This is a little leftside for me, but as I did one of my last ever visits to Twitter this morning I saw a thread from the lovely Cat Rubens, who is one of the Human Rights Solicitors at Leigh Day. It took me aback because I’ve seen posts from Cat on social media for years, but had never seen her share anything personal.
I’ve spoken with Cat, and am reproducing her Twitter thread here so that I can add in some extra context, a comment or two from Axa and also to enable it be shared on other platforms.
This is Cat, and her mum, Jane, in happier times.
On 1st November, Jane was hit by a large vehicle as a pedestrian in St. Louis, USA.
She suffered a severe brain injury and at this point in time, she remains in a coma in hospital.
Since the accident, Jane has had multiple brain surgeries.
One of the surgeries Jane has undergone is a craniectomy, to remove a piece of her skull, which is performed to relieve pressure on the brain from bleeding and swelling.
Cat shared pictures of her with her face obscured (I’ll not share them here because I don’t think it’s necessary), but in the pics you can see that Jane has had to have her head shaved for surgeons to operate, she is wearing a protective helmet, is unconscious and has some blue tubing attached to her.
Cat says on twitter:
“As you can imagine, the past few weeks have been hell for me and my family.
We are out in America, trying our best to support her.
This already hellish situation has been made immeasurably worse by the approach taken by Axa, including refusing to take account of medical advice from neurologists that it is not in Jane’s best interests to fly at this stage of her injury”.
Imagine being Cat. You’re carrying on with your life, assuming your mum is having a great time overseas, and then you get a call to tell you what has happened. I don’t think all my imaginings would get to the edges of what it feels like to receive that news, to spring into action, and to get to your mum’s bedside.
At this point in time Jane lacks capacity in all domains. She has suffered a severe brain injury, is in a coma, in a hospital 12.5 hours away from her home.
Cat though, being a sensible sort, who is all too familiar with how things can go wrong in health and social care, has already taken pre-emptive steps should such a situation arise.
Cat has power of attorney for her mum, Jane, registered with the Office of the Public Guardian in Scotland. She knows that she now needs to make decisions, on Jane’s behalf, in Jane’s best interests. What I don’t imagine she could have anticipated was the battle that this would become.
Jane, hadn’t been reckless when planning her trip. She had secured travel insurance from AXA Partners. Isn’t the least we expect when something goes wrong on a trip, that our insurance will support us to recover and return home when we’re in the best position to do so?
Cat shares that there has been a failure, on behalf of AXA, “to take account of my mum’s best interests when considering repatriating her home to the UK”.
Here’s where things are at.
Jane’s family have received advice from multiple neurology experts, including the neurosurgeon in the USA, that it would not be in Jane’s long-term best interests to fly her back to the UK at this acute stage of her injury.
Cat provided this advice, in writing, to AXA.
Despite this, on Sunday (24 Nov) AXA wrote to Jane’s family to state that they had to agree to repatriate Jane tomorrow, this coming Wednesday (27 Nov) or they would pull the cover for her medical expenses in the USA.
Jane’s family were told that they had to give their agreement to repatriation the same afternoon.
Cat requested more time, explaining that they were due to have a conversation with the neurology team in the States on Monday 25 November, specifically focused on the repatriation timeline and risks to Jane’s long term recovery.
Of course everyone wants Jane home. This needs balanced with safety, and the best chance for Jane to make an optimal recovery. Cat advocates on Jane’s behalf, requesting time to speak to the team.
The response from AXA was a straight no.
“AXA would not even allow us 24 hours for this decision”.
Jane’s family have not been passive in this situation. They are articulate and resourceful, and trying their damned hardest, from Jane’s bedside, to progress matters.
Cat contacted the hospital to which her mum would be taken, to check whether they were ready for her to be handed into their care.
“We had already spoken to the potential receiving hospital in Scotland.
They confirmed to us that they had not received any of Jane’s scans or medical records. There has been zero contact between the treating hospital in the USA and the Scottish hospital”.
Increasingly concerned, Cat pushed AXA to explain their decision making. This is what she found out:
- AXA have no neurology expert in their own medical team
- AXA do not feel the need to consult with the neurologists who are treating Jane in the hospital where she is currently receiving care in the States
- AXA do not feel the need to consult with the neurologists who will be treating Jane in hospital when she returns to Scotland
- AXA would not, or could not, provide their procedure/policy/protocol for how disagreements between insured and the insurer are resolved. This would appear critical when discussing matters as important as the medical best interests of a comatose patient, with a severe brain injury, that the insurer is pushing to be flown home where there are questions about the safety of that travel
- AXA accepted no plan had been provided to Jane’s family for her repatriation, and they were therefore being asked to agree to a plan that they had not seen.
