WAYPOINT REVIEW AIRMED & RESCUE 2010

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ESSENTIAL READING FOR TRAVEL INSURANCE INDUSTRY PROFESSIONALS WWW.ITIJ.CO.UK OCTOBER 2010 • ISSUE 117 Safety in the spotlight Travel insurance report released Tourists have been warned to take extra care before booking excursions or water sports Datamonitor has released its latest report into activities in Turkey following several deaths in the UK travel insurance sector, which provides recent months. Mandy Aitchison has the story unique market size information and discusses the main challenges and trends facing travel insurance According to leading British law fi rm Irwin Mitchell, providers. Sarah Watson has the details there has been a signifi cant increase in the number of clients it has seen asking for legal representation after The report, UK Travel Insurance 2009, also analyses members of their families were injured – or worse – which underwriters are leading the way in this in accidents in Turkey. Currently on the fi rm’s books market and forecasts what the future holds for are Linda Hudson, whose husband Glenn died while the sector in the coming four years. The report parasailing in Turkey on 24 July; two survivors of a hot information ranges from predictions of gross written air balloon accident that resulted in the death of one premiums up to 2013, based on Datamonitor’s in- of their friends in May; and the families of two tourists house expertise and proprietary model, to a detailed who died in fatal jeep accidents. analysis of the marketing spend of the top-10 UK Irwin Mitchell’s concerns about safety in Turkey travel insurance advertisers. have been underlined by the more recent death Highlights of the report include the revelation that the of a nine-year-old girl from Wales who drowned number of visits abroad by UK residents decreased by following a rafting accident. Demetrius Danas, a 16.6 per cent between the fi rst quarter of 2008 and travel law specialist with the law fi rm, said that court the fi rst quarter of 2009, from 18.2 to 15.2 million. cases in Turkey proceed notoriously slowly, and Datamonitor noted that this is considerably different that compensation is often viewed as insubstantial. to trends identifi ed in previous years, which have Thus, he urged holidaymakers to take extra care measures will not be as rigorous as those within the actually received; and Britons being put on drips witnessed consistent growth in the fi rst quarter of each to check the small print of their travel insurance European Union.” when they were only experiencing minor problems. year. Elsewhere in the report, it was said that in 2008, policies to make sure that whatever activities they Meanwhile, Europ Assistance has issued its own In order to try and overcome the problem, Europ advertising expenditure continued to increase in the plan to take part in are covered under the terms of warning to tourists heading to Turkey who need Assistance has urged its customers to get in touch travel insurance market to £7.7 million, which can be the agreement. If possible, he added, tourists should medical advice when they are there. The provider with their travel insurance provider as soon as they attributed to competitors increasing their spending on only book tours through companies that have a said it has already seen numerous instances of can so that the company can liaise with the medical outdoor advertising. Spending on outdoor advertising well-known operator registered in the UK, so that unnecessary medical treatments for minor problems, facility at the fi rst possible opportunity. Paul Everett, displayed signifi cant growth in 2008, increasing by 307 if anything were to go wrong, they would be able costing unsuspecting tourists, and their travel insurers, sales and marketing director for Europ Assistance, per cent to £1.3 million. to pursue the case in a British court. “The Turkish thousands of pounds. Three instances in particular said: “We are shocked by the number of instances Overall, the UK’s travel insurance market witnessed tourism industry’s record on health and safety is a were noted by the company, including tourists of unnecessary medical treatment, overcharging and a small improvement in its gross loss ratio, which real concern,” said Danas, adding, “A disproportionate simply wanting over-the-counter medication fi nding pressure on customers occurring in some Turkish reduced by 0.7 percentage points from 65.4 per number of the fatalities and serious injuries that we themselves being pressurised into being taken to a clinics this summer. The Turkish medical community cent to 64.7 per cent. Growth in premium income deal with each year have occurred at Turkish resorts, private clinic by car; customers feeling pressurised are, in the most part, true professionals and we was the main driver of this improvement, which with many tourists not realising that health and safety by doctors into signing for more treatment than they would never want continued on p.6 grew by a larger proportion than claims incurred. Elsewhere, it was shown that uptake of single-trip insurance fell compared to the annual cover market, where there was considerable growth in policyholder Vietnamese cover urged numbers. One explanation given for this trend is that the average single and annual policy prices are A call for near-universal travel insurance Department of the Vietnam National Administration of converging, currently standing at £29.40 and £30.60 in Vietnam could bring new business for Tourism, Vu The Binh, has said that the requirement respectively. There, the negligible difference between international providers. Mandy Aitchison reports should be expanded to include groups of Vietnamese the two levels of cover has enticed individuals to take tourists taking domestic tours, as well as international out annual insurance over the past few years. It may A Tourism Law that came into being in 2005 made it visitors to Vietnam. Of particular concern for him was also be the case, according to the report, that some mandatory for Vietnamese tourists travelling abroad that the current law fails to stipulate a minimum level infrequent travellers would have chosen not to go to carry travel insurance, but the director of the Travel of travel cover for an continued on p.6 abroad in the past continued on p.6 IN THIS ISSUE

REGULARS

News continued 4 Editorial comment 6 Company brief 9 Insurance matters 10 Health matters 13 Travel matters 14 IPMI news 16 Cross-border care 18 Air ambulance news: the Waypoint AirMed & Rescue 2010 Review 20 ITIJ Awards 24 Service directory 39 Grapevine 46 On the move 47

ITIJ CONTRIBUTORS FEATURES Tatum Anderson is a freelance international health and Feature: Fair's fair 26 technology business writer with a decade of experience. Her ITIJ considers what insurers can do to halt the fl ood of specialist subjects include emerging markets, business, health and complaints to Ombudsmen. public health policy. She has written for a variety of publications, including The Economist, Guardian Weekly, BBC News Online, Wall Feature: Law of the piste 28 Street Journal Europe and the Financial Times. Injuries on the ski slopes cost insurers thousands of pounds, is an avid traveller who has visited 119 but can such costs be recovered? Roger St Pierre countries and rising. He writes and broadcasts extensively on the tourism industry, motoring, cycling and music. He is also Assistance & Healthcare World Markets: Portugal 32 fascinated by how the global economy works. At 15, he already ITIJ investigates the healthcare facilities on offer in one of Europe’s had five regular newspaper columns covering sport but also most popular tourist attractions happens to be a qualified associate of the Chartered Insurance Institute and writes regularly on business and financial matters for a number of prestigious publications.

