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Phuket hospital hits back over UK claims they put money first after tourist's motorbike accident


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2 hours ago, stevenl said:

The civil service cover for spouses is a completely different cover, and has nothing to do with the free emergency treatment.

http://www.thephuketnews.com/all-citizens-now-entitled-to-free-emergency-services-in-first-72hrs-61662.php#XjGw1q0WMWo56c27.97

Does NOT cover foreigners unless they are under SS or their wife's civil service policeis.  It states it covers ALL citizens of Thailand for free care for first 72 hours at ANY hospital . After that they have to be taken to the hospital they are covered at under their Gov Policy scheme. Foreigners not under their wife's Civil service policy or Social Security from working here are not covered.

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Having founded and owned an Insurance adjustment company and a private investigation agency for over 30 years, I suspect the basis for the denial is not listed in the Insurance Contract. 

 

Most all travel policies now exclude motorcycles even motorcycle taxis.  Some insurance companies may charge an additional premium and cover motorcycles  by endorsement. 

 

Having worked  independently for over 325  Insurance companies and  self-insurers  and recommended by the AM. Best company for all lines, I've never seen any policy limiting the number of accidents.

 

My recommendation is to examine the insurance contract very thoroughly and pay particular attention to exclusions and any content involving motorcycles.

 

 I would be happy to examine the insurance contract and offer my opinion for no charge. 

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50 minutes ago, gamini said:

you are wrong. as a permanent resident many years ago I got the free emergency treatment "id"  and I still have it.

If your now hold Thai citizenship or permanent residence then your not actually a foreinger are you.

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4 hours ago, steven100 said:

Try and get treated in the US or the UK after an accident ......

of course they want to confirm how the treatment is going to be paid ..... they are a business not a charity.

 

As for his insurance ....  inclusions and exclusions will be documented in the policy I would assume,  either he is covered or he is not ...  so if it only covers an accident on a motorbike once in a year and if that is in the fine print then thats it .....  you cannot argue if it's in back and white. The problem is not all the truth is told such as what is jake saying happened ? and what really happened ?   what has he told his family happened   ?

 

I am in no way defending the insurance company as I have little sympathy for the m .... just saying how it is.

In the U.K. Medical treatment after an accident, or anything else, is free on the National Health Service. Not in the US, I agree.

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18 minutes ago, HooHaa said:

yes that would be intereting to see. 

we dont know if he had a helmet on, whether the bike was a private one or an uninsured taxi, the sobriety of the driver etc.

 

under english law its likely he was breaking many more rules than he had broken here.

 

and we still haven't seen his policy or the terms, so i suspect you have very little idea of what you speak.

1) Yes but highly unlikely we will ever know even if the case went to court. It won't.

2) All irrelevant. IF the policy excludes injuries when not wearing a helmet (it almost certainly does) then that would be the basis of the insurance company's rejection of the claim. It is not. Ditto. Ditto.

3) How so. In any case irrelevant, English law does not apply in Thailand.

4) Ah, once again here, the ignorant telling the knowledgeable they have no idea. I have seen his insurance company's standard policy wording. I am highly experienced in contract law.

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54 minutes ago, gamini said:

you are wrong. as a permanent resident many years ago I got the free emergency treatment "id"  and I still have it.

Thank you for posting that stevenl keeps arguing about that, will not admit to being wrong.

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13 minutes ago, dcsw53 said:

He paid his policy and the insurance company entered into an agreement to cover him. He then had an accident where he had to claim. After that accident the insurance company should have told him that any further claims would be refused. Whether they considered him reckless or not ( he was not driving just a passenger so this is higly debatable ) they still had a contract with him and as such should pay the claim.

Agree.

That's insurance companies for ya. If they can wriggle out, they will.

Hate 'em. Always have.

In most cases it is a license to steal money.

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11 minutes ago, Mises said:

1) Yes but highly unlikely we will ever know even if the case went to court. It won't.

2) All irrelevant. IF the policy excludes injuries when not wearing a helmet (it almost certainly does) then that would be the basis of the insurance company's rejection of the claim. It is not. Ditto. Ditto.

3) How so. In any case irrelevant, English law does not apply in Thailand.

4) Ah, once again here, the ignorant telling the knowledgeable they have no idea. I have seen his insurance company's standard policy wording. I am highly experienced in contract law.

 

my but your hackles are now that the stream of coffee running through my nose has subsided, i would ask why you would make such a remark without posting the information to back up your claims,  or why you had not pointed out you had the policy information before making any assertions - it is not like the policy information is confidential.

I defer, however, to your high knowlegeability, ignore the contradictions in your remarks, and bid you a good weekend.

an expert on the internet, go figure. 

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Wide open for the lawyers to get involved.

 

IMHO as he was not the rider, he was the pillion, and it appears the bike was rear ended then reckless does not come into it. You are perfectly capable of riding pillion with one hand to brace yourself......IF the ride is riding responsibly. 

