written by DisgustedinSpain on 25/10/2017
I purchased a HCI policy for my wife. During the policy period she developed tendonosis in her left ankle and the doctor recommended surgery. I completed the claim form, had the doctor and clinic insert their information and submitted it to HCI for pre-approval, as required by the policy. The surgery was approved, but I was told that I needed to pay for it and then submit a claim for reimbursement. Did all that, and now we are told that the claim was denied because the tendonosis was a pre-existing condition. There was no pre-coverage history of this and our doctor confirmed that it was not pre-existing. HCI did absolutely nothing to investigate whether the condition existed during the five years prior to the inception of coverage, but simply denied coverage after they had authorized the surgery. To make matters worse, the policy requires arbitration in the Isle of Guernsey. To make matters worse, the policy provides that HCI's decision is prima facie proof of the existence of a pre-existing condition. In other words, just saying the words makes it a fact, unless I can prove that it is not. Done with this company forever
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Arouth's Response to DisgustedinSpain's Review
Written on: 26/08/2022
You could have taken your dispute to the UK Insurance Ombudsman's office. They would have reviewed your issue and if they decided you were in the right, they would have ordered HCI to pay the claim. Why didn't you do that?