ITIJ TEAM

Editor-in-chief: Ian Cameron ITIJ Published on behalf of: Voyageur Publishing & Events Ltd, Editor: Sarah Watson Voyageur Buildings, 43 Colston St, Bristol BS1 5AX, UK Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK Title editor: Mandy Aitchison Telephone: +44 (0)117 922 6600 The information contained in this publication has been published in good faith and Copy editor: James Paul Wallis every effort has been made to ensure its accuracy. Neither the publisher nor Voyageur editorial dept: Ext. 3 Ltd can accept any responsibility for any error or misinterpretation. All liability for loss, Conference manager: Denise Clements disappointment, negligence or other damage caused by reliance on the information advertising dept: Ext. 1 contained in this publication, or in the event of bankruptcy or liquidation or cessation Production: Helen Watts of the trade of any company, individual or fi rm mentioned is hereby excluded.

Kirsty Diclaudio fax: +44 (0)117 929 2023 Printed by Pensord Press, South Wales, United Kingdom Advertising sales: David Fitzpatrick email: [email protected] James Miller Copyright © Voyageur Publishing 2010. Materials in this publication may not be reproduced in any web: www.itij.co.uk form without permission Finance: Elspeth Reid INTERNATIONAL TRAVEL INSURANCE JOURNAL ISSN 1743-1522 Louise Goddard Would you like to make a comment? Design: V Creative Design WOULD YOU LIKE TO SUBSCRIBE? Please get in touch with Ian Cameron, vcreativedesign.co.uk VISIT www.itij.co.uk Editor-in-Chief of ITIJ on +44 (0)117 922 6600 ext205

International Travel Insurance Journal ■ www.itij.co.uk

4 NEWS

Gap year claims rise Insurer exposed to VHI not covering holiday firm failures cancellations The number of claims made on gap year travel insurance policies has risen by more than half Until recently, UK-based AmTrust Europe – re- The largest travel insurer in Ireland by market according to Essential Travel, which has seen the branded in July from IGI Insurance Company share, VHI, has confirmed that its policies do not, number of claims made on its backpacker policy leap Ltd – offered travel warranty and supplier failure and will not, cover the cost of cancelled hotel by 61 per cent comparing the period December insurance that provided consumers with cover in the accommodation for its clients. The issue has come 2009 to May 2010 to the same period a year before. event of an airline or tour operator ceasing to trade. to the fore as a result of the failure of online hotel Medical expenses accounted for 52.4 per cent of the However, according to sources close to the firm, it booking agency 1800Hotels, which has left hundreds claims, while 18.4 per cent were due to claims for has been exposed to a number of such collapses this of consumers out of pocket. Many have arrived at personal effects. The average value per claim also summer, including Goldtrail and Globespan. Although their intended hotel only to be told their rooms had shocked the insurer, which rose from £77 per claim the insurer has declined to comment on its potential been cancelled, while others with forward bookings to £584, an increase of 658 per cent. exposure to the failures, there have been suggestions have been told there is no booking at all. Stuart Bensusan, a spokesman for the firm, said: “It’s that this could amount to more than £2 million – A spokeswoman for VHI said: “In the case of logical that medical expenses would account for a particularly for parents, to hear that claims from equivalent to the profits the firm made in 2009. customers affected by the 1800Hotels issue, we high proportion of claims from backpackers when backpackers encountering mishaps abroad are on the AmTrust has recently withdrawn from the supplier have offered to provide them with the names and you consider the growth in popularity of adventure rise, but it goes to show how important it is for them failure market, and earlier this year it stopped numbers of nearby hotels to help them source sports activities among gappers, such as bungee to take out adequate insurance before they leave. providing coverage for scheduled airline failure as alternative accommodation. However, the cost of jumping, sky diving, skiing and white water rafting.” Preparing for a gap year abroad is arguably the most well. The insurer said earlier in the year that its their accommodation will not be covered by us The firm’s figures show that more than 50 per exciting time in a young person’s life, and nobody travel business had ‘suffered greatly’ from the fall in under their policy.” cent of the claims it received originated in Asia and wants to think about the pitfalls.” the value of the pound Australia, which a spokeswoman for the company Specialist insurer Hiscox has also urged gap year against both the dollar said was because of lax regulations for dangerous travellers to consider ways of protecting their personal and the euro, combined sports in these areas, compared with the rules that safety and keeping out of trouble while they are away with a rise in ‘recessionary would be observed if the same activity were to from home. Before they go, Hiscox recommends that claims’. In March, though, take place in the UK. She added that one of the clients investigate the health situations in their intended it said: “The volume of most common, and costly, claims the firm sees is destinations, and ensure they have the required business written by the for medical expenses that follow a moped accident. vaccinations; that they gain an understanding of local company in its core lines She reminded holidaymakers that although in Asia laws and customs to avoid a run in with the authorities; grew substantially during a motorbike licence is not required, and nor is a ensure necessary documents are carried and kept safe, the year [2009] despite helmet, most Western insurers consider riding a taking along copies of important items like passports. fierce competition, moped to be a dangerous sport. Austyn Tusler, home and travel insurance expert at financial turbulence and Bensusan also said that the higher average claim Hiscox, said: “For many gap year travellers, the real gap the continuing soft market amount was partly due to the fact that modern could be in their knowledge of how to keep safe while conditions.” Gross written gap year travellers often travel with high-value travelling to different countries. Thousands of travellers premiums doubled to electronic items in their possession, such as laptops set off with a backpack of clothes and possessions, but £80.1 million in 2009, or smart phones – this propensity also contributed have little idea about some of the simple precautions compared to £40 million to the higher number of claims made for personal they can take to avoid becoming the victim of crime or a year earlier, with £57.9 possessions. Bensusan added: “It is unnerving, falling foul of local laws and customs.” million of that written in the UK. Following the news that AmTrust had withdrawn the supplier failure cover, Rock Insurance issued a statement to its clients: “Rock Insurance Services has been aware that AmTrust was looking at this withdrawal as an option. Rock Insurance is pleased AR status offered to announce that a new insurer has been secured for both supplier failure cover and supplier failure for free insurance. All policies will be moved to Rock’s new policy range of Ultimate Protection Cover Insurer Holiday Extras is inviting travel agents in the from 1 September 2010 for all future departures.” UK to apply for Appointed Representative (AR) status The firm added: “In the majority of cases, terms for free, enabling them to sell travel insurance directly will remain unchanged; however, there may be to customers. Holiday Extras currently has 207 firms some adjustments according to the risk exposure. that are registered as ARs, and has stressed the Supplier failure has been and continues to be a need for travellers to be guided in their purchase of focus at Rock Insurance and will remain a growing insurance before they travel. Andrea Clayton, head part of our business.” of insurance for the firm, said: “There are no hidden Rock Insurance has been in negotiation for some extra costs with the Holiday Extras programme; time with a number of insurers to allow it to continue travel agents simply apply by visiting [our website]. providing supplier failure cover with the same or better From there, we will provide all the online training as cover than the original products. As a result, Rock has well as an instruction manual for each agent in the selected to work with Northern firm. The process takes & Western Insurance Company around a week. In addition (NWIC) for the provision of to that, they’ll still get 29 supplier failure cover from 1 per cent commission on September. Formed in 2000, any policies sold.” NWIC is entering its 11th year In related news, the of operation as a general lines company is altering the property and casualty insurer. terms and conditions of its Financial guarantee business travel insurance policies, accounts for approximately adding in new covered 90 per cent of the company’s medical conditions, and premium volume. It has capital other specific clauses, as and surplus of b1.5 billion and is a result of changing its accepted in the London market as underwriter to Mapfre well as by brokers, intermediaries Asistencia. “We’re (also) and banks worldwide as an insurer, introducing a specialist reinsurer or guarantor. Rock sent cruise insurance product out new policy certificates to to give specialist travellers reflect the new insurer within a more choice in their week of the change. product,” said Clayton.

