UKC

Sorry this is long – short version is: AAC insurance did not work for us, refused to organise emergency evacuation but left us to organise it, then refused to reimburse the cost.

We’ve had the basic AAC insurance for many years and always regarded it as very good value for the basic essentials – rescue and medical cover. No cover for gear, or accommodation for another person accompanying the injured climber etc etc, but that’s OK for the price. However, the proof of the pudding is in that claim you hope you never have to make. Recently we did have to claim, and it fell down very badly, leaving us currently nearly 12 thousand euros out of pocket.

My partner Alan broke a hold on a new route in the Tsaranoro, Madagascar, and ended up with a compound open fracture of the tibia/fibula. Climbing team were great, getting him down from the wall, stabilising the leg, and going for help. Locals were great, carrying him down on a stretcher. Staff of camp Tsarasoa were great, organising 4wd for evacuation to nearest town, and Malagasy-speaking assistant to come to the hospital.

Meanwhile I had phoned Europe Assistance, who handle the emergency assistance for Knox, theAAC’s insurer. They were UTTERLY USELESS. I (naively?) believed that they would take over and organise the onward evacuation. I imagined that they would have a decision tree to refer to which would tell them what to do in the circumstances. Instead, they appeared to have no understanding at all of the conditions in Madagascar or the need for urgent evacuation. They told me to “call an ambulance” which of course was not possible. In what was probably at least a 10-minute phone call, no assistance of any kind was offered, and I eventually gave up on trying to get them to take charge.

I then set about organising the evacuation myself. Thankfully, I had help from camp Tsarasoa staff, I had several credit cards, and I had at least a rough plan of what needed to be done. After being driven along the very bad jeep track and then the bad road to the nearest town of any size, Alan had basic first aid treatment in the (terrifying) hospital there, was then taken to the local airfield and picked up by a private plane, flown to the capital Antananarivo, and on to La Reunion.  La Reunion is a tiny French departement in the Indian Ocean, only a little more than an hour’s flight, and has the nearest modern medical care. (the FCO say “In general, medical services in Madagascar are poor … it is advisable to arrange anything but the most basic of treatment outside the country. Serious illnesses, accidents, or complicated cases may require evacuation to Reunion Island, Mauritius or South Africa.”)

This whole process was a 48-hour epic during which the leg became infected. But at least Alan was now in a modern hospital with great nursing staff, and was operated on by the same surgeon who put Alain Robert back together after one of his accidents.

Europe Assistance were again UTTERLY USELESS in organising the repatriation, their service was absolutely terrible, and everything was done with a view to reducing cost. We were put under pressure to take an unsuitable flight back to Europe against the medical advice of the surgeon, with the threat that otherwise it would not be paid for. Eventually, after dozens of e-mails, this was sorted and we were flown home with Alan in business class so he could have his leg stretched out.

Then we set about putting the claim in. They have refused to pay for the air ambulance from Madagascar to La Reunion on the grounds that we organised it ourselves. I have pointed out that if we had waited for them to organise it, Alan would probably have died. It is only because they did not do what they are supposed to do that we had to organise it. I am now waiting for a response from them on this

That is bizarre and quite worrying! I had the misfortune of having to call on them when I broke my leg in Chamonix in February, and other than apparently being entirely incapable of speaking to the hospital I was in other than through myself (confined to bed four floors above the office of the relevant person) they were pretty good. Airport transfer and business class flights back to the UK with zero fuss, and an entirely unnecessary paramedic escort for the journey.

They were admittedly infuriating to deal with on the phone (in both my opinion and the opinion of the French lady in the hospital whose job it is to deal with insurance companies), but apart from that no issues. That said, France is a big modern country with easily-accessible modern healthcare. It's not exactly a trying scenario.

Yes, I get the impression that it is basically set up to work in the alpine countries and probably works OK there.

Have you also contacted OeAV and your chapter? If not, do so. They need to know that the service they sell is not dealt as advertised. 

