Red Sands Insurance Company (Europe) Limited · DRN-6237809

The complaint Mr and Mrs C are unhappy with the way Red Sands Insurance Company (Europe) Limited handled claims made under their travel insurance policy (‘the policy’) whilst abroad. Over a period of a few weeks, Mr C was hospitalised on different occasions for two conditions and needed emergency medical treatment. All reference to Red Sands includes its medical assistance team and other agents. And although Mr and Mrs C are being represented in this complaint, for ease, I’ve referred to them throughout. What happened I issued a provisional decision explaining why I was intending to uphold a limited aspect of this complaint. An extract of my provisional decision is set out below: ………………………………………………. In considering what’s fair and reasonable in all the circumstances of the case, I’ve taken into account all relevant law and regulations, regulator’s rules, guidance and standards, codes of practice and good industry practice at the relevant time. That includes Red Sands’ regulatory obligation to handle insurance claims promptly and fairly. And to not unreasonably decline a claim. I’ve also considered all the points made by the parties (along with all the other evidence). I won’t respond to each of these. I hope they understand that no discourtesy is intended by this. Instead, I’ve focussed on what I think are the key issues here. The rules that govern the Financial Ombudsman Service allow me to do this as we are an informal dispute resolution service. If there’s something I’ve not mentioned, it isn’t because I’ve overlooked it. I haven’t. I’m satisfied I don’t need to comment on every point to fulfil my statutory remit. The relevant policy terms and conditions Subject to the remaining terms and condition, the policy does provide cover for expenses related to emergency medical and repatriation expenses. However, it makes clear that: This is not private medical insurance. There is no cover for any expenses incurred in private medical facilities if we have confirmed medically capable public facilities are / were available. We reserve the right to organise a transfer from a private medical facility to a public medical facility where medically appropriate. This is repeated a number of times throughout the policy document. Respiratory infection

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Mr C was taken to a private hospital for medical attention. Whilst there Mr C’s son contacted Red Sands’ representative. I’ve listened to the call recording. He confirms the name of the hospital and Red Sands’ representative asks if there’s a public hospital nearby. Mr C’s son replies there wasn’t, that this was the closest hospital and confirms that the public hospital was too far away. He was told that travel insurance policies don’t usually cover private medical care unless the public facilities were too far away. Mr C was treated, discharged and was re-admitted a couple of days later overnight before being discharged again. Medical costs were incurred (over £6,000) and a request for a claim form was made. This was provided by Red Sands, and it asked Mr C to provide stipulated documents. In the circumstances (including Red Sands’ acceptance that it couldn’t have arranged for Mr C to be transferred to a public facility in time due to the ‘swift admission and discharge’), Red Sands concluded that it would consider covering the medical expenses subject to Mr C providing some outstanding information first requested in February 2025. In its final response letter dated May 2025, Red Sands told Mr C that “the claims team are currently awaiting further additional supporting documentation to complete the claim assessment, and they will be in contact shortly to advise of the required documentation”. I think it’s fair and reasonable for Red Sands to request the outstanding information as it’s relevant to the claim verification process. However, I haven’t seen anything to persuade me that Mr C was chased for this information after mid-February 2025 which I would’ve reasonably expected Red Sands to do if it was proactively handling the claim. If it had clarified what, specifically, was outstanding, I’ve got no reason to doubt that this wouldn’t have been promptly provided by or on behalf of Mr C. So, I’m satisfied that this unnecessarily delayed the progression of the claim and that this caused unnecessary distress and inconvenience to Mr and Mrs C. I’m intending to direct Red Sands to pay £100 compensation to reflect the impact of this. I’m only considering matters up to the date of the final response dated May 2025, but I understand that the outstanding information has been provided and Red Sands has agreed to proportionately settle this claim. It says that Mr and Mrs C didn’t fully disclose Mr C’s relevant medical history when taking out the policy and if they had, the policy would’ve cost more. So, it’s proportionately settled the claim in line with the percentage difference between what they paid for the policy and what they should’ve paid if all conditions had been disclosed. If Mr and Mrs C don’t think that’s fair, they’re free to raise this with Red Sands in the first instance. As this occurred after the date of the final response letter dated May 2025, it isn’t something I’ve considered as part of the complaint I’m deciding. Leg injury Not long after, Mr C unfortunately incurred a leg injury. Mr and Mrs C say this was linked to the medication he was prescribed for the respiratory infection, which made the leg injury more likely. Whether or not that’s the case, I don’t think is relevant to the issues I’m determining. Neither Mr C, nor his family, contacted the 24/7 medical assistance line detailed in the policy booklet before taking him to hospital, as set out in the policy terms.