International Travel Insurance Journal NEWS 5

Cover concerns Travellers warned of holiday perils Not just illness

The news of Tom Moss, a British man paralysed Travelex, the international currency services destinations named include such staples as Florida, Sainsbury’s Travel Insurance has told consumers that it is and stranded provider, has Spain and the Greek Islands. Ana Ansell, director vital they take out travel cover before they go abroad on in Thailand warned travel of Travelex, expressed surprise that these popular their holidays, stressing that such cover is not simply useful following a insurance resorts were placed at such high positions in the in the case of a medical emergency, but has so much serious moped policyholders rankings of holiday danger areas by the company’s more to offer. Scot Gorman, travel insurance manager accident, has that even research. She commented that holidaymakers of Sainsbury’s, explained how a policy could come in served as a those heading may not be aware of the real level of risk at their useful if the policyholder was the victim of a crime abroad, wake-up call to popular intended destination, saying: “Holidaymakers or if luggage were to go astray. Nonetheless, he still for travellers destinations should ... check sites like TripAdvisor or the maintains that the best reasons for taking out travel cover across the can fall foul [UK's Foreign and Commonwealth Office] for is to protect consumers from costly medical bills – the world – Moss of health any current warnings, local customs, transport company has seen a rise in medical expenses of 6.25 per had taken problems, advice, as well as local tourist offices, to ensure cent in the past 12 months. He added: “The message out travel scams and they are fully aware of all potential hazards in their is clear. If you do not protect yourself by taking out a insurance fraudsters. destination, including creepy crawlies and other comprehensive travel insurance policy, then you could be for his trip, The wildlife that may be lurking.” left facing bills that run into thousands.” but having decided to stay a bit longer in Thailand, he failed to realise his cover had expired. His family, friends, and some kind strangers have come up with the thousands of pounds needed to pay for the cost of his repatriation in an air ambulance and the medical care he received whilst in Thailand. Sarah Findlay, online marketing manager for insurewithease.com, has asked whether holidaymakers know that there can be restrictions when it comes to extending travel insurance. She added: “Before travellers decide to extend their trip, it is important to think about how this will affect their travel insurance cover. It is usually possible to extend travel cover while overseas (up to the maximum number of days that the policy allows) as long as the policy has not actually expired. However, if the policy expires and the policyholder then tries to extend it, this will not be possible due to licensing laws that prevent most insurers from issuing a new policy to someone who is outside the UK.” She went on to say: “Travellers should be aware that if their insurer is unable to provide cover for the full number of days that they wish to extend their trip, they will be advised to return home on the original date, as they will be uninsured after this. Buying a short policy and extending it later may seem like a good way to save a few pounds, but it could leave you in serious debt if you forget or are unable to extend it.”

Ferry crash injures tourists

As many as 30 tourists were injured after a ferry carrying holidaymakers and daytrippers crashed into a dock in Kos, Greece. The ferry, The Aegean Cat, was carrying 213 people and six crew members. The vessel was heading from the port of Altinkum in Western Turkey to the island of Kos on its weekly voyage when disaster struck. It is understood that the boat, operated by the Yesil Marmaris Company, slammed twice into the wharf on Kos as it was attempting to dock, throwing people around the deck of the boat and even throwing a few people into the sea. Five passengers were reported to be seriously injured as a result of the accident, while a further 25 suffered minor scrapes and bruises. One tourist, Phil Simonetti, said: “There was so much blood everywhere it was like a battlefield. People suffered broken bones and whiplash injuries as they were thrown about as the boat slammed into the wharf.” Some of those onboard have criticised the initial response of the crew and the dock workers, but within an hour of the accident, all of the injured had been transferred to a hospital in Kos and were being treated. Chief executive of Yesil Marmaris Company Sukru Tugay said there were plans to take the tourists back to Bodrum by another ferry later that same day, and a coach organised to take them back to Altinkum.