Really sorry to hear you're having continued trouble with this Kate. Keep at 'em, you definitely made the right choice. 

They were superb at getting me home after suffering a broken ankle on Kalymnos.  Para Medic, Business Class Lufthansa and reimbursed taxi fare from Birmingham Airport to my house.  They wouldn't pay for taxi fare from the cliff to the hospital as that was my choice. They also did not pay for my extended stay as it was my decision to discharge myself from the hospital after 5 days.

I've always thought of AAC as being good value for Europe but if I went anywhere else I would go with the BMC.

Al

Not yet, but I will do.

I will take this as far as I need to, including the Austrian insurance ombudsman if necessary.

Incidentally, something which was a minor issue for us, but might be v important for other OeAV Sektion Britannia members:

They also refused to pay for the emergency treatment in Madagascar on the grounds that we had to send the claim to our "obligatory health insurance" first. This presumably refers to something which Austrians have to have, so I wrote back explaining that the NHS does not work that way and that there is nowhere I could possibly send a claim. I said that although it was not important to our claim (total was a couple of hundred euros) they should reconsider because this issue would affect all Sektion Britannia members. They still refused to pay.

I wonder whether the cases of those who got paid out OK went to underwriting? Perhaps this is our problem. Knox have referred it on to Generali, their underwriters, and they are refusing to pay.

Really sorry to hear you had to go through this. I had AAC cover new routing in Malawi, and clearly was very fortunate in that I didn't have to use it! Will definitely reconsider for future trips. Thanks for sharing.

PS - Great work on handling the evac. I work full time in expeditions, and understand how challenging and intense it can be. Even worse when it's someone you care deeply about. Hope I don't sound patronising when I say really well done.

Thanks Joshtee and Mischa.

I'm in no doubt at all that I took the right decisions, even if we end up paying for it ourselves.

I just wish I could have got him out faster.

Thanks a lot for this. Like you I've always had faith (blind faith?) in the AAC insurance, ever since my first Alps trip in 1966. You've reinforced my view that it's probably geared up for The Alps and despite it's Worldwide cover it struggles with non Western infrastructures (if any). For this reason in recent times, for my twice a year jaunts to Morocco I've chosen to use the top up insurance that Knox make available if you can cope with the application form in German. Also at a very good price it ups the hospitalisation limit to €500,000. I have believed that might do for most places other than North America.

Your experience has one wondering if Knox is of much use anywhere except Europe, topped up or not. I was this about to take out the top-up for next month's trip. Thanks to you I'll be doing more research before I do, although I'm now wondering how any other insurer might have coped in your situation. I've heard anecdotes about BMC insurance failures too.

Incidentally with regard to your "must first invoke your obligatory insurance" experience this was their stance when a pal had a ski-ing injury in France last Winter. This necessitated much email and letter writing and form filling in order to establish just what were the NHS' obligations in this regard. As a consequence it was some months before my friend received the limited contribution Knox would make - I think around €250 out of a total bill of €450. Chicken feed compared to your expenditure but relevant to the discussion I feel.

I think worth bearing in mind distinctions between AAC, the insurers Knox/Generali and the emergency claims handlers EuroAssist, who are used for many travel policies with different insurers. Whilst I can understand why they might initially push back on Business Class flights, as you say if they expect you to sort out logistics (and I can’t imagine how they would organise a local rescue in Madagascar) they can’t then really quibble on the choices you made to get to the nearest decent hospital.  With regard to the emergency treatment, can you try with the NHS (which I think the claim form requests in the first instance) then forward the rejection to Generali? 

I can't; when I suffered almost the same injury ( but less messy), they booked business class flights by default. Someone with a broken leg - whether in a cast or not - can hardly be expected to sit in a seat with limited legroom for a several hour flight.

Interesting. I've been a member of the AAC for many years and I have never had to use their insurance but I know people have made comments to me in the past about actually claiming...

