How to Make a Claim

You bought the policy, now get your insurer to pay up. Here are the ten steps to follow to ensure you get the compensation you deserve.

The overwhelming majority of the British public is extremely law-abiding, a model of probity and honesty - except when it comes to making insurance claims, or so it would seem.

If a recent survey is to be believed, more than two thirds of us are willing to submit a dishonest claim to our insurer, inflating it by up to a third. This despite 88 per cent of people accepting that doing so is dishonest.

Perhaps the biggest area where fraudulent claims are likely to be made, aside from contents insurance, is in relation to travel insurance. Insurers reckon that up to 10 per cent of travel claims are fraudulent, at a cost of up to £100 million a year.

Holidays on the cheap

I can’t say I’m too surprised by these figures: many years ago, my girlfriend’s best friend thought nothing of funding almost every annual holiday by having a non-existent handbag, plus camera, watch, personal stereo, purse with up to £100 in the local currency, earrings and bracelet conveniently “nicked” by local thieves.

The thought that the rest of us might have to pay higher premiums because people like her were defrauding their policies somehow eluded her.

The Holiday Money section on this site has more on travel insurance fraud.

The party’s over

Nowadays, it would never happen. Insurers have systems in place to detect serial claimants. But often the real problem is not so much the fictitious claim as the inflated one: where a £50 camera turns into a £500 video recorder.

Insurers then toughen up their response to all other claims, forcing us to jump through seven hoops of fire before they pay out – not that they’re exactly generous at the best of times!

In fact, complaints about travel insurance once made up about 1 in 8 of all cases before the Financial Ombudsman Services: only the surge in endowment policy complaints has reduced the overall proportions.

Making a legitimate claim

So how can we make sure that we can get insurers to meet legitimate claims? There are a number of important stages to make sure this happens.

1. Check the policy before you buy

A lot of disputes happen because people think they are covered and discover too late that they are not.

In particular, look out for:

Maximum individual limits on each item you can claim for.
Excesses: if the excess is £50 per item, that’s £50 for the camera, £50 for the money, £50 for the passport and so on.
The extent of medical protection you have: this matters if you are likely to be on holiday in countries, like the USA, where the cost of care can be very high. Some experts argue that you need at least £2m of cover, plus two or three that amount in liability insurance, in case you get sued.
Any exclusions on the policy, such as pre-existing medical conditions.
Whether cash is included and how much.
Whether loss is covered along with theft.
Whether 24-hour emergency assistance is available.

2. Declare any pre-existing medical conditions

The contract between insured and insurer is based on the notion of “utmost good faith”. This means you have a duty to disclose any information that may affect the granting of a policy, any exclusions that might be applied or its price.

Fail to tell the insurer that you had a heart transplant a few days before going on a mountaineering expedition and you may well find your medical claim is voided if you fall ill.

Insurers also operate on the basis of: “if in any doubt, tell us first”. Here, the Ombudsman is not so clear-cut. There has to be some supposition that telling would affect a claim or the quote itself.

Be honest about where you are going and the activities you are likely to be involved in, whether you think they are hazardous or not.

Some insurers say the sports you may need to inform them of in advance include golf, tennis, horse riding, sailing and jet-skiing. Personally, I would say demanding information on a gentle round of golf or a quick set of tennis is a bit rich. But I wouldn’t want to muck up any claim you may want to make, so if in doubt, tell ‘em.

3. Take a copy of the policy with you on holiday

When you are satisfied that the policy meets your needs, make sure that you take a photocopy of it on holiday with you – NOT the original, in case it gets lost.

This is not just riveting bedtime reading: the policy will usually have in it the procedure to adopt in the event of theft or loss, what you may be covered for or otherwise, plus details of who to call in an emergency.

4. Keep a record of any highly expensive item you may be taking abroad

If you are planning to take an expensive item of jewellery for that special night out, or a costly camera/video recorder, make sure you have a picture of it at home, along with any purchase receipts.

You can leave these at home. But remember, after a theft one of the most common areas of dispute between policyholders and insurers is over the actual existence of the item and what it originally cost to buy. Having that kind of proof helps enormously.

Remember that your cover may involve the insurer replacing the lost/stolen item, rather than simply giving you the money to buy a new one.