 

This to me is where the "reckless" could and should come in if the rider was a nut. However, if the bike was being ridden responsibly then this reckless red herring is just that ...a red herring.

 

It is standard practice now for insurance companies to refuse right off. Few claimants take it further and even fewer, perhaps less than 5% take it to a lawyer or the Financial Ombudsman. I did have to twice .... and won my full claim both times before the Ombudsman had determined. 

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3 hours ago, KittenKong said:

 

To my mind even sitting on a stationary motorbike in Thailand is reckless. These things are hideously dangerous as this chap has discovered (twice).

 

I've not been on a motorbike anywhere for more than 40 years and have intention of ever doing so.

I have been on a motorbike everywhere almost every day for more than 40 years without any accident  incident and have intention of ever doing so.

No offence, just showing every one's story is different :smile:

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This guy fits the definition of the village idiot. It is entirely probable his bain dramage is genetic and was exercised to it's limits to obviously not wear a helmet in addition to his other idiotic behavior. This village idiot will be eliminated from the gene pool in the near future no doubt.

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Healthcare is a human right. Unil the public and all governments accept this principle, insurance companies will continue to reap huge profits off the ill and injured; hospitals and dcotors will overcharge; and the Pharmaceutical industry will continue to have huge markups on life savig medicines.

 

Government in every country worldwide needs to take over the provision of healthcare; regulate all providers/doctors/pharma as non profit and essential put health insurance companies out of business.   Once all this is done- a universal rule of reimbursement goes into affect in which a citizen of any country anywhere gets treatment and the reimbursement comes from the injured passport country.

 

Taxes of each country will fund it and providers will be limited in charges based pon what is reasonable and proper not what the market will bear. As an American, I continue to be appalled by the lack of a coherent policy towards healthcare. There is only one solution- a single payer system such as the UK has.  It has its faults but everyone is covered and no one is mortgaing their home or goin bankrupt from healthcare costs.

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2 hours ago, Mises said:

His mother needs to take this up with the insurance ombudsman and/or a solicitor (preferably no win no fee). I am not at all convinced riding pillion on a scooter with a broken arm is reckless. Furthermore it is almost certain that the broken arm did not in anyway contribute to the second accident and hence it is irrelevant to the claim.

The insurance contract was made in England and therefore subject to English law, I very much doubt that the insurance company's position will stand up in an English court.

 

It all comes down to one's own interpretation of reckless, but the final say is with the insurance company, not with the insured or with Thai Visa forum commentators. People doing dangerous things on holiday would be wise to consider the risks and outcome before doing something that might endanger their lives or cost them dear in hospital charges. Personally, I wouldn't have gotten on the back of another bike after sustaining such an injury in a previous accident, whilst having my arm still in plaster, because it'd be reckless of me to do so. Can't blame the insurance company here, as they'd already paid out a claim from this individual 3 weeks prior. He's clearly reckless when it comes to safeguarding his own well-being. Besides, having your arm still in plaster, your grip and balance would not be as good as a person with two arms in use. Therefore it is relevant to his claim.

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1 hour ago, Tony125 said:

http://www.thephuketnews.com/all-citizens-now-entitled-to-free-emergency-services-in-first-72hrs-61662.php#XjGw1q0WMWo56c27.97

Does NOT cover foreigners unless they are under SS or their wife's civil service policeis.  It states it covers ALL citizens of Thailand for free care for first 72 hours at ANY hospital . After that they have to be taken to the hospital they are covered at under their Gov Policy scheme. Foreigners not under their wife's Civil service policy or Social Security from working here are not covered.

Yes, that's what I said.

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21 minutes ago, Lone Ranger said:

Are you [email protected]% sure of that fact?

I thought I read  anyone- be it Thai or Farang -was eligible as long as it was an emergency?

Yes, anyone as long as he is Thai. So also farang Thai.

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22 minutes ago, Tchooptip said:

I have been on a motorbike everywhere almost every day for more than 40 years without any accident  incident and have intention of ever doing so.

No offence, just showing every one's story is different 

 

Great. I think you're completely mad, but so are people who climb mountains or pursue other dangerous activities. It's not a problem for me though, except in as much as I have to pay higher insurance premiums to cover the antics of the insane.

 

If one day you are unlucky enough to have a road accident you may regret being on a bike rather than in a two-ton pickup. But hopefully it wont happen at all. I certainly dont wish it on you.

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1 hour ago, dcsw53 said:

He paid his policy and the insurance company entered into an agreement to cover him. He then had an accident where he had to claim. After that accident the insurance company should have told him that any further claims would be refused. Whether they considered him reckless or not ( he was not driving just a passenger so this is higly debatable ) they still had a contract with him and as such should pay the claim.