With regard to the organisation of rescue in remote (e.g. not Europe/US) countries though (irrespective of paying for it afterwards) do we thing that the BMC/Snowcard/whoever have this decision tree plan for affecting a rescue in place?

eg. country/terrain location/injury type ??

I hope this resolves itself for you guys .

cheers

mark

I hope it is OK, I have bought this post to the attention of the AAC(UK) office who appear to be taking it up, not sure but they may get in touch with you.

I am aware of others that have had a very different experience to you, one of the attractions of the AAC insurance is that it is no frills rescue/repatriation.

Anyway, I hope it gets sorted amicably for you.

Steve D

The ridiculous part of this was that they demanded a photo, then based their decision on the fact that the leg was not in plaster!

(Because it was too serious to be put in plaster.)

There is a clear risk of DVT when flying after an injury like this, and keeping the leg elevated is essential - as the surgeon said in his fitness-to-fly certificate.

They also tried to get Alan to fly back BEFORE he had been passed as fit to fly; they booked a flight without consulting the hospital, then told us to be on it or else we could pay for it ourselves. (It was a non-direct flight when a direct flight was available, adding several hours to a long journey.) It was only when I put in writing "are you telling him to fly against medical advice?" and enlisted the surgeon's support to speak to them, that they backed down.

They did eventually provide a direct business-class flight with paramedic escort, and an ambulance from the airport, so I wouldn't want to make too much of an issue of this. Except that, they actually made it so difficult that there was a point where I was ready to give up and  pay for the direct business class flights ourselves.

No problem. I had tended to assume they would not get involved.

But even if they do not get involved in our case about the evacuation, something needs to be done for UK members about this "obligatory health insurance" thing which prevents us claiming. I am not even aware of any NHS organisation we could send such things to in order to get a refusal to send to the insurers. Asking the NHS to reimburse costs incurred in Madagascar would be so plainly absurd - yet Knox are saying this is what we have to do

Agree probably not in Madagascar but the NHS do cover the cost of treatment in Europe, emergency/ non emergency and with or without EIHC card (at least for now) so perhaps not as daft as it seems. 

Agree probably not in Madagascar but the NHS do cover the cost of treatment in Europe, emergency/ non emergency and with or without EIHC card (at least for now) so perhaps not as daft as it seems. 

Very sorry to hear of the accident and all the resulting trauma.  Congratulations on extracting yourselves from a location which by European standards cannot be at all easy.

AAC(UK) is of course concerned about the way in which your incident was handled.  We are investigating further with the OeAV, and KNOX Versicherungsmanagement GmbH.  At this stage we cannot say more.

As regards having to send the claim to the "obligatory health insurance" first, AAC(UK) will follow this up.  One comment in this email trail points out that "NHS do cover the cost of treatment in Europe", so it appears that the claims process in this area needs to be clarified, Europe versus rest of world.

As a note to a comment by Martin Bennett, the "top up" insurance does have an English-language application form and description.  https://www.knox.co.at/wp-content/uploads/2016/07/Alpenverein-Premium-Singl...

Mike Garrett, Acting Chairman, AAC(UK)

I think what this has highlighted to me is the research that should be undertaken when getting insurance cover for activities in regions that don't have a well developed infrastructure for CasEvac. I take it for granted that when I'm leading trips, I have recce'd the destination and written my own CasEvac plan, which is known by the company. However on personal trips, I am so much lazier! I have a rough idea, but I do assume that the insurance company will assist. 

The reality is, the insurance company itself will only be relevant once the situation has been resolved, and it will be resolved through the emergency assist organisation that the insurance company uses. So I will be looking more at the emergency assist companies, and contacting them to check their level of knowledge of my destination, before getting out any cover.  Good to hear from Mike Garrett. I hope the noted issues are dealt with.

J

Yes, me too.

I think the most important thing of all is to have a plan. I am thankful that we had done some research and had "some sort" of plan, but in future we will have a proper, detailed plan.

