DRN-6269143

The complaint Mr H and Mr P complain about the way Red Sands Insurance Company (Europe) Limited (Red Sands) handled the claim they made under their travel insurance policy. This complaint has been brought by both Mr H and Mr P, but as Mr H has been leading in this complaint, and for ease, I’ve referred to him throughout. Any reference to Red Sands in this decision also includes the actions of its agents for which it is responsible. What happened The circumstances of this complaint will be well known to both parties and so I’ve summarised events. Mr H held an annual multi-trip travel insurance policy provided by Red Sands. In March 2025 Mr H travelled abroad but began suffering from severe back pain. He reported this to Red Sands’s emergency medical assistance team on 12 March 2025 and received treatment from the hotel doctor. Red Sands initially declined Mr H’s claim as it said his policy didn’t cover the area he had travelled to. Mr H raised a complaint about this as he said he had told the agent where he was travelling to during the purchase of this policy. Red Sands subsequently confirmed cover could be provided. Mr H was admitted to hospital on 15 March 2025 for further treatment. After receiving treatment Mr H told Red Sands the hospital wouldn’t discharge him until they had received a guarantee of payment, but Red Sands were still validating the claim. Mr H ultimately paid for treatment so he could be discharged. On 20 March 2025 Red Sands issued Mr H with a final response to his complaint. It said the claim was declined in accordance with the schedule of insurance it had been provided and its agents acted promptly for coverage to be confirmed. Mr H submitted a claim to Red Sands for the costs he incurred. In April 2025 Red Sands settled Mr H’s claim. It reimbursed him the cost of the hospital treatment he had paid for and asked for a copy of the invoice for the medication he had purchased so it could review this. It said the other costs Mr H had claimed for weren’t covered. Mr H raised a complaint about the way his claim had been handled. On 8 May 2025 Red Sands issued Mr H with a final response to his complaint. It said it could have better managed Mr H’s expectations regarding the claim process but it didn’t think its communication was lacking whilst Mr H was abroad, nor during the claim process once he was back in the UK. Mr H referred his complaint to this Service. Our Investigator looked into things but didn’t uphold Mr H’s complaint. Mr H didn’t agree with our Investigator. He provided a very detailed response but in summary he said:

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• Red Sands refused to issue a guarantee of payment which forced him to pay for the emergency medical treatment. • Throughout the claim Red Sands repeatedly requested documents which had already been provided. • Communication failures were persistent and severe. And he was subject to unreasonable delays. • Red Sands refused to reimburse legitimate expenses including medically advised rest accommodations, transport and communication costs. As an agreement couldn’t be reached, the complaint has been passed to me to decide. What I’ve decided – and why I’ve considered all the available evidence and arguments to decide what’s fair and reasonable in the circumstances of this complaint. I want to acknowledge I’ve summarised Mr H’s complaint in less detail than he’s presented it. I’ve not commented on every point he has raised. Instead, I’ve focused on what I consider to be the key points I need to think about. I mean no discourtesy by this, but it simply reflects the informal nature of this Service. I assure Mr H and Red Sands I’ve read and considered everything that’s been provided. I also want to be clear about what I’ve considered as part of this decision. I’ve considered the events which have taken place prior to Red Sands final response of 8 May 2025 and which Red Sands has addressed within its final responses of 20 March 2025 and 8 May 2025 respectively. I’m aware Mr H submitted a baggage claim which was declined by Red Sands, but this wasn’t included as part of Mr H’s complaint to Red Sands, nor can I see it has issued a final response about this. So, if Mr H is unhappy with this he would need to raise this as a separate complaint with Red Sands. I’m also aware Mr H submitted a claim for the cancellation of a separate trip he was due to go on. He has provided this Service with details of what he considers to be failings by Red Sands in relation to this separate claim. Again, this is something that would need to be raised as a separate complaint with Red Sands and so I won’t be addressing anything to do with that claim as part of this decision. The relevant rules and industry guidelines explain Red Sand should handle claims promptly, fairly, and shouldn’t unreasonably reject them. Red Sands initially declined to cover Mr H’s claim as his policy schedule showed he didn’t have cover for the area he had travelled to. Based on the evidence provided, this appeared to be an error by the business who sold Mr H his policy rather than an error by Red Sands. I’m satisfied Red Sands took the appropriate steps to clarify this and did so within a reasonable period of time. So, whilst I acknowledge it would have been distressing for Mr H to be told his claim wouldn’t be covered, I can’t hold Red Sands responsible for this. Mr H has said he is unhappy Red Sands wouldn’t send a guarantee of payment to the treating hospital. This meant he had to pay for the treatment himself so he could be discharged.