Not if the insured is deemed to have breached the terms and conditions of the contract, which in this instance the company believes to be the case. Would it stand up in Court? I don't know and that's why I believe the insured should contact the ombudsman or a no win no fee lawyer if he was wearing a helmet.

7 minutes ago, soalbundy said:

I thought that travel insurance doesn't cover motorbikes anyway.

Some do, some don't. This one covers riding bikes up to 125cc as long as you wear a helmet.

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1 hour ago, colinneil said:

Thank you for posting that stevenl keeps arguing about that, will not admit to being wrong.

Again, you're confusing free emergency care in life threatening situations with standard cover under civil service or SS.

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10 minutes ago, soalbundy said:

I thought that travel insurance doesn't cover motorbikes anyway.

 

Many dont, quite rightly and for obvious reasons. They also generally exclude accidents occurring whilst the insured is under the influence of drink or drugs, or participating in any particularly dangerous activity. It all makes perfect sense to me.

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6 hours ago, darksidedog said:

So his travel insurance did cover traveling by motor bike, but only once a year it seems. To my mind riding pillion with a broken arm in plaster is not "reckless".

70% of the traffic accident victims leaving the hospital do so by bike. It is absolutely normal here. Many have no other way of getting home.

I hope the insurance companies miserable argument is seen for what it is, and others spend their money with a firm who can be trusted.

 

 

whilst riding a motorbike with a serious injury that incapacitates might not be the brightest idea, depending on the circumstances, it's not automatically reckless.

 

Had he crashed the bike or fallen off then fair enough. But he didn't. According to police he was on a bike that was rear ended.

 

It's time governments looked at the little get out clauses insurance companies insert and their interpretation and implementation by teams of people whose job it is to avoid paying.

 

Did this insurance company make their stance crystal clear when approving the initial claim - i.e. you're no longer covered as we consider further riding would be reckless? If so, then he was taking a known risk. If they didn't and only thought this up due to a second claim then it stinks of avoiding their responsibilities.

 

Time some level of responsibility for actions, contractual obligations specified and implied, were imposed on insurance companies and their talent for avoiding paying.

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5 hours ago, darksidedog said:

I agree with you about the mother, and you are correct, the first 72 hours is supposed to be free anywhere.

Two accidents in 3 weeks is very bad luck, though this one can't be blamed on him, regardless of how the first one happened.

My point however was that a bike is the sole means of transport for a vast number of the population. Whether a local or a tourist. this is how people get around here.

The travel insurance was for a trip to Thailand and the insurance company must have been aware of this.

The situation in the UK is obviously very different and most people have  a car.

Where I live, I can find a motor bike taxi easy enough, but an actual taxi is not likely. And I like many others try not to use the taxis anyway, as I don't like bad manners, bad driving and being overcharged.

ever heard of a songtail? a taxi?even a samlor?  there are other ways of getting around in thailand!

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20 minutes ago, Baerboxer said:

Did this insurance company make their stance crystal clear when approving the initial claim - i.e. you're no longer covered as we consider further riding would be reckless? If so, then he was taking a known risk. If they didn't and only thought this up due to a second claim then it stinks of avoiding their responsibilities.

 

Time some level of responsibility for actions, contractual obligations specified and implied, were imposed on insurance companies and their talent for avoiding paying.

 

I suspect the insurance company screwed the pooch when they paid out the first (probably much smaller) claim, giving the guy a reasonable expectation that he was covered for that activity.  Unless he did something different (or they notified him in writing that he was no longer covered when riding scooters), his new claim should be as reimbursable as the first one.

 

I also suspect it was the amount of the newer claim that triggered scrutiny at a higher level within the company, and that a good lawyer will have them regretting that they paid out the first one.

 

Edit:  That doesn't mean I think he was wise to get back on the horse...

 

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2 hours ago, The Deerhunter said:

Where I live I might have to travel 50km or probably more to reach a town where any taxi has 4 wheels, unless you include mini busses.

You might as well wait for the hearse at that point. 

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5 hours ago, steven100 said:

Try and get treated in the US or the UK after an accident ......

of course they want to confirm how the treatment is going to be paid ..... they are a business not a charity.

 

As for his insurance ....  inclusions and exclusions will be documented in the policy I would assume,  either he is covered or he is not ...  so if it only covers an accident on a motorbike once in a year and if that is in the fine print then thats it .....  you cannot argue if it's in back and white. The problem is not all the truth is told such as what is jake saying happened ? and what really happened ?   what has he told his family happened   ?

 

I am in no way defending the insurance company as I have little sympathy for the m .... just saying how it is.

I dont know about the U.S. but you would not be required to show ability to pay in the U.K. even as a foriegn National, they would treat you automatically and you would get exactly the same treatment as anyone else yes hsopsitals in the UK are businesses but they are not required to make a profit, that is why the NHS in the UK is in financial meltdown, so many people who come in to the UK have no insurance cover and some even come to get treatment as health tourists getting treatment for things they would have to pay for at home.

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