Then, the other things are:

Have a phone that works, (and a charger for it) with you at all times. This may mean a satellite phone. We will be buying one; they are not as expensive as they used to be.

Credit cards or other access to cash in large amounts.

Insurance.  So, insurance is still important, but now comes last rather than first. I will be doing plenty of research on that before our next trip. As you say, researching the emergency assistance companies as well as the insurers. As JMarkW said, "do we thing that the BMC/Snowcard/whoever have this decision tree plan for affecting a rescue in place? eg. country/terrain location/injury type ??". I don't know. We need to share info on this.

I did contact Global Rescue, who are not insurers but actually organise rescue and evacuation. They sound good, but again, who knows? When I asked about how they would have handled the situation in Madagascar, they made all the right noises but were short on specifics.

Well, yes and no. Knox themselves have so far been prompt and polite in dealing with the claim, but that does not help if Europe Assistance are useless, and in particular it does not help if Knox's underwriters (Generali) refuse to pay and fail to give detailed reasons.

My view is that my contract is with Knox and they should sort out the others who they choose to outsource things to.

The AAC is not directly involved but, as the organisation which gives the insurers our business on a plate, they obviously have a role and should have a strong influence if necessary

Indeed, and considering the users of OeAV and wht kind of coverage they 'promise'. They need to be aware that it is not working properly. Luckily they do know now, so perhaps they will put pressure on Know to require their underwrites & support services to be more up to tasks. After all, they market rescue coverage around the globe bar Artic (and Antartic) regions. So they should bloody well deliver just that.

Funnily enough, while you might get a lot better rescue services in Artic Norway (e.g. Lofoten, Lyngen, and Kvaloea), which is not coveraged... then what you'd get in say Morocco or heck, even parts of the EU.

Wow, I didn't know Lofoten was not covered; I never looked at the definition of "Arctic", just assumed it wouldn't apply to me

I agree with most of that.  I just wonder sometimes whether there is a perception that one scheme is better than another because people think AAC or say BMC employees are dealing personally with claims.

I'm not sure about giving our business on a plate, Brits join AAC because the insurance is unique/good value and it might not be that easy for the AAC to keep it so, but as you say they have a responsibility to make sure it works as intended.    

AAC used to use Tyrol Air Ambulance? so perhaps the change to Europ Assistance (owned by Generali) means there is more of an incentive to reduce costs, or maybe the service is just worse,  or emergency assistance companies are all much the same and you were unlucky with the accident location and who was dealing at the other end. 

well, I haven't looked into the small print... but the general description does seem to state that they exclude artic areas (ie. above the artic circle in the north)... and Lofoten is well north of it.

luckily the rescue in norway is free (provided you we in real distress... not just tired or didn't feel like walking back to the car). and healthcare as far as emergency heathcare goes, also free or nearly free with EHIC (afaik, do check... us nordics have also other agreements, so we might get a better deal).

I looked into the issue of what UK state system will reimburse and whether they will issue letters refusing to reimburse.

If you're in a country where EHIC covers you, then you are supposed to get reimbursed via the other country's  system whilst still abroad. If this is not possible, there is a system for reclaiming after you return to UK. However, the forms are not generally available, you have to ring up and get a form which will come pre-filled with your NI number etc for you to send in with your bills.

If you're trying to make a claim you know will fail, simply to get a refusal letter for Knox, they will not send you the form. And it would not be at all reasonable to expect them to do this completely pointless extra admin work.

So OeAV Sektion Britannia really need to sort this out with Knox so we are not asked for this in the case of non-European countries.

Off to the hospital now to see Alan. We're awaiting test results on nasty malagasy bacteria that got into the leg

Just updating to say I am very disappointed to have still had no reply whatsoever to my e-mail of 5/10 asking for explanation of the reason for refusing cover, nor to my appeal letter of 14/10.

Nothing since the original letter just saying it's not covered.

This is unacceptable, and I've contacted then again asking them to treat as an official complaint and escalate as necessary.