www.itij.co.uk 6 NEWS

Barwell Travel Volcano prompts clients left in limbo purchase

Barwell Travel customers have been left unsure as Estonian insurance company Ergo Kindlustus has to their next move after being informed that the reported that in July, the number travel insurance financial failure insurance they were sold as part policies sold tripled compared to July 2009. The of their holidays may not actually cover the cost company said the extra policies have been sold So ... the word is, on the market, that it’s going to be of their lost holiday. A message on the collapsed as a result of the fact that people have become a tough winter, with many travel insurance contracts travel company’s website urges customers to more knowledgeable about the risks of travelling being renewed over the next few months, it looks contact insurers Towergate Chapman Stevens, but a and after the chaos caused in the aviation sector like rates are set to increase substantially. We’ve spokesperson for the insurer said that it was as yet by the Eyjafjallajökull volcanic ash cloud, which has heard rumours of underwriters looking for increases unsure about the nature of the insurance protection prompted people to purchase travel cover. Annika of 20 per cent and more – it’s another thing whether for customers. He added: “We have requested Malo, head of the personal insurance department of they’ll get it or not. I guess it’s cold comfort that our number be taken off the Barwell website Ergo Kindlustus, commented: “The number of sold this reflects the trend in the whole of the insurance because we can’t do anything until the company is insurance policies in July has grown by approximately market. Whether the increase in rates will result in a declared insolvent, which won’t be until 1 October. 60 per cent in comparison to the month of July rise in the retail price of a policy remains to be seen. Customers were given financial failure insurance as last year. Lately, the travel problems caused by the It wouldn’t be the first time that some of the players part of their holidays, but don’t know if those due volcanic ash have been a good lesson to many.” in the market have sold policies at a loss... to travel before 1 October will be able to claim Also in July, Ergo Kindlustus registered a total of Anyway, I’m sure we’ll see the various players in the refunds as, right now, the company has not been 2,010 cases of damages related to insurance policies travel insurance market from underwriters, to air made insolvent.” – a 17-per-cent rise on the same month last year. ambulances and hospitals, doing their Oliver Twist Most customers have been referred to administration One of the reasons for the increase, according to the impersonations, and uttering those time honoured firm Bridge Business Recovery (BBR). James Carr company, was a rise in the number of damage claims words “Please Sir, can i have some more?” of BBR confirmed that there was no rescue plan on travel policies, which tripled to 256. in place for Barwell, which would definitely be Ian Cameron declared insolvent on 1 October. He added: “It’s Editor-in-Chief terrible, people were calling us from abroad saying Risky Brits [email protected] that they [are being] forced to pay again for their False economy of accommodation, but we can’t do anything to help Research from the Post Office has revealed that 7.1 them. We are not dealing with the failure either, million UK travellers have learnt a sport or hobby on cheaper cover so we are telling customers to claim on their credit holiday in the past three years, which has prompted cards or their insurance, but we don’t know if they the travel insurance provider to remind UK travellers World First Travel Insurance is urging customers to Safety in the can claim until the company is insolvent.” to ensure their travel policy will provide adequate fully research the range of travel insurance products Although Barwell Travel held an Air Travel Organisers cover when they learn a new activity. Examples the available before making a purchase. The company spotlight continued from p.1 Licence, it was not a member of the Association of organisation gave include activities such as bungee is advising purchasers to look for a policy with the British Travel Agents. It was licensed to sell just 600 jumping, mountain biking and even tennis – all of which right level of coverage, warning that although price to discourage travellers from visiting the country. package holidays a year, the majority of which were can require additional coverage from a travel insurer. comparison websites give the ability to browse However, it is more important that tourists receive for accommodation only at La Manga in Spain, which Post Office Travel Insurance has also advised hundreds of alternatives, cheaper products can leave the correct and appropriate medical treatment for would not have been protected. holidaymakers that appropriate travel insurance travellers out of pocket when it comes to making a their ailment; therefore we wanted to make the cover should be carried in addition to the European claim. The firm cited higher excesses as an undesirable public aware of this potential problem and prevent Health Insurance Card (EHIC). “Some UK travellers feature of some low-cost policies. Martin Rothwell, any more tourists being caught out.” taking activity holidays in Europe may wrongly managing partner of World First Travel Insurance, said For more information about fraudulent medical Students uncovered assume that any required medical treatment will be that excesses should be seriously considered when practices in Turkey, please see our Cost covered by the EHIC. Although the EHIC entitles the choosing a travel insurance product, as travellers may Containment Supplement. One in five British students is going on holiday holder to the equivalent medical care as a resident in be asked to pay an excess upfront when seeking without taking out adequate travel insurance, participating countries, it does not cover the cost of medical treatment abroad. according to a survey from online provider Wander repatriation or private treatment. In many countries, Student Travel Insurance. One third of students who travellers may automatically be taken to a private Vietnamese cover took part in the survey said they were simply too lazy clinic after an accident – so travel insurance should be to book travel cover, whilst a further 27 per cent said considered vital.” urged continued from p.1 they did not think it was necessary and they were willing to take the risk of travelling with no cover. outgoing tourist. Binh said: “That is a sensitive point, and More than a third of respondents said they only take there are a number of tour operators that have utilised out travel insurance because they are forced to by New agreement signed this lack of clarity to minimise insurance costs as much as their parents. (Thank goodness for parents! – Ed.) possible.” He would like to introduce a minimum level Wander Student Travel Insurance has since warned There has been a new reciprocal health agreement of compensation for an insured outbound Vietnamese the student travelling population that with 67 per signed between the UK Department of Health and tourist of US$100,000 – at the moment, the highest cent of students taking one or two holidays a year, the Isle of Man, which means that travellers from the compensation on offer from a Vietnamese tour many thousands could be leaving themselves open to Isle will be able to receive free medical care if they operator is $30,000, and there are only a handful of huge medical bills. Claire McKinnon, spokeswoman are taken ill while on holiday in the UK. The Isle of operators that offer this lower level of cover. for the insurer, said the survey showed a ‘worrying Man’s Minister for Health David Anderson signed a Although the Tourism Law was flawed, Binh did say level’ of students travelling uncovered, adding: new and permanent agreement that takes the place that a positive effect of it was the level of knowledge “Travelling without adequate cover could risk turning of the temporary one put in place six months ago, about travel insurance has risen significantly in the a dream holiday into a nightmare and leave students and formally began on 1 October. Travel insurance country: “Initially, very few people realised the with a medical bill they can scarcely afford.” importance of travel insurance, but after experiencing report released misfortune or disaster when abroad, the need continued from p.1 became a lot more apparent. The increasing number year due to fears of accidents that have occurred, both on domestic Spending in the over job security, leading to a fall in single-trip policy tours and international tours, and reported in spotlight numbers. According to Datamonitor’s survey, 89 per the media, have underscored the need for travel cent of travellers from the UK go abroad with some insurance.” Binh believes that while it is good news kind of travel insurance – whether it is separate cover that the level of awareness is rising, travel cover Research from the UK’s Foreign and Commonwealth or from a packaged bank account – and with around should not be an option – it should be a necessity. Office (FCO) has found that UK travellers spend 69 million visits abroad by UK residents each year, this Doan Thi Thanh Tra, marketing director of tour an average of £12 at their departure airport on represents a market worth around £750 million in operator Saigon Tourist, said that hers is one of magazines and sweets – more than double the gross written premiums. the firms in the capital that does offer insurance cost of some single-trip travel insurance policies. Worrying for insurers, though, was the revelation that to its customers, albeit with a limit of $30,000 However, Post Office Travel Insurance research claims bills are only getting bigger. The total claims on international tours, and a limit of just $3,000 shows that as many as 20 per cent of travellers fail bill for 2009 was £457 million, some 6.1-per-cent on domestic tours. She added: “We run this to take out travel insurance before leaving the UK. higher than the previous year. Not surprisingly, medical programme, although it means we may make smaller The insurer has urged travellers to consider travel expenses continue to account for the majority of profits compared to other tours that offer no travel insurance as ‘an essential component of any trip'. expenses, with the average claim amounting to £741. insurance, or leave it up to the individual to buy it.”