Despite these admissions, the call handler insisted that Jane’s family had to agree to AXA’s position by that afternoon, or no further medical expenses would be covered.
I’m sure you can imagine the panic, frustration and desperation that Jane’s family members were likely to feel at this point. They did, what I imagine any of us would do, they pushed for their concerns to be escalated.
“We asked to speak to a manager at AXA. We were told no manager was available.
We asked the call handler for a manager to call us back. He said that could not be arranged.
We asked to speak to an underwriter at AXA. The call handler said that was not allowed”.
AXA claim they offer choice and simplification for their customers, with 24/7 access and the ability to switch between on and offline.
It would seem that Jane’s family are receiving 24/7 support, from someone who was not able to meet their most basic of needs, and who apparently had no safety net to escalate their concerns to someone with any medical expertise, or any decision making powers.
Cat explained on twitter how hard they tried to make AXA understand their situation.
“We reiterated that Jane is very vulnerable and this is a very difficult decision, given the medical advice we have received.
We explained how upsetting the situation already is for us; that we’re exhausted and have been sleeping at the hospital. We asked for more time.
Again, AXA said no. The call handler said he could open a complaint, but this wouldn’t affect the timescale in which we had to give our decision”.
This feels like a standard process when things go wrong in health and social care, the ‘I’m sorry you feel that way, here’s our complaints policy’, which wilfully misses the concerns being raised by the family involved, and dismisses opportunities to work together to improve the care being provided.
At the start of this post I said this was a little leftside for me, but actually there are considerable parallels to the inquest I was reporting last week, into the death of Morgan Betchley. Her family members, in desperation, had written to the care provider, Sussex Partnership, to try to provide information, raise concerns and hopefully ensure that they could work with the Trust to improve Morgan’s care. What happened? The clinician who received the letter was irritated that it had not gone through the complaints procedure, she failed to take any of the information provided onboard and did not incorporate it into Morgan’s care planning. One family member, a senior midwife with over thirty years experience working in the NHS, described the meeting where her letter, and an apology letter that Morgan had written, were discussed, as “brutalising”, and told the court that she had left the meeting and been physically sick. The jury found “a failure to act professionally by some members of hospital staff” and that the staff’s behaviour had made things “unnecessarily stressful for Morgan”. Morgan later died by suicide. Anyhow, back to Jane and Cat’s battle.
Jane’s family are sat by her bedside. They are exhausted and desperate. They are advocating as strongly as they can on Jane’s behalf, at great emotional and physical costs to themselves. Cat says that they have been shown:
“Zero empathy, customer care or reasonableness from AXA at one of the darkest times of our lives”.
Jane’s family explained what was happening to one of the trauma doctors treating Jane in hospital in St Louis, on Sunday afternoon.
They stepped up to try and help, and sought an urgent opinion from neurosurgery.
“The neurosurgeon confirmed that what would be in Jane’s best interests would be to fly her after the craniectomy has been reversed (e.g. the piece of skull reattached to her brain). That’s 3 – 6 months down the line.
The trauma doctor called AXA to explain the neurosurgery advice. The call handler at AXA refused to let the trauma doctor – Jane’s treating clinician – speak to the AXA medical team.
The call handler at AXA told Jane’s doctor they considered Jane fit to fly. They then told Jane’s doctor that they wanted to fly Jane out tomorrow (25 Nov) – two days earlier than they had told us. They couldn’t tell the doctor who Jane’s receiving physician would be.
AXA confirmed to Jane’s trauma doctor that the family had to agree today or they would pull cover. The doctor said he would put the opinion in writing to AXA (which he kindly did). None of this changed AXA’s position that we had to repatriate Jane tomorrow or lose cover”.
Under duress, Jane’s family felt they had no option, but to agree with AXA’s demands around Jane’s repatriation. They could not possibly afford to lose the medical cover that Jane has been provided so far, or the costs of returning her to the UK.
“We told AXA that their plan is contrary to medical advice and we think it is not in Jane’s best interests”.
In utter desperation Cat felt she was left with one remaining option. To share the most intimate details of her mum’s injury with the world, and beg social media to draw attention to their plight.
