Medical Cover?

[Albert the Frog]

This is a story in the Manchester Evening News today-I've never heard of this before but blimey it makes you think!

Holiday mum in pay-out wrangle

Kathleen Ackers.THE family of a critically-ill woman who fell on a holiday in America have been told her insurance policy will not cover her treatment - because she had been drinking.

Kathleen Ackers, 63, slipped and hit her head at an apartment in Orlando.

She suffered bleeding to the brain and is now in intensive care at a Florida hospital.

She has already been treated at two hospitals and was airlifted between them by helicopter.

Her family fear the medical bills will run into thousands and flying her back to Britain would cost £10,000-£20,000. The Halifax told the family the insurance policy is invalid because Mrs Ackers had been drinking on the night of the accident.

It was only after the intervention of the M.E.N. that the Halifax offered to pay up to £20,000 to fly her home as a goodwill gesture.

Mrs Ackers, from Ashbourne Avenue, Wigan, was sharing the apartment with husband Ted, son Mark and his two children.

Speaking from Florida, Mr Ackers said: "I found Kathleen lying in a pool of blood. We phoned 911 and she was rushed to Celebration Hospital, but they wanted her to see an expert neurologist at Florida Hospital.

"We were told the policy would cover the cost so Kathleen was taken by helicopter to Florida. It also said it would cover my accommodation.

"Kathleen was talking initially, but has since deteriorated rapidly and I have been told the prognosis is bad. She might not make it, but if she's going to die I want to take her back to the UK."

Mrs Ackers, a mother-of-two, had about 300 milligrams of alcohol per 100 millilitres of blood in her system - equivalent to about eight to nine vodkas.

The family's travel insurance policy has a clause invalidating payment if she is under the influence of alcohol. It says: "Your policy does not cover you for any claim directly or indirectly resulting from... the misuse of alcohol or you being under the influence of alcohol."

Mr Ackers said: "We have never hidden the fact we'd had a fair bit to drink, but who doesn't while on holiday? The alcohol clause is buried in the policy. The company should warn people."


Mrs Ackers' condition was complicated because she has a heart valve fitted. She was unconscious and has been given a tracheotomy to help her breathe.

Carol Wright, a spokeswoman for Halifax Travel Insurance, said: "Insurers are guided by the opinion of the medical carers of the holidaymaker. In the case of Mrs Ackers, it was the opinion of the medical carers that she was seriously under the influence of alcohol and that this directly contributed to the incident."

The Association of British Insurers said the clause was standard with travel insurance.

Spokesman Kelly Ostler said: "If you are drunk and something happens, you are responsible for the state you have put yourself in. Travel insurance is there to protect against the unexpected. We would encourage people to be responsible."

[LiesaAnna]

crikey, sounds awful!!

[Katys Grandad]

<blockquote id="quote" class="ffs">quote:[i]

Mrs Ackers, a mother-of-two, had about 300 milligrams of alcohol per 100 millilitres of blood in her system - equivalent to about eight to nine vodkas.

Mr Ackers said: "We have never hidden the fact we'd had a fair bit to drink, but who doesn't while on holiday? The alcohol clause is buried in the policy. The company should warn people."





[/quote]

Why should the responsible people who pay premiums to insurers have to sustain claims from those who ignore the conditions and behave in this way? What is it about so many of our fellow countrymen that they have to be drunk to enjoy themselves wherever they are?[msnmad]

If this family want to over-indulge THEY should take the risk.

[Macka]

Would you say the same if she had only had one small sherry then Phil?

[Katys Grandad]

<blockquote id="quote" class="ffs">quote:Originally posted by Macka
Would you say the same if she had only had one small sherry then Phil?


[/quote]

If it was a causal factor in what happened - most definitely 'Yes'.

It's nothing to do with the amount, it's about the effect the amount has, surely?

The only diffeence between 8 vodkas and a small sherry is that 8 vodkas are more likely (probably certain) to be a factor.

[florida4sun]

Macka,
they judge 'under the influence' as being over limit. Nearly all insurance policies will have this exclusion.

<blockquote id="quote" class="ffs">quote:Originally posted by Macka
Would you say the same if she had only had one small sherry then Phil?


[/quote]

[E. Cosgrove]

Several years ago a collegue of mine went skiing with family and friends.
In the evening they were walking home after a couple of beers when her husband slipped on a patch of ice and fell. He sustained a head injury and sadly died.
Her insurance company wanted nothing to do with the claim as he had been drinking and the only way she was able to get his body repatriated was, as luck would have it she had completed an E111.
She never denied that he had been drinking but has always maintained it was no more than 2 pints max.[msnsad]
He certainly wasn't drunk.