Seems my understanding was slightly wrong; Knox are not the insurer and Generali the underwriter - Knox are a broker and Generali the insurer.

I have not had any contact from AAC, but apparently they are still looking into the issue and 'not allowed' to say anything.

Incidentally, if you go to

https://aacuk.org.uk/p-mountain-rescue-search-insurance

and scroll down to "Read our members Rescue experiences", the second one is somewhat similar to what happened to us - except that in that case the claim was paid! And note that, that was before the change from Tyrol Air Ambulance to Europe Assistance - perhaps significant.

I wonder if they would like to add our experience!?

Reporting back... I have had confirmation that the insurer will pay!

(Just awaiting cash in bank now.) This is, I believe, entirely due to intervention by AAC at the highest level. (Thank you.)

We are very relieved and pleased.

Issues remain with the insurance, which I hope that AAC are looking at. Obviously they will not be able to comment during the process, but I hope there will be some clarification at the end.

There are also wider issues about insurance and planning for non-european trips which I think might be better off in a separate thread, so I will be starting one on this.

That is fantastic news, and it's great to hear that the AAC have taken you seriously and intervened.

Just saw Alan's x-rays on fb yesterday. Wow, you really don't want that to happen in Madagascar! What a nightmare. Well done on sorting things out.

Ha, yes Kate! I had a feeling it would come through for you but nonetheless very relieved - good determination and perseverance. I hope Alan can focus on healing now worry free. 

Great news for you both.  Well done for all your efforts, and thanks very much for keeping us up to date on the situation.

I'm sure the AAC [and similarly the BMC when a [European] claim failed a few years ago] are as disappointed/worried as their members when these kinds of things happen.

Best of luck for the rest of Alan's recovery.

What a relief that must be. Well done for persevering. 

As an adjunct to this discussion I can now add a new (to me anyway) piece of information. I habitually buy the AAC 'top-up' insurance from Knox in Austria for my frequent trips to Morocco. I've just been on-line to buy it again and found the following news. First the good : the on-line application form is now available in English; the hospitalisation benefit hadsdoubled to €1,000,000 (at a cost - the price for Europe trip is up to €37 - still cheap). The bad news? The last line of the application asks you to complete your address by selecting your country from a drop down menu. Fair enough you might say, except that the drop down menu has only 3 countries, Austria, Germany and Italy. 

Assuming this to be a mistake, perhaps down to the newness of the changes site, I emailed the insurer Europaeische via Knox and received a reply to the effect that yes that's correct it's only available in those 3 countries.

So it's back to the good ole BMC for me.

Where is the english online app form?  I could still only find these links in Deutsch:

https://oeav.mitgliederversicherungsservice.at/versicherungen/premium-reise...

Hiya Bruce. had me going for a bit there - for a moment i couldn't find the link again either, but here it is: https://www.europaeische.at/en

Good luck - maybe you'll find more countries listed???? But here is the gist of their email reply to my suggestion it might be a mistake:

Dear Sir, thank you for your mail.
In regard to our poducts sold via www.europaeische.at, eg. TravelCover, may we inform you, that the list of "country of residence" is indeed limited to the mentioned list (Austria, Germany and Italy) and it is not possible to take out the insurance via the phone.

Thanks Martin.  That appears to be a standard travel insurance application not linked to the AAC, although the info and forms are similar.  And you are right that it is only offered to those three countries.

But the Deutsch app form linked via the AAC (link in my post above) does still allow for GB residents, so maybe just stick with that!

I'm not sure how all this is going to fall apart next year however.

Ah. Well interpreted. My mistake. I can't understand how I got sidetracked and thus confused by that after buying the top-up insurance a number of times in recent years without problems.

Thanks for putting me right - I hope anyone reading my erroneous contribution read on to see this - To avoid confusion I'd delete the original if I could, but for some reason one is not allowed so to do.

Ah, that's good to know then.  You had me worried for a while.