General Insurance Article - 5 Insurance policy excuses for unwary skiers

 Britain's financial watchdog has warned last week that customers may be unaware winter sports are considered an "added extra" by most insurers and contain restrictive exclusions.

  

 "Even if someone's paid extra for a specific sort of cover, they're still unlikely to be covered in every situation," says Caroline Wayman of the Financial Ombudsman Service. "Inevitably this 'small print' is at the centre of most complaints that reach us," she said.

  

 We list five favourite excuses used by insurers to deny a payout.

  

 Excuse No 1: Packaged bank account doesn't include sports

 Steve and Michele Crease, who ski once every few years, are among those caught out by little known exclusions on a policy.

  

 On a trip to Canada in 2013, Mrs Crease, 49, tore a ligament in her leg and needed hospital treatment and a wheelchair to travel home in. The couple said the accident happened at the end of the trip so "didn't ruin the whole holiday".

 The holiday wrecker turned out to be the 1,000 pounds hospital bill that their insurer refused to pay - saying they did not have winter sports cover.

  

 Mrs Crease, a personal assistant, held an "Additions Active" current account with Barclays, which included annual travel insurance in return for a monthly fee.

 She was sold the account in 2011 and told that it included ski cover, but Barclays denied any mis-selling when the couple complained.

  

 After she referred the case to the ombudsman, the body said the bank "didn't give clear information about the travel insurance policy".

  

 The ombudsman ordered Barclays, after a failed appeal, to pay back the claim plus 8pc interest.

  

 "I've banked with Barclays for more than 30 years, so the bland letter they sent refusing our payout was very disappointing," Mr Crease, 50, an IT manager, said. They closed their account.

 Packaged bank accounts are the fourth-biggest source of complaints to the ombudsman, up by 126pc on a year earlier.

  

 Excuse No 2: Our annual winter sports insurance only covers 10 days of skiing

 Even customers who have paid for a 12-month insurance policy, which includes winter sports, may be disappointed to discover that just one or two ski trips are included.

  

 Research by Telegraph Money shows that insurers advertise "annual winter sports" policies - but the terms and conditions limit actual cover to a few days.

  

 Virgin Money and Insure and Go, for example, say that ski cover is limited to 10 days a year. Insurance Republic offers 17 days.

 Even when covered, policy exclusions suggest that the actual ski activities covered are very restrictive.

  

 Virgin Money puts an asterisk against 14 activities deemed as winter sports, including downhill skiing and snowboard fun parks, with the condition that "cover for these activities may carry an increased medical excess and may not provide cover for personal accident".

  

 Excuse No 3: We won't cover your emergency surgery because we didn't approve it first

 When Mrs Robinson* broke her ankle after falling on the slopes in the United States, she had surgery at a local hospital. The hospital said it had contacted the insurer - which gave the go-ahead for the procedure.

  

 But the insurer refused to pay out - saying it hadn't authorised the surgery.

 Hospital notes of a telephone call between a doctor and the insurer showed that they had discussed the fees, suggesting that the insurer had, in fact, authorised the surgery. The ombudsman agreed, adding that the insurer's information, "full of abbreviations and acronyms", wasn't clear enough and ordered it to pay the costs plus 8pc interest.

  

 Excuse No 4: Beware going to a private hospital - it may not be covered

 After breaking her leg while skiing in Italy, Mrs Johnson* was admitted to the local state hospital, which recommended urgent surgery at a private clinic.

  

 Her husband rang the insurer to check that the treatment would be covered by the policy, but the person he spoke to couldn't say "because claims would only be dealt with once the insurer had received the medical records".

  

 By the time the insurer replied saying it wasn't prepared to pay for private treatment, the surgery was already under way.

  

 As the treatment was urgent, the ombudsman said that the couple "hadn't been in a position to question the doctor's assessment" and told the insurer to pay the medical fees plus 8pc interest.

  

 Excuse No 5: No payout for snowmobile accident - you don't have car cover

 Mr Kelly* took out winter sports cover for a trip to Canada, and on the second day he rented a snowmobile. He crashed the vehicle and, although unhurt, had to pay the rental company for repairs. Although his policy covered "snowmobiling", there was an added exclusion on claims relating to a "motorised vehicle".

  

 Mr Kelly complained to the bank that sold the policy, saying he had paid extra for winter sports cover and expected to be covered for all activities. The ombudsman said Mr Kelly must have overlooked the exclusion, adding that it was not an unusual exception for insurers to apply, and turned down the complaint.