[florida4sun]

E111 does not cover repatriation, it only covers emergency medical care. I used to rock climb (long time ago) and we were out in France doing some pretty tricky routes. The lead climber took a nasty fall breaking various parts of his body. We only had E111 cover, which git him stabalised (he lloked like a mummy) but he got the bill for flying him home, this was well over 10,000 pounds. The E111 cover is very limited and you have to pay upfront and then claim it back through the NHS.

<blockquote id="quote" class="ffs">quote:Originally posted by E. Cosgrove
Several years ago a collegue of mine went skiing with family and friends.
In the evening they were walking home after a couple of beers when her husband slipped on a patch of ice and fell. He sustained a head injury and sadly died.
Her insurance company wanted nothing to do with the claim as he had been drinking and the only way she was able to get his body repatriated was, as luck would have it she had completed an E111.
She never denied that he had been drinking but has always maintained it was no more than 2 pints max.[msnsad]
He certainly wasn't drunk.
[/quote]

[wrpac00]

Insurance companies will do anything not to pay out (I know from bitter experience), I do sometimes wonder if it is really worth it.

A friend of ours was hit by a baseball whilst watching a game (this was three years ago) and the saga is still going on between the hospital and the insurance company. The insurance company say they didn't get permission from them first, the fact that she was whisked away in an ambulance seems to be irrelevant with them.

[george]

I think it is scandalous the way insurance companies try to wriggle out of everything! If you are on vacation and have a few drinks it is perfectly normal I'm sure the British are not the only race who do this. As somebody else says it makes you wonder if it's worth paying for insurance year after year.

[MTP]

I think that we have created too much of a nanny state in the UK and we now have unrealistic expectations based upon this.

In the UK the NHS more than often picks up the tab for our mis-adventures, why do we expect this to happen internationally? Whither it is drinking or extreme sports or even doing something that may be considered a simple holiday pleasure like hot air balloon or airboats rides, why do we expect the consequences of our actions to be universally underwritten? We have taken private insurance against any problems, this is a limited contractual agreement, not a carte blanche safety net.

There are similarities in this thread and the thread about taking children out of school that is currently simmering (http://www.orlando-guide.info/forums/topic_33675.asp). I am not saying that I have any answers, but equally I don't think we should shirk away from the responsibilities of our actions, simply because that is what happens in the UK.

[Mo Green]

<blockquote id="quote" class="ffs">quote:Originally posted by wrpac00
Insurance companies will do anything not to pay out (I know from bitter experience), I do sometimes wonder if it is really worth it.

A friend of ours was hit by a baseball whilst watching a game (this was three years ago) and the saga is still going on between the hospital and the insurance company. The insurance company say they didn't get permission from them first, the fact that she was whisked away in an ambulance seems to be irrelevant with them.
[/quote]

Your friend may have been unlucky with the company they were insured with. I went to the A&E department at Englewood late on a Saturday night having been unable to contact my insurance company. While there my BP went sky high - probably at the thought of how much this might cost - but the insurance company paid in full.

[wrpac00]

MTP,

I agree with you about the 'taking children out of school' post. Personally I can't see why someone shouldn't be fined if they take their kids out of school for 3 weeks. I wish my wife (a Deputy Head) could take 3 weeks outside of school time, we would save a fortune in air fares.

I don't think you can compare having a few drinks with extreme sports. Who determines how much drink is excessive?? I am sorry but I and everybody I know have had bad experiences with Travel Insurance, my son has one pending but I bet they wriggle out of it some way.

[Albert the Frog]

I think that the question here is what constitutes too much to drink. If I've decided to stay at the villa/hotel and have a few drinks rather than go out and drive but then slip and injure myself-whether drink related or not- from this story I wouldn't be covered-I gladly take responsibility for my own actions but I need others (insurers) to face up to their commitments to me as well.--It is a 2 way street.

[Katys Grandad]

<blockquote id="quote" class="ffs">quote:Originally posted by Albert the Frog
I gladly take responsibility for my own actions but I need others (insurers) to face up to their commitments to me as well.--It is a 2 way street.

[/quote]

The insurer's commitments to you are contained in their terms and conditions. If the people in the news story had read them, they would have known that their actions invalidated the cover.

Seems fair enough to me.

[wrpac00]

<blockquote id="quote" class="ffs">quote:Originally posted by Albert the Frog
I think that the question here is what constitutes too much to drink. If I've decided to stay at the villa/hotel and have a few drinks rather than go out and drive but then slip and injure myself-whether drink related or not- from this story I wouldn't be covered-I gladly take responsibility for my own actions but I need others (insurers) to face up to their commitments to me as well.--It is a 2 way street.

[/quote]

I think your absolutely right, its a one way street with insurers - their way. You have to know 'insurance talk' to know exactly what their T&C's cover.

After my Dad died whilst we were out in Florida and the insurance Co wouldn't pay up we decided to pay an additional premium when we went the following summer in case something happened to my FIL. They adverstised the fact that you could pay an additional premium but when we rang them they said they wouldn't cover his pre-existing illness so basically the insurance was worthless.

