Assisted a major UK travel insurer in response to a large loss claim

A comprehensive, Post Incident Analysis provided the essential evidence required for a travel insurer to defend its decision of not covering a large-loss insurance claim.

The Claim

A traveller in Cuba experienced a critical, medical emergency. Medical Reports from the hospital suggested the illness was alcohol and narcotics induced. The traveller refuted this.

As a result of the Medical Reports, the large-loss claim was denied, and the hospital was instructed to settle the medical bill directly with the traveller.

After six-months, the hospital had failed in their attempts to collect the outstanding bill amount. In their response to this, the hospital changed their initial Medical Reports, six-months after the patient had been discharged, to state that the cause was in-fact not caused by alcohol or narcotics, and then tried again to claim the outstanding amount from the insurer.

Post Incident Analysis

Inherent Risks' was instructed by the insurer to conduct a Post Incident Analysis to reconstruct and assess the chain of events that took place up until the medical emergency, and to establish the reason why the hospital had changed their Medical Report so long after the fact.

Through our in-country Associates', a Medical Doctor, and Investigator, and supported by our wider team, we were able to piece together the chronological events from three-days prior to the incident, up to and including the day of.

This included reviewing both the traveller, and his friend's social media accounts to establish locations, and behaviour based on image content, and comments made, and interviewing staff from three separate establishments, analysing CCTV footage, and liaising with local law enforcement.

We also investigated why conflicting reports had been provided by the hospital, the results of which was further compounded by the involvement of a local assistance company.

The Result

Inherent Risks' work was able to establish that the medical emergency was in-fact alcohol induced, and the events leading up to the incident completely contradicted the traveller's version of events. In addition, we were able to establish that a hospital administrator had been coerced into changing the medical report in an attempt to validate the claim. This provided the essential evidence required for our client to defend its decision of not covering a large-loss insurance claim.