A woman had suffered from indigestion for years and had, from time to time, taken prescription medication to relieve the symptoms. In November 2019, she went to her doctor because she was experiencing heartburn and pain on her first mouthful when eating.
The woman’s doctor prescribed the same medication, ordered some blood tests, and told her to come back if she did not improve. The blood tests returned a normal result.
About a week later, the woman and her husband booked a trip to Europe and purchased travel insurance.
Towards the end of December 2019 the woman found that food was ‘sticking’ when she tried to swallow.
She returned to her doctor who immediately referred her to a specialist, concerned that she might have cancer. In January, the specialist unfortunately diagnosed her with cancer, and she started treatment.
On her doctor’s advice, she cancelled her trip. She submitted an insurance claim for the lost accommodation and travel costs. When the claim was declined, she complained to FSCL.
The insurance policy excluded cover for loss caused by a pre-existing medical condition. The insurer said that, because she had been to her doctor with signs or symptoms that later proved to be cancer, this was a pre-existing medical condition and not covered by the policy.
The woman said that when she went to the doctor in November, she thought she had indigestion.
Although the doctor had told her to come back if the symptoms did not improve, she said that doctors always say that, and there was no suggestion that her doctor thought she might have cancer.
As she had had indigestion in the past, the medication she had been prescribed was not new for her. She did not think there was any reason to tell her insurer about what she considered to be a routine visit to her doctor that satisfactorily resolved her problem.
FSCL looked at the woman’s medical records and could not see any suggestion that the doctor thought her symptoms were anything more than a reoccurrence of her indigestion.
FSCL also looked at the questions the woman was asked as part of the medical questionnaire in the insurance application process.
She was asked: “Do you have any undiagnosed signs or symptoms where you have yet to seek medical opinion, or are under investigation, or are awaiting specialist opinion?”
She had answered, “No”, and the dispute resolution service considered this was the correct answer.
FSCL asked the insurer to reconsider the claim.
The insurer decided to overturn their decision to decline the claim and to pay the woman for her loss.
The insurer considered there was enough doubt around her visit to the doctor in November for them to be satisfied that both the patient and doctor believed the symptoms were a recurrence of indigestion, which would be covered by the policy.
FSCL said: “It is often difficult to know how much an insurer wants to know about any pre-existing medical conditions you have. It is best to err on the side of caution and tell insurers about any recent visits to your doctor, any medical appointments you are waiting for, and any medications you are taking.”
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