Woman with brain injury faced insurance refusal

The family of a woman who suffered a severe brain injury while on holiday say they were faced with having to accept her return to the UK against medical advice or her travel insurance policy would be cancelled.

Jane Rubens was involved in an accident in the United States earlier this month and remains in a coma.

Her insurance company, AXA Partners, initially told the family Mrs Rubens would need to be repatriated on Monday despite several medics advising against the move, her family told the BBC.

Following a social media outcry, the insurers backed down, saying: “The welfare of Ms Rubens and her family remains our priority."

“We were already having the worst time,” her daughter Cat, 34, who is a lawyer, told the BBC. “Mum may not survive this, we just don’t know. And then to have to deal with all this.”

Mrs Rubens was on holiday visiting family in Missouri when she was hit by an SUV in St Louis on 1 November. She sustained severe brain injuries and multiple haemorrhages.

Since then she has been a patient at St Louis University Hospital, where she has undergone five different operations including a cranioplasty where part of her skull was removed. The most recent surgery was on Thursday.

Prior to travelling, her family say, the 73-year-old from Edinburgh took out a travel insurance policy with AXA Partners, which covered medical expenses for up to £15m ($19m).

On Friday the insurance company contacted her two children Cat and Andrew, who are by her bedside, to say they intended to require her repatriation to the Royal Infirmary in Edinburgh this week.

On Saturday, the family sent a letter to AXA Partners outlining the medical advice they had received, not just from her doctors in Missouri but also from NHS specialists to whom they had spoken, as well as the brain injuries charity Headway. All agreed that from a neurological stand-point, she needed several more weeks in the United States.

On Sunday, the family say, they woke up to an email from the insurers saying that “based on all the medical information which has been provided, it has been confirmed that your mother, Jane Rubens, is Fit to Fly via an Air Ambulance, with appropriate medical escorts with immediate effect. We have availability to proceed with the repatriation on 25/11/2024. If you do not accept our decisions and do not want to be repatriated, then we will not provide any cover.”

When Cat Rubens made a call to the insurers later that day she says she was told:

• The policy would be revoked on Monday if repatriation was not accepted on Sunday
• They could not see the repatriation plan, which also had not been shared with the medical team in Missouri
• They were not allowed to speak to the insurer’s medical team, underwriter or even a call centre manager
• They were not allowed an additional 48 hours to make a decision.
• Other than raising a complaint, there was no way for them to challenge the decision.

“Getting from St Louis to Edinburgh is a long way,” said Cat. “But they couldn’t provide any details – how many stops would there be, what level of sedation would she receive. Nothing.”

Following the call, one of the doctors in St Louis caring for Mrs Rubens also called AXA Partners. He got no further and was not even given the name of a clinician in Edinburgh he could talk to about his patient.

On Sunday evening, the family reluctantly wrote to the insurance company to say “In the circumstances you have given us no choice but to agree to your repatriation plan. This has placed us in an impossible position. You have asked us to agree to a repatriation plan in respect of which we have no proper details, not even the name of her receiving physician in the UK.”

Cat Rubens then took to X to highlight their predicament. “We were backed into a corner, I didn’t want to do it, but I felt I had no option but to post on X.”

Following the social media post, Ms Rubens said, AXA Partners called to apologise to the family saying they would not do anything without the consent of the family and of both the treating and receiving hospital.

“We know that repatriation has to happen – it’s what we want for mum,” said Cat.

“But it has to be based on the neurological opinion not just on whether she’s fit to fly from an aviation point of view. We weren’t being unreasonable – they just weren’t listening.”

In a statement, AXA Partners said they were “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. We are considering all available options and the welfare of Ms Rubens and her family remains our priority.”