‘My son fell ill in Cuba and died, and then his insurer refused to pay £90,000 medical bill’
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My son went on holiday to Cuba in January 2019 with a friend. While there, he suffered severe stomach pains. He thought it was food poisoning from some fish he’d eaten the previous evening. A doctor agreed. The next day the pain became severe, and he was admitted to hospital. There he was diagnosed with acute pancreatitis and put in an induced coma. He never recovered. After being flown home from Cuba, he died. He was 37.
When he was first admitted to hospital his friend notified his insurance company, Fit2Travel, which is a partner firm to a larger company called Tifgroup. The policy is underwritten by a company called Union Reiseversicherung AG.
At this point things got complicated. The Cuban doctors diagnosed acute pancreatitis and, despite having no access to his British medical records, they labelled my son as an alcoholic. My son was not an alcoholic, and has never been diagnosed as such. His official post mortem did not find the pancreatitis was a result of alcohol consumption. But because of this mistake, and based on evidence of what it calls “prior alcohol abuse”, which is outlined in the terms and conditions of my son’s insurance, Tifgroup is refusing to pay the £25,000 hospital bill.
Tifgroup is also refusing to pay the £65,000 cost of repatriating my son. Before flying him home we consulted specialist doctors here in Nottingham as well as Cuban intensive care consultants, to see if it was safe to transfer him home. They agreed it was safe.
Tifgroup’s own medical aviation expert said it wasn’t safe for him to fly. But with the booked flight due to take off, and us fearing for our son’s life, he was flown home. It was so traumatic. I feel Fit2Travel has ruined me financially and put me under the most enormous stress.
– KA, via email
I’m deeply sorry that you lost your son in such tragic circumstances. Your case is among the most harrowing I’ve dealt with, and I cannot even begin to imagine what an ordeal this has been for you. Your son is dead and you are £90,000 out of pocket. You feel that in your family’s greatest hour of need, this insurer, Tifgroup, which operates a number of travel cover brands, was not there for you.
When I asked Tifgroup to reconsider your case it responded to questions via lawyers. I can see why it initially raised doubts over your son’s insurance being invalidated by his drinking. Unfortunately, Cuban doctors wrote in your son’s medical notes that his pancreatitis was a result of him being an alcoholic.
Your son’s policy excludes anyone with a prior history of “alcohol abuse”, and when he bought the policy, he would have been warned about this. You say he wasn’t an alcoholic and, following my involvement, the Cuban hospital produced a stamped and signed note to retract its assertion that your son was an alcoholic, as it was based on no evidence. It issued an apology.
Pancreatitis is commonly caused by alcoholism, which is probably why the assumption was made. However, there are many other possible causes, which it said must be considered. For example, your son smoked.
So was Tifgroup going to change its mind about paying the £25,000 hospital bill? Sadly not. Tifgroup had reviewed your son’s British medical records and found evidence of sporadic heavy alcohol consumption.
It said it was unable to pay the claim because it believed your son’s pancreatitis was the result of “both his long and short-term drinking”. So, it appeared that it was excluding him under the “alcohol abuse” clause in its terms.
Having reviewed his British medical records myself, I can see no evidence that your son was ever diagnosed with long-term alcoholism.
It seems, then, that he was excluded under the broad umbrella of being someone who has “abused” alcohol on a sporadic or short-term basis. I asked Tifgroup how it defined “alcohol abuse” for the purposes of accepting or rejecting insurance claims. It said it “looks at this on a case-by-case basis, using the guidelines laid out by the NHS and the National Institute for Health and Care Excellence”. According to the NHS, alcohol misuse is: “When you drink in a way that’s harmful, or when you’re dependent on alcohol.” It recommends that both men and women do not regularly drink more than 14 units a week.
Tifgroup’s terms and conditions also contain a clause that says anyone found to have more than 0.19 blood alcohol units will be excluded from cover, but since no blood alcohol test was performed on your son at any stage in Cuba, how could it possibly say how much he’d had to drink? To my mind, it could not.
And what about the £65,000 repatriation costs that remain unpaid by Tifgroup? It said it wouldn’t pay because you chose to listen to separate medical advice saying it was safe to fly your son home in an air ambulance, ignoring its own expert’s advice that he was not safe to fly. Under such extreme stress it must have been terribly difficult for you to have known what to do for the best, so I can understand why you chose to go ahead and book the air ambulance. You were trying to do the best for your dying son.
Still, I asked Tifgroup to pay and the answer was no. You asked me what you should do next and I helped you formulate a case to take to the Financial Ombudsman Service.
The Ombudsman took many months to respond, but in the end agreed with me that it wasn’t unreasonable for the claim to have initially been declined. However, it noted the lack of evidence of your son’s drinking while on holiday. It said it understood Tifgroup’s position that “on the balance of probabilities” your son’s condition was caused by alcohol consumption or alcohol abuse, but it said the available evidence did not lead it to the same conclusion.
In the end it said the entire £90,000 claim should be paid, including the hospital and air ambulance bill, plus 8pc interest. Tifgroup and the underwriter, Union Reiseversicherung AG, have gracefully accepted its recommendation.
This has come as a huge relief, but it is now more than two years since your son died, and frankly, you feel you have been put through hell. This week I checked in to see how you were doing and was sorry to hear that both you and your wife had suffered strokes recently.
While you have made a full recovery, your wife has been left with mobility issues, which must be difficult for her to cope with. On a brighter note, however, you have now both had the Covid-19 vaccine and are very much looking forward to enjoying some much-needed freedom later this year. You are blessed with another son, a doctor, who has been an enormous support to you since the death of his brother. I know he continues to be there for you, which is heartwarming.
If this case is anything to go by, I would implore future holidaymakers to think extremely carefully and check the terms and conditions of their policy if they are proposing to drink alcohol while relying on their travel insurance.
A Tifgroup spokesman said: “This is a sad and tragic case and we were sorry to hear the customer passed away. He was very ill and a long way from his home and family; we fully understand this was extremely difficult for his family. Now the Ombudsman has made their decision we hope this will give the customer’s family some closure.”
The full Katie Morley Investigates column will appear in print every Saturday and Sunday. You can get an early taste every Friday at 12:00
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