5. Keep your valuables safe at all times

This is often this is defined by the Financial Ombudsman Service as a “reasonable” duty of care. It means, for example, keeping valuables in the hotel safe or, if unavailable, in a locked suitcase hidden out of sight in your room. The more valuable the item, the more care you must take.

As to whether a claim might be successful, common sense tends to apply. If you leave your bag unattended while you go to the loo for a couple of minutes, you probably won’t be able to claim successfully. But if it is taken from the floor next to you while you were momentarily distracted, your claim should be met.

The interesting question is over the grey areas in-between: for example, a court has found in favour of one punter whose bag was stolen from his car by a sneak thief which he briefly left unlocked when going to pay a petrol bill inside the kiosk.

The judge said the only moment when he would not have been paying attention to the car was when he was signing the credit card slip. But if the car had been a Porsche instead of a runabout, or the bag had contained £10,000, the duty of care would have been higher.

The Ombudsman takes a similar view.

6. Report all theft and loss swiftly

If any property is lost or stolen, report it immediately to the local police. Make sure that you obtain an accident report number or similar document as proof that you have reported the loss.

On package holidays, make sure you also report the theft/loss to the hotel management and/or the travel rep. If possible, obtain a report of the theft from them.

If a bag is lost or stolen at the airport, make sure you report it then. Obtain a receipt from the airline or baggage handler in the event of loss or damage.

7. Get your paperwork in order for medical claims

For medical claims an insurer may require a completed E111 form, available at post offices. This qualifies travellers for the same medical treatment as local residents.

Insurers use the E111 form to claim back from the DSS some of what they pay you.

You need to fill the form in and send it off before you go on holiday. But sometimes you can do this on your return.

If you have taken a copy of your policy document with you on holiday, you will know what steps your insurer requires you to take in a medical emergency.

Follow them to the letter. Always make sure that any doctor or hospital knows that you have medical insurance and what for. If you have to buy any medicines, keep both receipts and original prescriptions, where possible.

If you have to go to hospital and the level of cover looks like being breached, you have emergency repatriation and your medical condition permits it, consider the possibility going back early.

If you are offered a return on a scheduled flight, check that staff on it are equipped to care for you, or that you will be accompanied – and that you will have a comfortable flight back, with plenty of room for that damaged limb to stretch out, for instance.

8. What to do on your return

This can be the most difficult and frustrating part. Insurers won’t make your life easy.

What you need to do, basically, is follow whatever procedure they have set down to make your claim.

My own experience in this matter – a few years ago, my partner broke her ankle half-way through her riding holiday – is to try to be exceptionally thorough.

Go through all the small print and work out what you can claim for. I found that under the terms of the policy it was possible to claim not just for the medical treatment but also for the three days’ riding lessons that were foregone.
When you make the claim, provide all supporting documentation to back up what you say. Overwhelm them with suitable evidence, including receipts, photographs, copies of any police or medical reports you have.
You should always send copies of the above to the insurer in place of the originals. But check first so as not to waste your time or theirs. If you do send any original documents, always make sure it is by recorded delivery.
Keep all correspondence between yourself and the company. Make accurate records of every phone call, the name of the individual you spoke to and the time you spoke to them.

9. And if your claim is rejected…

The claim may be rejected or scaled down for all sorts of reasons, the most common of which are either that you are not covered or through a legalistic interpretation of the insurer’s small print.

You should first appeal against the decision, producing any additional evidence or making further comments as required to help the insurer decide in your favour.

The Financial Ombudsman Service may be of help here, even before you decide whether to make a complaint to it.

It has a useful site that you should be find of interest.

The Ombudsman site has a search engine which allows you to check back on a variety of travel insurance-related issues. In many cases, decisions by the Ombudsman tend to set a precedent, so if you can find anything that strengthens your case, quote it back at the insurer.

10. Keep track of the countdown

An insurer has eight weeks to deal with your initial claim. You then have the opportunity to appeal against the decision.

If it looks as if you cannot get the company to change its mind, you can ask for a “failure to agree” or “deadlock” letter and take the matter to the Financial Ombudsman Service.

You have six months from the date of the final deadlock letter to complain to the Ombudsman.

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