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I accept that Mr C’s son emailed Red Sands to inform it of the leg injury, that he’d been admitted the day earlier to the same hospital as before, he required surgery, a deposit had been paid, and the balance would be paid in a few hours. Surgery was due to take place within the next two days. I’ve listened to the recording of the call Red Sands’ representative made, following up that email. Mr C’s son was told towards the end of the call not to go ahead with surgery as there was a “slight complication” it being a private hospital. Mr C’s son then replied that the surgery was going ahead anyway and that there were no other local (public) hospitals nearby. That was why Mr C had been taken to the private hospital. As stated above, the policy doesn’t cover expenses incurred in private medical facilities if suitable public facilities are available. Red Sands has provided evidence that the closest public hospital was slightly nearer to where Mr C was staying than the private hospital. I’ve considered the reasons why his son says this public hospital wasn’t suitable. However, from what I’ve seen and from researching this hospital, I’m persuaded that it had an accident and emergency department and an orthopaedic and trauma department. So, on the balance of probabilities, I’m satisfied that if Mr C had been taken to this public hospital, he would’ve received suitable care. I’m also satisfied that there was another public hospital which was around 40km further away than the private hospital which also looked suitable. And if the closer public hospital couldn’t treat Mr C’s leg injury, I’m satisfied that it’s likely (on the balance of probabilities) that he would’ve been transferred by ambulance to the other public hospital, as Red Sands suggests. Further, I think there was sufficient time for this to be arranged after Mr C had been admitted to the private hospital, but Mr C’s son categorically said that Mr C would go ahead with surgery at the private hospital. That was, of course, a decision for Mr C and his family. However, I’m satisfied in the circumstances of this case that Red Sands has fairly concluded that the medical costs incurred in connection with the leg injury aren’t covered outside the terms of the policy. When making this finding, I’ve taken into account that Red Sands has, in principle, agreed to cover the medical expenses incurred at the same private facility for the respiratory infection. However, I think the circumstances of that claim are different and it was initially based on Mr C’s son saying that there wasn’t a local public hospital nearby, which isn’t the case. I’m also satisfied that before the surgery took place at the private hospital for the leg injury, Mr C was made aware (by Red Sands informing his son) that he shouldn’t go ahead with surgery because he was in a private hospital. Even if I were to find that Red Sands should’ve provided more information about why this was unlikely to be covered, I don’t think that would’ve made a difference in this case. I don’t think it would’ve prevented Mr C from going ahead with surgery at the private hospital for reasons already set out above. ……………………………………………….

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I invited both parties to provide any further information in response to my provisional decision. Red Sands replied confirming it agreed with my provisional decision. Mr and Mrs C didn’t agree. In summary they said: • documents requested by Red Sands in relation to the claim had been promptly provided. • Mr C had previously been treated at the same hospital over a week before, so it was reasonable for him to be taken to the same hospital after he’d experienced his leg injury. • the public hospital I refer to in my provisional as being slightly closer to where Mr and Mrs C were staying is not operating at 100% and everything gets referred to the other public hospital which is further away. • the policy isn’t providing total travel protection. • when applying for the policy, all questions were answered correctly. 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. That includes all points made in response to my provisional decision. I’m sorry to disappoint Mr and Mrs C but I remain satisfied that Red Sands has acted fairly and reasonably by not covering the medical expenses associated with Mr C’s leg injury. I’ll explain why. • I’m satisfied that Mr C could’ve been treated at a public hospital, rather than a private hospital. Although, Mr C had been treated for a respiratory infection at the private hospital, which Red Sands agreed (in principle) to cover, this was on the basis of informing Red Sands that the public hospital was too far away. • I remain satisfied that there was a public hospital within a reasonable distance from where Mr and Mrs C was staying which is likely to have, at least, initially examined Mr C’s leg injury and either provided further treatment there or arranged for him to be moved to a different public hospital. • In any event, once Red Sands made Mr C aware – via his son – not to go ahead with surgery on his leg at the private hospital, Red Sands’ representative was told that Mr C would be proceeding with surgery where he was. • Cover under a travel insurance policy (like all insurance policies) is subject to the terms and conditions of each individual policy. • I’m satisfied that Red Sands didn’t promptly and proactively manage the claim up to the date of the final response dated May 2025. I remain satisfied that this has caused some distress and inconvenience for Mr and Mrs C. Although, their son has primarily

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been in contact with Red Sands, I’m satisfied this would’ve still caused Mr and Mrs C some upset. • As mentioned in my provisional decision, if Mr and Mrs C are unhappy with Red Sands proportionately settling the claim it has agreed to cover under the policy, they’re free to raise this with Red Sands in the first instance. That issue doesn’t form part of the complaint I’m deciding. For these reasons and for reasons set out in my provisional decision (an extract of which is set out above and forms part of this final decision), I partially uphold this complaint. My final decision I partially uphold this complaint to the extent set out above. I direct Red Sands Insurance Company (Europe) Limited to put things right by paying Mr and Mrs C £100 compensation for distress and inconvenience. Under the rules of the Financial Ombudsman Service, I’m required to ask Mr and Mrs C to accept or reject my decision before 17 April 2026. David Curtis-Johnson Ombudsman

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