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Before issuing a guarantee of payment, a travel insurer will usually carry out validation checks to ensure the policy can provide cover for the treatment being provided. This will often include reviewing medical reports from the treating hospital, and reviewing the insured’s past medical history to make sure the appropriate medical declarations have been made. I don’t think it’s unreasonable for an insurer to carry out these checks before providing a guarantee of payment, but I would still expect it to complete these checks promptly. Based on the claim notes and correspondence, the reason Red Sands didn’t provide a guarantee of payment earlier was because it needed Mr H’s GP to complete a report about his medical history and provide information about medication Mr H had been prescribed. I don’t think this was unreasonable as this was required before being able to confirm Mr H had the appropriate policy coverage in place for it to pay for his treatment. I can see Red Sands received the consent form to contact Mr H’s GP late on the Friday evening and sent the request to his GP early Monday morning. It also followed this up this request with a phone call to the GP surgery asking for a response urgently given the circumstances. This was received and the cover was confirmed the same day. So, I think Red Sands obtained and review this information as soon as it could have done. Red Sands were aware the hospital wouldn’t discharge Mr H until it had received a guarantee of payment, and it did ask its agent whether the hospital would allow Mr H to be discharged and then it provide the guarantee of payment at a later date, but the hospital refused. I think it took the steps I would have expected it to in these circumstances. Whilst I acknowledge the upset and frustration this would have caused Mr H, I’m not persuaded Red Sands unreasonably delayed the guarantee of payment being issued to the hospital. I acknowledge Mr H was unhappy with the communication he received during this period. I can see Red Sands had some difficulty getting through to Mr H on the phone at times, but overall I’m satisfied it kept him appropriately updated with the progress of his claim. I can see Mr H had asked for a manager to call him back, and I can’t see this was actioned which I think caused some frustration. However, I’m not persuaded a call from a manager would have progressed matters or alleviated the distress Mr H was experiencing due to the hospital refusing to discharge him. Mr H submitted a claim to Red Sands for the costs he considered should be reimbursed. I can see Red Sands requested further information from Mr H in support of his claim. On the whole I think Red Sands requests for information were reasonable and were communicated within a reasonable timeframe. And I think it settled Mr H’s claim promptly. Mr H was unhappy with the settlement Red Sands paid as he believes there are further costs which should be paid. Red Sands didn’t agree to refund Mr H the costs he say he incurred for a taxi as he was unable to provide a receipt for this journey. I don’t think this was unreasonable as without a receipt Mr H has been unable to evidence the loss he says he incurred. Red Sands also didn’t agree to refund Mr H the cost of a sim card or the non-sterling transaction fee he incurred. I can’t see any section under which Red Sands provide cover for these losses, and the policy specifically excludes costs of telephone calls, and any other loss unless it’s specified in the policy. Mr H claimed for the cost of upgrading his hotel to a villa and for massages/wraps which he says were recommended by the treating doctor. Red Sands’s medical team has said it doesn’t consider these expenses to be medically necessary and so it hasn’t agreed to cover them.

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I appreciate Mr H may have been told verbally by his treating doctor that massages/wraps would be beneficial for him, but I’ve not seen medical evidence which shows this was recommended as necessary treatment for his condition for which his policy provides cover for. Similarly, I’ve not seen medical evidence which shows it was medically necessary for Mr H to change his accommodation to a villa. So, these aren’t costs I require Red Sands to reimburse him for. Mr H would like Red Sands to reimburse him for the cost of his holiday he says was effectively ended as soon as he arrived given the symptoms he was experiencing. Mr H’s policy provided cover if he had to end his trip sooner than planned, but Mr H remained abroad for the duration of his holiday, returning on his originally scheduled flight. So, he didn’t end his trip early. There may be specific circumstances in which this Service consider someone’s trip to be effectively curtailed even if they didn’t return home any earlier than scheduled. I’ve taken into consideration what Mr H has said about the impact his symptoms had on his trip, but I’m not persuaded it would be appropriate to conclude his trip was effectively curtailed. Mr H has said he was still able to use the facilities, such as the pool at his accommodation, albeit for a short period of time. And whilst I can acknowledge Mr H’s trip may not have been as he planned it to be, his policy doesn’t provide cover for loss of enjoyment. Therefore, I don’t require Red Sands to reimburse Mr H the cost of his trip. I naturally empathise with Mr H given the circumstances and I know how strongly he feels Red Sands has treated him unfairly. However, for the reasons I’ve explained I don’t require Red Sands to take any further action in relation to his complaint. My final decision For the reasons I’ve outlined above, I don’t uphold Mr H and Mr P’s complaint about Red Sands Insurance Company (Europe) Limited. Under the rules of the Financial Ombudsman Service, I’m required to ask Mr H and Mr P to accept or reject my decision before 13 May 2026. Andrew Clarke Ombudsman

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