In many cases, claims for Personal Lines insurance, such as home, motor, or travel policies, are managed directly by the insurer. This process is typically efficient and designed to provide straightforward assistance to policyholders. However, if something goes wrong, such as a delay, dispute, or an unexpected decline, we are here to step in and support our clients when it matters most.
One of our clients faced a situation where their insurer was unwilling to pay out on a travel insurance claim as they believed the client failed to disclose pertinent information at the start of the policy. That is when our in-house Claims Team stepped in and provided assistance.
This case illustrates the importance of disclosure and how our involvement can make a substantial difference to a claim outcome.
The Background: A Medical Emergency Abroad
In October 2024, our client and his wife were travelling abroad on a cruise on the west coast of the USA and Canada, when she experienced a cardiac problem. The situation was serious enough for the client to be disembarked for emergency care at the nearest American hospital. The total costs, including medical treatment, travel curtailment, and accommodation, amounted to circa $40,000.
Initially, the claim was progressing as expected. However, during the insurer’s due diligence process, a prior medical record was discovered noting an episode of elevated blood pressure in 2022. This had occurred in the context of temporary, pre-operative anxiety before two eye surgeries (classic ‘white coat hypertension’), and had not been diagnosed or treated as a chronic condition. Nonetheless, because this incident was inadvertently not disclosed during the original application, as it had been forgotten about, the insurer declined the claim on the basis of non-disclosure, and the only offer extended to the client was a token sum of £50.
Our Involvement and Approach
We believed the client had acted in good faith when taking out their travel policy, and therefore made the decision to step in and provide support.
Over the next several months, we coordinated extensively with the insurer, medical professionals, and international third-party claims handlers. We:
- Provided medical evidence clarifying the context of the 2022 incident;
- Argued that the condition was transient and not a chronic illness that required disclosure;
- Demonstrated that the insurer had not conducted appropriate medical screening at the inception of the policy or before the claim was declined;
- Escalated the matter through the insurer’s internal complaints process and prepared the case for potential referral to the Financial Ombudsman Service.
After a detailed and persistent effort, the insurer accepted our position. They acknowledged that the undisclosed condition would not have altered how the insurance policy was underwritten, had it been declared, and as such, agreed to settle the claim for 93% of the total amount; a significant reversal of their initial decision.
Client Response and Reflections
The client was highly appreciative of the support provided. We assured him that our support in difficult cases is part of the service we provide.
He later provided a Google review, from which the following excerpt is shared with permission:
“McClarrons has been superb in supporting us in pursuing a rejected substantial travel claim. This resulted in a positive outcome for us, and we feel that without the assistance and support of Mike Seals-Law throughout, this would not have happened. The help he provided has been outstanding. It’s heartening to see that some businesses can still provide an excellent level of customer service. Thank you also to Charlene Ward for suggesting Mike.”
Disclosure Matters
When arranging any insurance policy, it is vital to disclose all material facts – meaning any information that could influence an insurer’s decision to provide cover or set terms. Even if a detail seems minor, temporary, or insignificant, it should still be disclosed, particularly where it is formally recorded, such as in medical notes. Read our ‘What is ‘Duty of Disclosure’ and why is it so important?’ blog to learn more.
Clients obtaining travel insurance may wish to carefully review their 5-year medical history, which is available from their GP or via the NHS App, and consider declaring each relevant medical incident or event as part of the disclosure process to insurers. Relying on memory alone can make it easy for details to be overlooked. In addition, online or telephone disclosure procedures may not always make it straightforward to provide complete information.
Insurers base their underwriting and pricing decisions on the information provided at the outset. As such, omissions, even unintentional ones, can give them grounds to reduce or reject claims later. Travel policies often contain specific wording requiring disclosure of all conditions noted in medical records, regardless of whether they are ongoing or considered minor.
Erring on the side of caution ensures transparency and protects you from the risk of a denied claim when you most need the cover you have paid for. We always encourage our clients to speak with us if they are uncertain about what needs to be disclosed. We are here to help you get it right – before a claim arises.
Expert Advocacy Can Make a Difference
We are committed to protecting our clients’ interests. That is why when we believe a claim is declined unfairly, we will intervene to fight our client’s corner and look to help secure a fair outcome. This case is a reminder of the value we strive to bring to our clients – not only through technical advice and placement of a policy but also through practical, results-driven claims support when it is needed most.
Claims management is just one component of the comprehensive service we offer as a trusted, independent insurance broker. When you insure through McClarrons, you gain access to a wide range of benefits that go far beyond the claims process. To explore how partnering with a broker can enhance your insurance experience, we invite you to read our ‘The benefits of using an insurance broker’ blog on the advantages of using an insurance broker.