International Travel Insurance Journal ADVERTORIAL 7

Flying through the Economic Clouds

As the economic clouds begin to clear, Jet “Stats bear this out, spending on travel and tourism I.C.U.’s owners talk about the positive future increased at an annual rate of 3 per cent in the second of the company and how they have continued quarter of 2010 - that follows an increase of 5 per to grow despite the global recession. cent in the fi rst quarter,” says Honeycutt. Fluctuating currencies and in particular the weak pound has made Founder and President Mike Honeycutt, together UK travelers look outside the normal euro-zone, with his long time friend, colleague and business obviously Orlando has once again been a favorite, partner Fred Judy – Vice President and Director of with new attractions like Harry Potter at Universal and Operations, have, they believe, weathered the storm Manta at SeaWorld, which have guaranteed an infl ux with a positive and progressive attitude of attacking of visitors and has seen nearly a 10-per-cent growth the global fi nancial downturn with actions that have on last year. Other destinations that have become meant making investment when most have sat back ‘hotspots’ are Egypt and Istanbul, Turkey, hosts for waiting to see what will happen. Not since 9/11 this year conference, but also being recognized as a has there been such a bad year for travel as 2009 in European City of Culture. So our thoughts for gaining the US, with 3 million fewer visitors than in 2008. more international business have been aided by this Those international visitors who did travel to the gradual upturn in travel”. United States in 2009 spent markedly less. Americans curtailed their travel-related spending, too, spending Medical Changes nearly 12-per-cent less while traveling abroad in 2009. New Chief Flight Nurse Heidi Dilworth, leading a So it was certainly a time that required careful fi nancial recently reorganized medical department, says: “We it’s not all about money! and strategic planning. Expanding perhaps would be continue to provide world-class critical care medicine seen as a foolish step at such a precarious time. But as to our patients. To further the ability of our personnel has also introduced commercial medical escorts into had any level of cover to get them home or may is often the way when things hit such a low, they really to provide excellent care, Jet I.C.U. also provides its portfolio of services. A strong and experienced have had evacuation cover to the nearest appropriate can only go one way. continuing education to all of our people, including team of medical fl ight personnel has been built under medical facility. So the association was formed to the guidance of Heidi and Matt Woolley, the medical provide cover for unquestioned repatriation. manager. These individuals are multi skilled and able to fl y in air ambulances and go it alone as a medical Looking Forward escort. Matt commented: “When we went through Refl ecting on 2010, Mike and Fred are upbeat our EURAMI accreditation we were really only about the year’s achievements and the future of the doing an occasional escort trip for private clients. company. They have both paid tribute to ‘the third Going through the process with Dr Taymans was member of the stooges’ – said Mike: “Andy Lee, very enlightening and we realized that we needed to our managing partner, joined us in July 2009 and has improve our approach to this part of our business; brought many things to the company, apart from his we also have onboard Andy Lee who built a strange accent, he brings industry knowledge and successful business in the UK doing medical escorts, contacts and a passion for this business that has really so we combined all that knowledge and experience helped take us forward. Fred and I are delighted to plus investing in extra equipment to produce the have him around.” Planning for 2011 and beyond is quality team we have today.” The company went to underway, remembering “A man grows most tired market and gained high-profi le assistance provider when standing still.” contracts that mean they are now carrying out several transports a month and still growing. Making Decisions the use of a state-of-the-art patient simulator lab Mike says: “We felt that although there was a that allows us to practice real-time scenarios and Keeping Busy downturn in business, it was still the right time to keep clinical skills that further enhances our medical crews’ Other initiatives keep the team busy; Mike faith with our plans to move the company forward. ability to stay on the cutting edge of medicine. After is heavily involved with the creation and As the new building was heading for completion, receiving our Eurami certifi cation, the company set up of the International Air Ambulance we made a decision to upgrade our fl eet of LearJets decided to go above and beyond the currently set Alliance. This is an organization for owner as well, by having new paint and interiors, together standards and not only do we require continuing operators of fi xed-wing air ambulances, with new avionics. We wanted a new corporate and is focusing on developing a set of image inkeeping with our plans to push for more standards that can be adopted by the international business, even though everywhere was industry. There will be further discussion full of fear and trepidation. But the old cliché of holding on this in Istanbul and a presentation in fl ight mode; Captain Mike Honeycutt your nerve was never more prevalent. It wasn’t by Gary Andrews, Chairman of IAAA, without its trouble - we often disagreed on what was to show the progress that has been happening with the hangar, the different designs for made since its introduction a year ago. the planes’ new paint jobs, what type of furniture, It’s something that’s really important to the phone system, and changing the logo all created JET I.C.U. and the company supports some very lively debates.” Fred’s response: “Mike is the initiative wholeheartedly. The very analytical and strategic, he naturally thinks things company also has a repatriation program through from all possible angles; where as I pretty Part of the Jet ICU medical department for missionaries travelling overseas much go with how I fi rst see it, Mike will contemplate, – the Missionary Travel Association deliberate, weighing the negatives and positives until monthly education of our medical personnel but (MTA) is dedicated to providing air the best decision is reached. we also have monthly QA/Chart reviews that allow ambulance service to missionaries of all The two extremes give us balance and between the medical management team to stay abreast denominations who maybe fall ill or get us we can arrive at the right answer. We think in of challenges in the fi eld so that we have the injured while working abroad. Many of 2010 we have done just that, as our year to date is opportunity to continually maintain and improve our JET I.C.U.’s transports have been the prospering even coming through our slow season.” in house standards of excellence.” The department recovery of such people who have not On the job; Captain Fred Judy www.itij.co.uk 8 NEWS

