test coming up, a scan, & we had the date to get it done. The travel insurers said we needed to know the result of the scan…& tell them, before we went on holiday. It took me about 7hours on the phone, phoning the hospital to find a Dr I had never heard of, he was just a locum,but he asked for the scan while David was in hospital. Once I had the result, the insurance company was happy. I need to look up a couple of things, then will tell you more….

[Broseley in reply to Pixix]

Thanks again!Re the knee XRay, I rang for the result. The rheumy didn't mention it in his letter. I can't remember the date I rang, but I'm guessing it would have been before our holiday, but I don't know.

I was a bit naive I think. I guess you don't expect these things to happen. Next time I will be more thorough. It wasn't a huge amount, as we were flying to the Isle of Man for a week. Around £1500 I think.

[Pixix in reply to Broseley]

Yes, but everybody is naive until they suddenly need to know more, much more about travel insurance! My hubby has 5 medical issues & I have 12, so it now takes me about 45 minutes to get a single quote for insurance. Compare,com just tells me nobody will insure me. Because of these things, I read up a lot about travel insurance & learned a lot! Theres a lot of stuff is in the small, I mean tiny, print, that nobody reads, but it means they have you bang to rights when you cancel!! I bet nobody has read all the paperwork they give you when you buy a policy? Well, having cancelled so many holidays this year, & losing £300 along the way…before we travelled in September I read ALL the tiny print! That’s where I found out about the medical tests but! Otherwise we would have gone a month earlier, instead of waiting for the test results. It’s really hard to get insurance if you have any test eg x-Ray, MRI, heart tests etc coming up before your holiday! This is how I believe it is…the insurers does not want to take a risk on an unknown!! Once a result is known they can charge you…eg if you had phoned before your holiday & said that you’d just had an x-Ray result & you have arthritis, they would charge you a bit more money, & it would be covered. BUT if you have a test, & you don’t tell them the results then it negates the whole policy. That’s the small print on my policy, but may not be same for each company, or each result to a medical test. The good news is that you weren’t going cruising round the world costing thousands of pounds, I’m relieved. It may be that, due to the (relatively) low cost they may not bother to look too hard or ask too many questions. I don’t know how you can copy or download your medical data…& then it would be tempting to only download the good bits!! I’m surprised they aren’t trying to get access. You could offer a GP’s letter & hope he/she just sticks to PMR, perhaps. I don’t know. Yes, next time read it up a bit more, read small boring print, & contact them if anything happens between any GP diagnosis or x-Ray etc, & report it. It may not even cost you more. I added PMR to my policy 2 weeks before we went to Florida for 3 weeks, as I couldn’t afford expensive USA medical costs, & I was worried the policy would be void if they didn’t know. I was on 17mg steroids, too. They didn’t charge me any extra, just noted it & sent me a revised policy. If I’d ended up in hospital with something completely different like a broken leg I may have ended up not getting our medical costs back. I guess you are going to wait for a reply & see what is said. I’d read up the small print in your policy, it could be different…but then you will have good knowledge!! Best of luck, fingers crossed, S xx

[Broseley in reply to Pixix]

Thank you for your long reply. The surgery are getting my full medical history together to send. I can only keep my fingers crossed now.