Wedding Disaster: Insurer Refuses Payout After Medical Emergency Forces Cancellation

Just two days prior to our wedding last May, my 23-year-old brother received a devastating diagnosis of terminal brain cancer, leading to an urgent surgery.

Having secured cancellation insurance 18 months before from The Insurance Emporium (TIE), I quickly filed a claim when we had to cancel the wedding.

The response from the insurance staff was devoid of compassion, and they even misplaced the claim forms, forcing me to submit them again. I found myself constantly having to follow up for any news.

Two months afterward, my claim was rejected on the grounds that my brother had experienced episodes of daytime sleepiness before the policy was activated. Although doctors saw no alarming signs then and made no diagnosis, the insurer concluded that these were early symptoms of his cancer.

In October, five months post-claim, TIE proposed a £9,000 settlement acknowledging the ambiguous medical evidence and the delicate situation. However, this offer was rescinded three weeks later. We are now out £22,000 and cannot afford to reschedule our wedding.

KW, London

This situation sheds light on the potential pitfalls hidden within many insurance policies.

You mentioned that in 2020 and 2022, your brother, who was studying medicine, sought medical advice for a drooping eyelid and recurring tiredness. He was referred to a sleep clinic on both occasions and given tips on improving sleep hygiene. A medical letter in 2022 confirmed there were no serious concerns.

The insurance was purchased in December 2023, and the application form inquired if anyone crucial to the wedding had any known or ongoing health issues. At the time, your brother’s unexplained fatigue didn’t seem relevant to mention. The policy also listed exclusions for any claims related to pre-existing conditions, defined as any illness showing “clinical signs” before the policy started.

TIE acknowledged that omitting your brother’s fatigue from the form wasn’t unreasonable, considering his doctors had not expressed concerns. Nonetheless, they insisted that these symptoms were retrospectively related to his cancer, thus applying the exclusion.

The policy terms and conditions are notably broad and ambiguously phrased, seemingly covering any symptom or past or potential illness of anyone in the wedding party at any time.

Additionally, TIE’s rejection letter suggests that a condition does not need to be diagnosed to deny a claim.

This implies that the insurer may use hindsight to justify claim rejections. The Financial Ombudsman Service, which looks into complaints about insurance claims, considers whether a customer should have been aware of an undiagnosed condition that could lead to a claim, especially if symptoms were minor and nonspecific. For instance, they note that while headaches might not initially indicate illness, they could later be identified as symptoms of something more severe like a brain tumor.

I challenged TIE on these points, but they stood by their exclusion for pre-existing conditions and its wording. They maintain that to be fair and consistent to all customers, they cannot modify or waive this requirement for individual cases.

However, following your grievances, they have revised their declaration form. Now, customers are explicitly asked about conditions that are awaiting test results or treatment, or any terminal illnesses.

Concerning the retracted £9,000 offer, the company has agreed to reinstate it after my inquiry. They have also compensated you £350 for the lack of adequate service. It’s possible that the Financial Ombudsman Service might support your complaint and demand a full payout.

Yet, given that your brother had sought medical advice several times before the policy was taken, there’s also a chance that the Ombudsman might find the insurer’s decision justified, potentially leading to a lesser settlement or none at all. Therefore, you have accepted the offer to concentrate on supporting your brother.

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