Declaring a ‘pre-existing condition’ — what exactly does your travel insurer need to know?

For many, it’s an online tick-box when taking out an insurance policy that we don’t give very much thought to. But if you need medical assistance on holiday, not answering that question correctly could result in your insurer rejecting a travel insurance claim outright.

Rip Off Britain has heard from viewers whose insurers refused to cover medical expenses incurred on holiday, because pre-existing conditions had not been declared when the policy was taken out. But the customers say they did not consider the conditions in question to be serious or recent enough to need to declare them.

Mental health nurse Lisa Robinson was diagnosed with an aggressive brain tumour whilst on holiday in Turkey, leaving her with a €65,000 bill after her travel insurer declined her claim.

Lisa, from County Durham, suffered with a severe headache and loss of balance in Antalya in June 2022. She was rushed to a private hospital where doctors diagnosed a bleed on the brain requiring immediate surgery.

“They were shaving my hair. I remember being in a corner, just saying ‘leave us alone’, terrified,” Lisa told Rip Off Britain. “And after that I can’t really remember anything.”

Lisa had a large brain tumour and underwent 13 hours of surgery before being moved to intensive care.

Her sister Sharon contacted Lisa’s travel insurer Coverwise about the medical bill, but underwriter AXA declined the claim, pointing to a recent GP visit two weeks before she took out her policy when Lisa had reported suffering from headaches.

AXA deemed this evidence of a pre-existing condition which Lisa had not declared when taking out the policy.

The hospital discharged Lisa after her family came up with €40,000 of the funds, with the remainder covered later by fundraising efforts.

Sharon complained to AXA, but the company said it had been correct to decline Lisa’s claim, as she had purchased a policy which she was ‘ineligible for’.

Lisa was also diagnosed with stage 4 cancer and began further treatment in the UK.

“You couldn’t predict this diagnosis, so I don’t know why they would say it was a pre-existing condition. AXA should have paid,” Lisa told Rip Off Britain.

Insurers need to know if you’re at higher risk of needing to cancel your trip or seek medical assistance whilst abroad, and as a result may increase your premium or offer you a different policy.

Consumer rights expert Martyn James says legislation puts the onus on insurers to ask customers the right questions in order to get the health details they need.

But according to him, simply requesting information about a customer’s ‘pre-existing conditions’ is vague and unfair.

“If insurers actually want you to explain every single medical visit that you’ve had to the doctors over a two-year period, then that’s what they should say instead. That way it’s clear, and we all know if there’s a problem and what we need to actually disclose,” said Martyn.

He says he’s come across cases where an insurer has ‘seized on a forgotten minor illness’ to refuse paying out for an unrelated major one.

As part of Rip Off Britain’s investigation, Martyn quizzed members of the public about the medical conditions that must be declared to insurers.

None of those questioned said yes to all ten conditions he’d listed — diabetes, high blood pressure, epilepsy, cancer, asthma, water infection, depression, flu, anxiety and migraine.

But according to Martyn, each one would be considered a pre-existing condition by an insurance company.

So what exactly does your insurer want to know about your health?

• Both physical and mental conditions are taken into account — including cancer, diabetes, epilepsy, anxiety and depression
• You must list any condition you’ve received medical treatment for, or attended a walk-in centre or A&E about
• You should declare any health concerns you’ve spoken to your doctor about, even if the doctor felt it was nothing
• That means minor illness should also be declared, including headaches, water infections and flu
• How far back you need to list your ailments depends on your insurer, so it’s worth asking them
• If you’re concerned about whether you can get insurance based on a previous health condition, you might opt to provide a letter from your doctor confirming you’re in full remission
• You may be able to ‘exclude’ a particular condition you have from your policy — so you can’t claim for that, but you can claim for everything else

“The rules do say very clearly that if you’ve not disclosed something by accident, you shouldn’t be held accountable, so we need to see more fairness and get rid of these technical terms,” said Martyn. “The insurer might be able to deduct a small amount from your claim payout to reflect what you might have paid in premiums, had the insurer known about the condition - but many insurers will just pay the claim in full.”

A spokesperson for the Association of British Insurers said: “Our members recognise that clear communication is essential and are always looking at ways to improve processes.

“Disclosing pre-existing medical conditions is key to making sure your policy meets your needs, so it is vital that all questions are answered fully and honestly. Insurers will provide important information to help you understand your policy and speak to your insurer if you have any doubts about what you need to declare.”

An AXA Partners spokesperson said: “We are very sorry to hear about Ms Robinson’s illness and we sympathise with her situation. However, we were unable to settle her claim because she had not declared her previous medical history, which included appointments with her GP for a persistent migraine that required treatment with prescribed medication, when she took out the policy. Declaring previous medical history and pre-existing conditions is extremely important when purchasing Travel Insurance, as not doing so can invalidate a policy. Had Ms Robinson disclosed her previous medical history, she would have been offered an alternative insurance policy that would have better suited her needs and covered her for medical assistance whilst abroad.”

Watch Rip Off Britain’s report on Monday 7th August at 7pm, BBC One, or on BBC iPlayer