Change in health
If you have any changes to your health after you take out a travel insurance policy, you’ll need to let your insurer know. Travel insurance companies may call this ‘ongoing duty of disclosure’ or ‘change in health’.
Types of complaint we see
We see complaints where the:
- insurer says the customer should have told them about a change in health
- insurer says a medical condition is pre-existing because it began after the policy started – but before a trip was booked
- customer’s unhappy with what the insurer did when they told them about a change in health
If your complaint is about a situation that took place when you renewed your travel insurance, use our information on pre-existing medical conditions.
How to complain
If you have a complaint about your travel insurance policy, talk to your insurer first. They need to have the chance to put things right. They have to give you their final response within eight weeks for most types of complaint.
If you’re unhappy with their response, or if they don’t respond, let us know. We’ll check your complaint is something we can deal with, and if it is, we’ll investigate to understand what happened and what went wrong.
Find out more about how to complain.
What we look at
The Customer Insurance (Disclosure and Representations) Act 2012 states that if an insurer asks you a clear question when your policy is sold or renewed, you have a duty to take reasonable care not to make a misrepresentation. We have more information on our website about our approach to complaints about misrepresentation.
Insurers will often ask questions at renewal so that they can find out whether your circumstances have changed since the policy was taken out. Your insurer will then decide whether to offer the policy for another year – and on what terms, including what premium to charge.
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When we’re looking at cases, we’ll consider whether we think there has been a significant change in your health that you should’ve realised was important enough to tell the insurer about.
An insurer can change or end an insurance contract if your circumstances change during the course of the policy which significantly alters the insured risk.
If your travel policy asks you to, you should tell insurers about significant changes to your health when you become aware of them. A significant change in risk is a change so great that it can be considered a risk the insurer hadn’t agreed to cover.
Travel insurers may try to get more information about your health during your insurance contract, by including a ‘change in health’ term on the policy. The term might say something like: “If, after purchasing this policy, any insured person develops a new medical condition, or has a change in a medical condition already declared to us, you must contact us.”
Policy terms like these are examples of where the insurer could be attempting to restrict cover for conditions that become apparent after the policy has started. It’s fair for insurers to do this – but they need to make sure that the relevant policy term has been applied in a fair and reasonable way.
If you have a less serious medical condition, you may not necessarily realise the importance of updating your insurer. This could be when you’ve had a minor cough or cold that resolved very quickly. In these cases, we’d expect your insurer to take this into account.
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A significant change in health usually applies to the diagnosis of a serious medical condition like diabetes, heart conditions, stroke, cancer or other serious medical conditions.
But it could also include other situations – for example if:
- you’ve been in hospital for a long time
- you were going to have a major operation close to the date of your trip
- you’ve recently been diagnosed with a medical condition needing ongoing care
We’ll consider whether:
- the risk is so different now that it would be fair for the insurer to change the terms of the policy
- a reasonable person should have realised the change in health might impact their holiday
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Even if the condition hasn’t actually been diagnosed, we might still think there was a significant change in your health.
If you were referred urgently to a consultant because of symptoms you were having, then we might think this is a significant change in health which you should tell your insurer about. We may not expect you to wait for a formal diagnosis before recognising that you’re experiencing a significant change in health.
If your doctor referred you for routine or minor tests, that doesn’t automatically mean you have a significant change in health that you should report to the insurer.
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Some policies extend the duty of ongoing disclosure to anyone that travel depends on – for example, close relatives or travelling companions.
In these cases, we’d take the same approach about disclosing a change in health as we would with the people on the policy.
Putting things right
If we think your insurer has made a mistake or treated you unfairly, we’ll tell them to put things right. This usually means that they need to put you back into the position you'd have been in if the problem hadn't happened.
We’ll also consider whether you’ve experienced any distress or inconvenience as a result of what the business did wrong and whether we think it’s appropriate to award compensation.
The following gives an idea of our approach:
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If you tell your insurer about a change in health, they might:
- cover the medical condition for no additional premium
- charge an additional premium to provide cover for the medical condition
- apply an exclusion to the policy about the medical condition
- withdraw cover altogether
If we don’t think there has been a significant change in health, then we don’t think it’s fair for your insurer to alter the terms of the contract mid-term. So, we’d usually expect them to cover the condition for no additional cost.
If we think there has been a significant change in health, then we may think it’s fair for your insurer to alter your contract – as long as they can provide evidence to support what they’re doing and why.
If your insurer withdraws cover entirely, we’d expect them to offer to cover the costs of cancelling any holiday which was due to be taken during the policy year. Even if cancellation isn’t medically necessary at that point, we think this is the fair and reasonable thing for insurers to do.
Often, you may want to go on the holiday anyway, so you’ll find cover elsewhere. So we might think it’s fair for your insurer to pay the difference in premium up to the value of any cancellation claim we would’ve expected them to pay.
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Your insurer may say that your claim isn’t covered because if you’d have told them about the change in health, it would’ve done something differently.
If we don’t think there has been a significant change in health, then we wouldn’t think it’s fair for your insurer to retrospectively amend the cover.
If we think there has been a significant change in health that you should’ve told your insurer about, we’ll need to consider when we think it would’ve been reasonable for you to tell your insurer about the change.
This isn’t necessarily the day of the diagnosis (or urgent referral), because it’s not always reasonable to expect someone who’s just had bad news about their health to think to call their insurer straight away. But we think it’s fair to expect that you should generally have called within a reasonable amount of time.
We’ll also consider what your insurer would’ve done if you’d them about the change in health. If your insurer can provide evidence that they would’ve covered the condition for an additional premium, then it might be appropriate for them to only pay a proportionate settlement. So, for example, you might have paid £100 for the policy. But, if you’d told your insurer about a significant change in health, you’d have been charged an extra £100. You then claim for £2000 of costs. As you’ve only paid 50% of the premium you should’ve (£100 instead of £200) then the insurer should pay 50% of the claim (£1000).
If your insurer can show us that they would’ve withdrawn cover entirely, we’d usually ask them to pay what the value of the cancellation claim would’ve been if you’d told them about your change in health.
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When looking at complaints about charges for cancelled trips, we’ll take account of the travel company's cancellation policies. Usually the closer it is to the date of the trip, the larger the charge will be – up to the full cost of the holiday.
We’d usually say it’s fair for the insurer to pay the amount that would’ve been charged at the time we think you should have called to tell the insurer about your change in health.
Case study
My insurer said my ear infection was a significant change in health
Insurance Medical Conditions
Information for financial businesses
If you’re a business looking for information to help you resolve complaints or want to find out more technical information, you can find more detail about complaints about change in health in the business section of our website.