Cat wanted to draw attention to the impossible situation that Jane’s insurer’s had put them in, when they are acting on behalf of their mum, who lacks capacity.
They are concerned as to why AXA are acting against the neurological advice that has been provided to them by Jane’s treating clinicians. They do not believe AXA have done due diligence. They are also concerned that this impossible approach, this backing people into a corner, will happen to others.
Since Cat shared what has happened on social media, there has been immense interest. At the time of writing this, 29 hours after Cat posted, her tweets have been viewed 4 million times.
I am left asking myself why should AXA customers have to resort to social media to receive help and answers. I asked AXA this yesterday afternoon and this was what an AXA Spokesperson said:
“We are contacting Ms Ruben and her family to discuss all possible options with regards to her insurance claim. The welfare of Ms Ruben’s mother and her family is our priority at this time.”
I had to do a little digging and see whether Jane and Cat were alone in their difficulties with AXA?
It would seem not. Their Trust Pilot rating is 1.2 stars (out of 5).
A search by the term repatriation revealed these experiences from others. These are just the first four chronologically, there are many more:
“After a tragic incident during our holiday when my mother-in-law sadly passed away, all companies associated with this process have been completely devoid of compassion. The service promised to us during this ordeal was never upheld & fell woefully short of what they said they would provide for us”. Vinnie
“Horrendous from start to present. Firstly the assistance line did not work so had to use british consulate for assistance. Then it took them two days and numerous emails and phone calls to sort the hospital guarantee of payment leaving my stuck in a foreign hospital for an extra 36 hours. The promised communication re repatriation did not occur and i was left injured i a foreign country. Upon return they have accused me of lying numerous times” Lucy
“That is ethically questionable behaviour from this organisation. I’m sure I’m limited to space, all I can say is I hope you read this and I pray that you try and find another insurance company so if your worst nightmare does come true and you are in a severe medical situation that you are able to find a company that can offer the support and help that is needed”. Consumer
“Axa treated myself and my family with zero empathy or understanding in the most difficult situation we could imagine and as the person left abroad on my own as my mums ‘plus one’ even refused to speak to me at one point without my mums authorisation even knowing that she was in the ICU on a ventilator and I was not even allowed to see her in the hospital due to covid restrictions and this was despite breaching DPA regulations on several occasions beforehand. Two hours after my mum died I was called by Axa’s repatriation team asking for my mum by name to organise flying her body home”. Mrs Gould
OK, you might think Trust Pilot isn’t particularly scientific, after all anyone can leave a review. Next I turned to the decisions of the Financial Ombudsman, the final port of call after a complaint process.
A search of all the Financial Ombudsman decisions with the search term ‘repatriation’ and business name ‘AXA’ turned up 88 decisions, over half of which, 47 were upheld.
Throughout these decisions AXA delays are found to be having a “substantial short-term impact” on their customers at what is acknowledged is an “already stressful time”.
In another case “AXA accepts that there were times when its communications could’ve been better, and – in particular – that on occasions it didn’t respond to Ms M’s son’s emails“.
There are many more such experiences. All of these, of course, require a degree of capacity and persistence on behalf of the complainant. All of these people have bothered to take out travel insurance, and have engaged with the companies processes, which if you believe the public customer feedback are not fit for purpose.
Shortly before 7pm last night, I was sent an updated statement from AXA. An AXA Spokesperson said:
“We are considering all available options and the welfare of Ms Rubens and her family remains our priority.
We are sorry for the distress Ms Rubens and her family have experienced when making a claim and we sympathise with their situation.
We have spoken with Ms Rubens’ family and will remain in contact with them over the coming days to support them. Our medical team and Ms Rubens’ treating doctors will agree the best course of action going forward”.
If you’re an AXA customer, you may wish to consider whether they are likely to be able to meet your needs, should you ever need to make a claim.
I feel so relieved Cat was prepared to share their family’s darkest moment, to try and get the support that was needed in her mum’s best interests. I think it’s an appalling indictment of the ‘service’ provided by AXA, in what is clearly not a one off situation, that she needed to.
I know that the trauma Jane and her family have all experienced will remain with them, for years to come. I hope that they are supported.
I wish Cat, and Jane, the very best. I hope that the timing of Jane’s repatriation is a decision taken in her best interests, and that Jane is given the best possible chance of a recovery.