‘My son fell ill in Cuba and died, and then his insurer refused to pay £90,000 medical bill’

Dear KA,

I’m deeply sorry that you lost your son in such tragic circumstances. Your case is among the most harrowing I’ve dealt with, and I cannot even begin to imagine what an ordeal this has been for you. Your son is dead and you are £90,000 out of pocket. You feel that in your family’s greatest hour of need, this insurer, Tifgroup, which operates a number of travel cover brands, was not there for you. 

When I asked Tifgroup to reconsider your case it responded to questions via lawyers. I can see why it initially raised doubts over your son’s insurance being invalidated by his drinking. Unfortunately, Cuban doctors wrote in your son’s medical notes that his pancreatitis was a result of him being an alcoholic.

Your son’s policy excludes anyone with a prior history of “alcohol abuse”, and when he bought the policy, he would have been warned about this. You say he wasn’t an alcoholic and, following my involvement, the Cuban hospital produced a stamped and signed note to retract its assertion that your son was an alcoholic, as it was based on no evidence. It issued an ­apology.

Pancreatitis is commonly caused by alcoholism, which is probably why the assumption was made. However, there are many other possible causes, which it said must be considered. For example, your son smoked, had diabetes and was overweight. 

So was Tifgroup going to change its mind about paying the £25,000 hospital bill? Sadly not. Tifgroup had reviewed your son’s British medical records and found evidence of sporadic heavy alcohol consumption.

It said it was unable to pay the claim because it believed your son’s pancreatitis was the result of “both his long and short-term drinking”. So, it appeared that it was excluding him under the “alcohol abuse” clause in its terms.

Having reviewed his British medical records myself, I can see no evidence that your son was ever diagnosed with long-term alcoholism.

It seems, then, that he was excluded under the broad umbrella of being someone who has “abused” alcohol on a sporadic or short-term basis. I asked Tifgroup how it defined “alcohol abuse” for the purposes of accepting or rejecting insurance claims. It said it “looks at this on a case-by-case basis, using the guidelines laid out by the NHS and the National Institute for Health and Care Excellence”. According to the NHS, alcohol misuse is: “When you drink in a way that’s harmful, or when you’re dependent on alcohol.” It recommends that both men and women do not regularly drink more than 14 units a week.

Tifgroup’s terms and conditions also contain a clause that says anyone found to have more than 0.19 blood alcohol units will be excluded from cover, but since no blood alcohol test was performed on your son at any stage in Cuba, how could it possibly say how much he’d had to drink? To my mind, it could not.

And what about the £65,000 repatriation costs that remain unpaid by Tifgroup? It said it wouldn’t pay because you chose to listen to separate medical advice saying it was safe to fly your son home in an air ambulance, ignoring its own expert’s advice that he was not safe to fly. Under such extreme stress it must have been terribly difficult for you to have known what to do for the best, so I can understand why you chose to go ahead and book the air ambulance. You were trying to do the best for your dying son.

Still, I asked Tifgroup to pay and the answer was no. You asked me what you should do next and I helped you formulate a case to take to the Financial Ombudsman Service.

The Ombudsman took many months to respond, but in the end agreed with me that it wasn’t unreasonable for the claim to have initially been declined. However, it noted the lack of evidence of your son’s drinking while on holiday. It said it understood Tifgroup’s position that “on the balance of probabilities” your son’s condition was caused by alcohol consumption or alcohol abuse, but it said the available evidence did not lead it to the same conclusion.