Page 24 - European Health Cover

Please see page 56 for an explanation of words that appear in bold 21
• you promptly give us all the information we request.
Do I need to provide any other information?
4.2 It may not always be possible to assess the eligibility of your claim from the medical
information form alone. In such situations we may require additional information and it is
your responsibility to provide any reasonable additional information to enable us to assess
your claim.
Be aware:
In order to establish the eligibility of any claim, we may request access to your medical
records including medical referral letters. If you unreasonably refuse to agree to such
access we will refuse your claim and will recoup any previous monies that we have paid in
respect of that medical condition.
4.3 There may be instances where we are uncertain about the eligibility of a claim. If this is the
case, we may at our own cost ask a medical practitioner chosen by us, to advise us about
the medical facts relating to a claim or to examine you in connection with the claim. In
choosing a relevant medical practitioner we will take into account your personal
circumstances. You must co-operate with any medical practitioner chosen by us or we will
not pay your claim.
What should I do if I have cover on another insurance policy?
4.4 You must tell us if you can claim any of the cost from another insurance policy or through a
state healthcare system.
If another insurance policy or healthcare system is involved we will only pay our proper
share.
What should I do if the benefits I am claiming for relate to an injury or
medical condition caused by another person?
4.5 You must tell us on the medical information form if you can claim any of the cost from
anyone else. If benefits are claimed for treatment to you when the injury or medical
condition was caused by some other person (the ‘third party’), we will pay those benefits
you can claim under the policy. If another insurance policy covers those benefits then we
will only pay our proper share of the benefits. However, in paying those benefits, we obtain
both through the terms of the policy and by law, a right to recover the amount of those
benefits from the third party.
In this case, the following shall apply:
• you must tell us as quickly as possible if you believe a third party caused the injury or
medical condition, or if you believe they were at fault. We may then write to you or the
third party if we require further information; and
• you must include all monies paid by us in respect of the injuries (and interest on those