I fainted in Lanzarote and spent three days in hospital where a pacemaker was fitted. Now my travel insurer refuses to pay the £8,500 bill: SALLY SORTS IT

During a holiday in Lanzarote in May last year I fell ill and fainted. I was taken to hospital where I spent the next three days going from intensive care to having a pacemaker fitted before being discharged.

The day after I contacted Insure and Go, my travel insurer, to tell them what had happened and was told not to worry and to complete my claim when I got home. Nine months later and now the insurer Zurich is refusing to pay the €10,000 (£8,542) hospital bill because I didn’t contact them quickly enough after falling ill. Can you please help? S.B., Kent.

Sally Hamilton replies: You have forwarded me a copy of the email you received from Zurich Assist, who processed your claim. I imagine its contents will test your pacemaker as soon as you read it.

The claims handler, sent to you in January, confirmed that upon assessment of your claim – which included reviewing your GP records and hospital paperwork in Lanzarote – you would be paid £30 in hospital benefits (a cash payment of £10 for each night you spent in hospital) and £500 towards the €10,000 bill for your hospital treatment.

It said: ‘After reviewing your medical report, we note that you were unwell for three days and could have contacted the medical assistance team within those days. “As a result, the insurers have advised that your claim settlement will be limited to £500 as you have not contacted the assistance team as per your policy terms.”

You were referred to page four of your policy document, which states that you must contact the company immediately as soon as you are admitted to hospital – otherwise you risk having your claim limited to £500. You were asked to pay the outstanding balance to pay the hospital – and send evidence that you had done so – before it would refund the £500. You were furious and upset and that’s why you contacted me.

You told me that the policy sheet you took with you on your trip clearly stated that you had to contact the insurer ‘as soon as possible’. In your view, and mine, you contacted us when you were out of danger, after you had been treated for an irregular heart rhythm and had the pacemaker installed. That was probably fast enough.

A policy schedule is an abbreviated version of the full terms and conditions. I thought you read the schedule correctly and that Zurich should not have denied your claim within three days. If the insurer wishes to enforce such a restrictive condition, this should be clearly highlighted on the schedule.

However, I believe that the requirement to contact ‘immediately’ was not applicable in your case, as you had become seriously ill. You told me that you had barely been conscious for the past three days and that you had no telephone or insurance papers with you.

I told Zurich what I thought, and the company agreed to investigate. After your case was reassessed, the insurer decided that a mistake had been made. As a result, it was concluded that not only will you receive the medical bills of €10,000, but you will also be paid extra as an apology for the distress caused.

A spokesperson for Zurich said: ‘We are very sorry for the challenges and delays our customer faced in making a claim on her travel insurance policy. We have now carried out a full investigation and can confirm that she was wrongly informed that she had no valid claim. This was due to a miscommunication between claims handlers.’

He added: ‘We have now spoken to her to confirm that we will make a full settlement as soon as possible and provide £850 in compensation for the inconvenience caused. We strive to maintain a high level of customer service and on this occasion we fell short. We will conduct a full investigation into the way this claim was handled to identify lessons learned and prevent this from happening again.”

Claim train delay

I have hit a wall with Great Western Railways (GWR) regarding a claim for delays and cancellations that affected my journey from Truro to Poulton-le-Fylde in Lancashire last August, causing me significant inconvenience.

I’m 84 and came home with a pinched sciatic nerve, caused by sitting on drafty platforms and waiting rooms that day while staff found alternative trains for me along the way.

I got home after midnight, 14 hours after starting my trip. It would take six hours. I complained to GWR but they refused a claim for a refund or compensation.

CC, Preston, Lancashire.

Sally Hamilton replies: I have experienced a number of delayed train journeys in my time, but the bitter pill is usually softened by the railway company refunding some or all of the ticket price. Your story of travel woes and denied refunds defies belief. The GWR website states: ‘If you arrive at your destination 15 minutes or more late because your GWR train is delayed or cancelled, you can claim delay compensation.’

The amounts refunded to travelers vary, but a delay of 120 minutes entitles the traveler to a 100 percent refund of the full costs (round trip).

Since your ticket cost €152.30 return, you should have automatically received €152.30.

You submitted copies of your tickets as required, but your claim was rejected because the railway company could not find a timetable that matched the first part of your claim.

You sent me a copy of the ticket. It clearly stated that it would leave Truro for Taunton at 11.50am. This train was canceled and you were transferred to a train leaving Truro at 1.30pm. Then everything went wrong, losing all your seat reservations, as well as the pre-booked assistance you requested for certain trains.

At each of the four stations you had to seek ad hoc help from the staff. By the time you reached Preston you had to end the journey 16 miles short of your destination as it was so late that there were no more trains running to Poulton le Fylde from there. You had to call a friend who kindly picked you up and took you home.

I have asked GWR to put things right. This prompted customer service to contact you and confirm that you would still receive your refund. Unfortunately, the apology did not extend to expressing regret for the five-month delay in delivering your refund.