Chartis covered Manila hijack Skiers warned to

Chartis Inc., a non-life subsidiary of American of HK$100,000. play safe International Group, was responsible for underwriting According to travel the travel insurance for some of the Hong Kong industry reports, it As northern-hemisphere ski resorts look to the season victims in the bus hijack incident in Manila, Philippines is business as usual ahead, the New Zealand Chiropractors’ Association that resulted in eight deaths and seven people being at Chinese travel (NZCA) warned skiers enjoying skiing holidays down seriously injured. The maximum insurance coverage agencies, with the under to take care on the slopes. The NZCA warned for those who died was raised to HK$1 million same number of people to take extra care, especially those who are (US$129,000) from the standard HK$500,000 in the Chinese tourists unfit or do not regularly hit the slopes. According travel plan underwritten by Chartis for some of the heading to the to the organisation, skiers are most likely to injure victims, according to Hong Thai Travel Services Ltd, Philippines, although themselves after 3 p.m. on the third day of a skiing which organised the tour the group was on when they some are enquiring holiday. This is due to the fact that after a few days of were hijacked. According to the tour operator, the about safety in their skiing using unaccustomed muscles, skiers become amount was raised as a result of the insurer taking into chosen destination. confident, but are physically tired, and their capability special consideration the fact that the hostage situation David Boh, a isn’t necessarily matched to their confidence. was an accident involving public transportation, as representative of It is often assumed that a ski injury is most likely to well as the casualty insurance cover held by the Asiatravel.com, said: happen on the first day, stated Dr Hayden Thomas, operator, which has contributed to a higher reward for “Normally people will travel from October onwards Quarter of UK spokesman for the New Zealand Chiropractors claimants. For injured claimants, the highest amount … so what some of our guests are doing is waiting to Association. However, there is a much higher risk of insurance benefits they can obtain for medical care see how the situation turns out. Some of the guests, travellers without of hurting yourself a few days into skiing, as muscle is HK$1 million, and post-medical treatment cover in what they do is that they purchase additional travel fatigue actually reaches its peak 48 hours after you Hong Kong for the next six months at a maximum cost insurance.” insurance start your holiday. Falls, knee ligament sprains and damage to upper limbs are all common injuries that As many as one in four Brits ventures abroad without can be caused or exacerbated by tired muscles. travel insurance cover, according to a survey carried Fortunately, said NZCA, there are a number of things Price rise in the offing out by UK insurance firm Protect Your Bubble. The that can be done to lessen the chance of injury. Dr online insurance provider, which specialises in both Thomas recommended that skiers increase their Peter Hayman, director of specialist insurance abundance of claims and the need for insurers travel insurance and cover for luxury items such as fitness before going on holiday, especially if they have provider PJ Hayman, has warned purchasers of to maintain their capital returns. He said: iPhone insurance, warned that those travelling without a sedentary job or lifestyle. Once on the slopes, it travel insurance in the UK that prices could rise “Insurers are forcing through increases that would insurance are unprotected against risks such as injury, is important to warm up before starting anything significantly over the coming months. Over the previously have been unthinkable in a competitive sickness, theft, and hospital cancellations. The survey strenuous and to avoid overexertion. past three years, competition within the industry market. Rate increases of 20-plus per cent are was based on 3,000 holidaymakers. Prevention is always better than cure, added Dr has forced providers to offer cover at the lowest not untypical, coupled with other limitations such Stephen Ebbett, spokesperson for Protect Your Bubble, Thomas, as just one joint or muscle out of line can possible cost, but a number of changes within as restrictions on age and degrees of acceptance commented: “Britons often spend months saving up be a disaster when travelling down a slope on skis. the sector in the past few months could prove for medical conditions.” Hayman added that for their one summer holiday abroad every year, and costly for consumers. Hayman said that the travel customers should be especially careful about really look forward to a relaxing break in the sunshine. insurance market has become highly unpredictable reading small print to ensure there are no ‘harsh So it is understandable that when something goes ‘almost overnight’, due to low interest rates, an exclusions that could come back to haunt them’. wrong – such as finding out the accommodation isn’t Seasonal cover check as expected, or the aeroplane is delayed by several hours – people will be disappointed.” He added that urged he was amazed that one in four Brits travels abroad without cover, despite policies being relatively cheap in With American hurricane season well underway, comparison to the cost of a holiday. independent travel insurance specialist Insurewithease is encouraging holidaymakers to double-check that their insurance covers catastrophes and extreme weather conditions. Sarah Findlay, online marketing manager for the insurer, said: “Whether locally FCO focuses on referred to as a tropical storm, hurricane or typhoon, we are advising travellers to do their research before road hazards travelling. It is a good idea to check out the seasons of a destination before booking – when you see a The UK Foreign and Commonwealth Office (FCO) bargain break advertised, check the local seasons first has sought to raise awareness of the number of Brits to avoid a nasty surprise when you touch down.” injured each year in road accidents involving hired She added: “Better deals are often available during motorbikes or scooters, and has subsequently issued the rainy, hurricane or typhoon seasons, and if you advice to citizens in the hope that it will prevent at decide to travel at these times, it’s important to make least some of them falling into common tourist traps. sure you’re covered by your travel insurance. When The statement from the FCO reads: “If you hire a choosing insurance, check that it will cover you for motorbike or scooter, not only are you at greater delayed departure or abandonment of a holiday due risk of having an accident as a result of unfamiliar to a natural disaster or extreme weather conditions or dangerous driving conditions, you could also striking before you even depart. Also, check that invalidate your insurance if you do not wear a crash the policy provides cover for some of the additional helmet, or if the vehicle you hire is unregistered. You unexpected costs that you may incur if a hurricane could face extremely high bills for medical treatment strikes when you’re at your holiday destination.” if you are injured as a result of a road accident and you do not have valid insurance cover.” Research from the FCO has shown that a quarter of young travellers have admitted to driving or being the passenger of a moped or quad bike without checking to see if their travel insurance covers them for such an activity.