[Mo Green]

I agree with MTP and Katy's Grandad that people do have to take some responsibility for their own actions. Insurance companies do base their cover on risk assessment. Even if they do not cover you for a pre-existing illness you are still covered for any unrelated medical treatment, personal accidents, baggage loss, personal liability and legal advice so the insurance cover is not useless. If you decide you still want to risk travelling knowing you are not covered for a pre-existing illness then the choice is yours.

[Clare R]

Last report I saw on this case says the lady in question was four times over the UK drink/drive limit - I have no sympathy with her and I am glad an insurance company refuses to pay out, it would only mean higher premiums for the rest of us.

I have made two small medical claims in the past two years both have been settled (less of course the usual excess), one of which included a visit to the Englewood hospital that Mo mentions!

[steph_goodrum]

"If you decide you still want to risk travelling knowing you are not covered for a pre-existing illness then the choice is yours."

Mo I think in Pauls case the FIL was not travelling with them, but has pre existing conditions in the same way his father did when he died suddenly whilst Paul was away.

We are in the same situation in the my fil is 86 and suffers from diabetes my mil is 81 and in general good health and he has an elderly aunt and uncle whom he is very close to as they have no children so he is a sort of surrogate and helps them whenever need and is registered as their next of kin, executor to will etc so would need to come back if anything happened unexpectedly to them.

I know of at least one other case where a feloow homeowners father died just after his daughter had arrived in Florida so she changed flights and came home earlier expecting to be reimbursed for the extra cost of the flight. Because the grandfather had a routine appointment at the doctors that morning and happened to suffer a heart attack (not related to the pre existing conditions) the insurers werent going to pay as they said she should not have travelled if he was ill and there was achance something might happen, are we all supposed to stay home until there are no illnesses in the family?

[Mo Green]

Sorry I misread your posting Paul. I know how awful it is when a parent dies while you are away as it happened to my own father but we did not even try to claim as it was a pre-existing heart condition. My fil, who is 89, is diabetic and has also had a couple of mini-strokes over the past two years so when we book a holiday we know we may have to fly back at our own expense. Nobody is suggesting people stay at home if they have a realative with a terminal or serious illness but it is up to the individuals to decide if they are prepared to take the risk.

[steph_goodrum]

It's the fact the insurance companies don't make it clear when they sell you the policy that is so frustrating, they are quick to tell you that if you have to cancel/curtail because of illness or death you are covered but hide it in the small print that it wont cover any preexisting conditions.

[Jo]

<blockquote id="quote" class="ffs">quote:Originally posted by steph_goodrum
It's the fact the insurance companies don't make it clear when they sell you the policy that is so frustrating, they are quick to tell you that if you have to cancel/curtail because of illness or death you are covered but hide it in the small print that it wont cover any preexisting conditions.

[/quote]

But if they made all the small print bigger, people still wouldn't read it as they say it was too much detail.

Would the lady in question in the original post not have had 8 or 9 vodkas had she known she wouldn't be insured? Sadly we will never know.

Whilst this is a scare story - i.e have a glass of wine with your meal or a few drinks with friends and invalidate your insurance, I don't think this case is quite like that.

There is a distinction between a 'normal' level of consumption and being that far over the limit.

However, when the only place we have the facts from is a newspaper, who knows the truth anyway?

Nevertheless I am sure we all feel sorry for the family and the lady concerned and hope for a good outcome for them - whatever the financial implications

[MTP]

I guess because we have always looked for annual travel insurance that covers our family's pre-existing medical conditions we are fairly careful to check what is and isn't included and are happy to pay any additional fee necessary to ensure it is covered. We have used our medical insurance sometimes, for example when I came out with chickenpox on our first visit to a villa (must have infected a plane full of people as the spots came out two days after arriving!); equally when we have forgotten to pack enough medication for the duration of the vacation for one of our family it was our mistake. We therefore paid for the doctor's consultation and the prescriptions necessary.

Now admittedly our bill would have been nothing like this family’s, and I wouldn't wish that kind of unforeseen expense on anyone, from what I have heard the medical billing companies are quite willing to negotiate and to look at payment options to pay up debts. As Jo also points out we are only getting the story second hand from the newspapers

[Macka]

I'm surprised by the cover a lot of people seem to have. We go away with my in laws often (always to Florida). My 70 year old FIL whilst being fit and in the main has had two strokes (one quite serious), he has a heart murmer, and low blood pressue. We insure him against all of this. His pre-existing conditions are subbject to a higher excess of £500 (not a lot when you consider the costs a reoccurance may incur.

In all honesty, if I couldn't get this level of cover, I wouldn't take them. The consequences could be really quite disastrous.