He did read the policy. He also read the 94 page medical manual they later sent him, which presumably wasn't in the original policy. He found the reason in all those pages of text why he was eligible for getting his costs covered, and they still replied with:

> “This is a general exclusion and doesn’t apply to you specifically. Our decision still stands with curtailment. No further medical input needed.

Why do you feel that he shares any part of the blame here? Why do you expect him to be an expert in reading and interpreting insurance policies in the middle of a medical emergency?

The blame comes earlier - he should have read his insurance policy before buying it. Along with the policies of the airline(s), cabs, web sites, phone services, hotels, ...

Basically, every service provider provides custom contracts with different exclusions, because that's the environment.

We need to get to a common set of expectations - like in a restaurant. Those expectations differ between countries/regions (is tipping expected? is water free?) but you have a common set of expectations that aren't governed by individual contracts for each restaurant.

He's being willfully ignorant there. That quote comes from the section saying when an airline requires medical clearance. Two pages later there are several pages of specific medical conditions and guidance on if they should fly. One of them is "Full plaster cast" and it says that you can fly 2 days after getting one.

I felt that paragraph was the most relevant to me, I had been told by my DR that I shouldn't fly. They had already told me I was crazy to have flown to SG with my finger hanging off without being stitched up first. And I didn't have a plaster cast, they had given me a make shift thing in Bali, but once I reached SG I was unfit for flying home due to the risk of further damage to the hand. It was massively swollen and 2 of the bones were pretty badly shattered. I wasn't going to ignore the advice of a DR who was holding my X-rays to appease an insurance company who doesn't give 2 shits about my health.

>I felt that paragraph was the most relevant to me

And not the one specifically dealing with broken bones?

>I wasn't going to ignore the advice of a DR who was holding my X-rays to appease an insurance company who doesn't give 2 shits about my health.

Which is not something anyone is going to argue about with you. Except, of course, those that have to write the $15K check. They are going to want more documentation that a one liner when standard medical advice says you can fly.

Standard medical advice? Are you even reading what he wrote? His doctor did not clear him to fly. It's crystal clear from the way they conducted themselves that the insurance company would find any excuse to deny his claim. It's also very probable that their delays were deliberate. I hope OP can talk to an attorney and take them to the cleaners. At the very least, he named them so potential future victims will have something to find if they perform due diligence.

With all the responses you've generated here and the way you go about your argumentation I wouldn't be surprised to find out that you work for the insurer.

>Standard medical advice? Are you even reading what he wrote? His doctor did not clear him to fly.

That's not how insurance works. They aren't going to pay for stuff on the say so of one doctor. The expectation is that they pay for treatment according to published and accepted standards of care. In this case, those say that you can fly with broken bones.

>With all the responses you've generated here and the way you go about your argumentation I wouldn't be surprised to find out that you work for the insurer.

Of course I don't work for the insurer. I am just an experienced backpacker that understands the concept of travel insurance.

> It's crystal clear from the way they conducted themselves that the insurance company would find any excuse to deny his claim

I see no evidence of that. What they offered was exactly what travel insurance is there for. That is, travel home for further treatment after a patient is stabilized. OP wanted to argue he wasn't stabilized. In response, they told him specifically what he needed to get from his doctor in order to justify his claim. As far as I know OP, for whatever reason, never bothered to get that.

IMHO, it's debatable whether or not you should be travelling with unset broken fingers. However, if all you bring to your side of the debate is a single sentence, you're going to lose.

We also don't know what their reaction to paying for the emergency services would be. OP, for reasons that are clear only to him, has decided not to claim ~$6,000 worth of covered expenses.

Just to clarify your comment on "What they offered was exactly what travel insurance is there for." They didn't offer me anything. Not one piece of my cover was offered. They 'offered' me a flight home as a goodwill gesture. They stressed that they didn't have to. It was a really shitty tactic. If you complain to a company and accept "their goodwill gesture" you are agreeing that no further action will be taken. If I had accepted their flight home, that would have been my insurance void and I would have no grounds to appeal.

Your booklet says:

We will not cover the following:

2. Any treatment or surgery which we think you do not need immediately and can wait until you return home. Our decision is final.

That's what travel insurance is. It's there to pay for care until you can fly home. Accepting their flight home isn't voiding your insurance. It's getting the coverage you paid for.

It would have been if they said "we will fly you home, as per your cover" but they didn't, the flight home was a goodwill gesture. If they weren't going to pay for my 2nd operation, I would have ditched the "reasonable attitude" and claimed for the 1st operation. They knew that, so by offering me the goodwill flight home they were literally trying to make me void my own cover.

Furthermore, the policy says clearly, until I CAN fly home. My DR had explicitly told me I could not. I wasn't going to risk my health for the sake of my arsehole insurance company and their bullshit attempts to wriggle out of paying.

Ask yourself, would YOU have ignored the advice of your DR, who knew your case personally, in favour of the "opinion" of a private company whose sole motivation is financial?

On one side: a gigantic company with a fleet of lawyers whose full time job is to write policies that are as advantageous as possible for the company.

On the other side: a random non-expert who needs some insurance, among a thousand other things going on in their life.

How much fault should assign to the second one?