International Travel Insurance Journal COMPANYBRIEF 9

Dynamiq adds Holiday NEWSWIRE assistance Extras Healix International has secured a new two-year contract to provide medical claims Australian firm Dynamiq has officially launched its new re-writes management to Virgin Atlantic flight crew wherever one-stop emergency medical and travel assistance arm they are in the world. – Dynamiq Assist – which the company says provides terms its clients ‘with real peace of mind’. The company Integrated Subsea Solutions, a supplier comprises a team of experienced and committed UK-based Holiday Extras is of services to the oil and gas industry, has appointed professionals, which include highly qualified emergency now offering additional pre- CEGA as its worldwide emergency medical doctors, medics and nurses, along with safety and existing conditions included in assistance provider. security specialists. Dynamiq Assist says that its its travel cover, as well as an operations centre is state of the art, which, combined in-house medical screening UK building society Nationwide has re- with 24/7 case management, nursing and doctor service, after teaming up launched its current account, which now includes staffing, adds value to the support that the company with Mapfre Asistencia. The the offer of free European multi-trip travel insurance can offer its existing client base. new policy also includes for both the bank account holder and their partner. insurance against natural disasters, which would cover New York-based Multiplan has been Europ Assistance customers for any expenses incurred by an event acquired by private equity firms BC Partners and such as an earthquake or volcano. BDAE Group Silver Lake. Multiplan clients include large insurers, enters Canada Furthermore, Holiday Extras has decided to bring launches tariff third party administrators, self-funded health plans its medical screening service back in house, and has and health management organisations. Europ Assistance (EA) has announced its expansion into added so many pre-existing conditions to its coverage the Canadian assistance marketplace, where it is offering it now boasts over 300 conditions that it will cover. The Bund der Auslands-Erwerbstatigen (BDAE) Health insurer UnitedHealth Group is a full suite of products and services to the market under Group has designed a new health insurance policy buying Executive Health Resources, a medical the EA Canada banner. Alex Kroon, president of EA specifically tailored to suit the needs of family and compliance firm currently owned by private equity Canada, said: “We have a range of offerings for each friends of foreigners residing in Germany. A new firm Abry. Terms of the deal have not been disclosed. area. Health, home and family, and travel assistance concept developed in co-operation with the risk are important to everyone and to every company. We carrier Wurzburger Versicherungs-AG, Expat Visit provide assistance and reassurance to the end user and offers its customers a greater scope of benefits than cost containment to Canadian corporations.” standard travel insurance products, such as not Mondial expands Being able to provide Canadians with healthcare having a maximum time limit placed on a visit. options is one of the company’s cornerstones and the The insurance policy also provides cover to Germans HSBC cover philosophy behind borderless healthcare. As such, EA going abroad for up to a year, provided the visit is assists the client in taking control of their healthcare not for business purposes. Premiums are calculated In partnership with HSBC, Mondial Assistance schedule and treatment as part of its medical on a per-day basis and linked to the exact length of UK had developed a range of optional roadside concierge offering. EA Canada’s medical concierge the journey, without any additional costs. Among assistance benefits for the HSBC Advance account. programme also provides clients with access to other benefits, the cover includes in- and out-patient As part of an exclusive partnership with the bank, executive medicals and second opinion services at treatment, pharmaceuticals, drugs and dressings, and the assistance provider is offering 24-hour roadside leading Canadian and global medical facilities. medically necessary outpatient dental treatment. assistance to HSBC Advance customers for two years, and the new suite of options builds on the existing cover available through the added value account. The three new optional add-ons are Home Sure Travel improves Assist, Full UK, and Full UK and European, which covers vehicles anywhere in Continental Europe. bag cover An HSBC spokesman said: “We are delighted to be able to extend the level of roadside assistance South African firm Sure Travel has found a unique cover for our HSBC Advance customers, and know way of counteracting the problem of stolen or from experience that the service Mondial Assistance damaged luggage by offering a complimentary benefit provides is of the highest quality.” on all its existing travel insurance policies through Bbagzz, a luggage ‘enclosure’ that offers ‘the ultimate in luggage security solutions’. The insurance is an New cover offered additional stand-alone cover, providing insurance for travellers’ luggage while in transit. The cover insures by Travelex items either lost due to pilfering or ruined by damage for up to R1,000 (b107) per item. In addition, In responce to the changing needs of travellers delayed luggage is also covered for up to R1,000 per today, Travelex Insurance Services has created a item, while R5,000 coverage is provided for total new protection plan called Travel Select Advantage, loss of luggage, with a R250 excess. Bbagzz seals off which has been designed with the travelling family luggage entirely, including all locks and zips. in mind, providing those under 21 years of age with Sure Travel chief executive Vanya Lessing said that cover for no additional charge when accompanied the introduction of Bbaggz into the market is an by a covered adult family member. In addition, the ideal solution to the widespread problem of pilfered plan automatically includes three popular lifestyle and damaged luggage. She added: “For a long time, packs, which provide tailored coverage to students pilfering, damage and tampering of suitcases while and athletes, families with children, and working in transit has been a major problem for professionals. the travel industry. Bbagzz Mike Ambrose, president of enclosures will assist greatly Travelex Insurance Services, in overcoming this problem, commented on the changes: “Travel not only by providing visible agents like the enhancements to suitcase protection, but also our Travel Basic products and, with providing insurance against the addition of full trip interruption any sort of tampering.” Each coverage and no age restrictions, Bbagzz enclosure has its own the product is even more appealing unique identification number to the cost-conscious traveller and travellers are asked to during these economic times. carry separate bags for each The new Travel Select Advantage leg of their journey. Each time with ‘kids free’ and three lifestyle a Bbagzz enclosure is used, the packs built into the product at no insurance needs to be activated additional charge is a tremendous through SMS using the unique value for travelling families.” code found on each bag.

www.itij.co.uk 10 INSURANCEMATTERS

FSA bans five executives NEWSWIRE Britain’s Financial Services Authority (FSA), the company, meaning that City watchdog, has banned five individuals in those customers were at Aon Benfield has said that July saw some of relation to insurance fraud and given one director risk of being uninsured the worst flood events in history, with Asia being a near-record fine of £150,000. The FSA said as their premiums were particularly affected by the deluge. that the five insurance executives in question had being misused. Aspden’s shown complete disregard for the interests of their wife, Melanie, and his Fitch Ratings has assigned German property customers. sister-in-law Gaenor and casualty insurer Westfaelische Provinzial Andrew Jeffery, a director of Jeffery Flanders Limited, Clayton were also banned Versicherung AG and the life insurer Provinzial was fined £150,000 for failing to put in place from financial services Nordwest Lebensversicherung AG insurer financial adequate insurance policies and knowingly forging operations for their roles strength ratings of ‘A+’ with stable outlooks. documents. The FSA said it was one of the largest in the affair, along with ever fines against an insurance broker. Barrie Duncan Orion executive Paul The combined market share of three of Aspden of Orion Direct Limited and Peppercom plc Willment, who was fined China’s top life insurance giants fell in the first half was banned for using customer cash to create a new a further £50,000. of this year in terms of premiums, according to the latest figures from the China Insurance Regulatory Bahrain sector Commission. The three insurers accounted for 49 per cent of total life and non-life premiums, down Technological revolution grows from 51 per cent a year ago.

