3 December 2012

Medical insurance claim rejected over a bunion.

A Telegraph reader sought help after AXA refused her claim for medical costs after getting an infected toe citing a bunion as a pre-existing condition.

A Telegraph reader requested help from Gill Charlton this week when her insurer refused to pay out on her travel insurance for medical costs. The reader, Irene Gordon, was on holiday in Barbados when she began to experience pain in her right big toe. As the pain increased and she started to feel generally unwell, she telephoned the insurers US helpline for advice. Axa, the insurer, responded with an insurance case number and advised her to seek medical attention.

When she did, the was diagnosed with a serious abscess on her toe that was spreading into cellulitis. She was treated for the abscess and given 48 hours of antibiotics for the infection. Several more visits were necessary to the clinic to change dressings until she was given the all clear. Both she and the clinic expected AXA to pay for the treatment.

Four months later, she received an email from AXA's US claims centre to say that her medical bills would not be covered as she had a pre-existing condition that had not been declared. Further communication revealed this condition to be a bunion on the same foot though not the same toe.

Ms Gordon did the right thing and requested AXA UK to review her case, but received a letter from their complaints investigator saying they were standing by their decision.

As the AXA insurance came as part of a package of benefits from Ms Gordon's membership of the Marks and Spencer Premium Club, Gill Charlton first approached M&S and asked them to review the case and included a letter of support from Ms Gordon's doctor.

AXA quickly reversed its earlier decision, paid the claim and offered £250 as a gesture of goodwill.

The case shows that it can be worth approaching the broker through which you bought the policy to support your case. Brokers put a lot of business towards end insurers and can often get heard higher up the chain than individuals. At MoneyMaxim we would certainly be very happy to assist if you were in a similar position.

The case does act as a reminder that insurers can be very quick to reject claims on medical grounds, albeit completely unjustified in this case. Although bunions are hardly the exclusive preserve of the elderly as many supermodels have revealed, as we get older, we're more likely to have some pre-existing medical condition that should be declared when purchasing travel insurance. Pre-existing conditions don't mean you can't travel, minor conditions may even be covered without increased premiums. We've produced a short You-Tube video on the subject or go direct to travel insurance for over 65′s.