Reports from ChannelNewsAsia suggest that the Chartis Singapore, the move towards a greater use Data released by the Central Informatics Zurich Financial Services has reported use of technology by insurance companies is set to of technology among insurers in Asia will not be Organisation (CIO) has shown that the insurance robust operating performance from its core change the entire industry as companies use the significant enough to put insurance agents out of a industry of Bahrain grew by five per cent in the first businesses for the six months ended 30 June, with information from new data capture systems to take job. He said: “There are going to be customers who quarter of 2010, compared to the previous quarter, continued strong performance at its Global Life and advantage of new business opportunities, automate are not comfortable with technology, and there are and by 15 per cent compared to the same period Farmers divisions. processes and cut costs. There are concerns, going to be some who are. So you have to make last year. The CIO’s figures also revealed that the though, that the move to online insurance purchasing sure you’re not alienating the customer that is not financial services sector of the economy grew by Delta Lloyd Group is transforming its will result in less face-to-face contact with customers, comfortable with technology, just to benefit those four per cent during the period, which represents an organisation and the way in which it serves its which could lead to a rise in fraud cases and who are comfortable with technology.” increase of six per cent year-on-year. customers. Processes, systems and communications adversely impact customer relations. The data from the CIO confirmed what figures from will all be drastically simplified in order to make the Li-May Chew, associate research director for IDC the Bahrain Economic Development Board (EDB) organisation more customer-focused and effective. Financial Insights, Asia Pacific, commented: “On had earlier shown – that the financial services sector average, we see that insurers spend, maybe, 0.75 contributed around 23 per cent of the country’s total Aviva has shown strong growth in profits and per cent of their revenues on IT, whereas a bank QBE restructures increase in gross domestic product (GDP) seen over capital generation this year, with operating profit might be spending two or three per cent. What the last six years, and it remains the largest contributor up 21 per cent to £1,270 million. The figures were we’re seeing is that there is a lot of focus on business Insurer QBE has decided to restructure its three to GDP, accounting for around 25 per cent of the total. helped by an increase in European bancassurance re-engineering projects around selected areas.” main operating divisions – Europe, the Americas Kamal Ahmed, chief operating officer for the EDB, sales of 20 per cent. According to Kevin Goulding, chief executive of and Australia Asia Pacific – as a result of its continued commented on the growth seen by Bahrain’s expansion. Following the restructure, Vince insurance industry: “Ethical values – the fundamentals The Australian Competition and Consumer McLenaghan, current group chief operating officer of transparency and sound regulation – have formed Commission has agreed to consult the market on and acting chief executive officer (CEO) in Australia, the basis for the steady growth of our strong financial National Australia Bank’s proposals to salvage its has been appointed to the position of CEO Australia sector in Bahrain, built over the past 40 years … a A$12-billion takeover of AXA Asia Pacific, according Thai life looks good Asia Pacific. Steven Burns, CEO of European great financial centre draws investment to provide to Reuters. operations and John Rumpler, CEO of Americas, will companies with the ability to grow their output, The life insurance industry in Thailand will see now report directly to group CEO Frank O’Halloran. profits and jobs.” The Indian insurance regulator has warned growth of between 18 and 20 per cent this year, McLenaghan said of the move: “I am delighted to It was noted that Bahrain Kuwait Insurance Co.’s that profitability of insurance companies will be despite the political turmoil that recently engulfed take on this new challenge within the group and (BKIC) gross premiums amounted to BHD18.79 impacted by the new guidelines for unit-linked plans, Bangkok, according to Sara Lamsam, chairman of to be working more closely with the Australian million (US$49.8 million) in the first half of 2010, and has advised insurers to reduce their expenses to the Federation of Thai Insurance Organisations, who operations executive and Mike Goodwin to expand compared to BHD18.36 million in the same period maintain their bottom line in the long run. was speaking at the recent Thailand Life Insurance our service and product offering across the region. last year. In the same period, BKIC posted a net Conference hosted by Fitch Ratings. He added: “The We have excellent teams to work with and exciting profit of BHD2.32 million, down 11.1 per cent from Mapfre has increased its turnover by 9.2 per industry was barely affected by the political violence, opportunities to capture and convert into further last year. The company has said this was due to the cent compared to the first six months of last year, growing robustly in the first half of the year by 15 per positive results.” significant decline of 43 per cent in investment income. reaching e10.9 billion. The company reported a net cent. We expect the industry will manage to surpass profit of e500 million. 18-per-cent growth by year end, as the second half is normally the peak season.” Allianz Group has recorded a profit of e3.9 Meanwhile, Narumol Charnchanavivat, director Insurers have the power billion in the first half of 2010, an increase of e0.7 of banks and insurance at Fitch Ratings in Thailand, billion from the same period last year. Half year agreed that the country’s weak economic Chief executive of Munich Re Dr Nikolaus von Bomhard said: “Increasingly, insurers are stepping operating profit for the property casualty book was environment and political instability would have a Bomhard has voiced his belief that insurance in to bridge the gap between green intentions e1.86 billion. limited knock-on effect on the insurance industry. companies can act as pace setters in the adoption of and actual capital outlays on green technology. The agency has predicted the life sector will green energy measures by assessing, quantifying and They are backstopping warranties on solar panels, Fitch Ratings has revised the rating watch continue its growth in the medium term, thanks spreading risk. He said that climate change should helping start-up companies with short track records, on OJSC Rossiya Insurance’s international financial to several factors, including increased product not just been seen by insurers as another means offering multi-decade guarantees on their products strength rating ‘B-’ and national IFS rating ‘BB- awareness, tax incentives, aggressive marketing to sell more policies that focus on loss prevention. and winning over sceptical customers and project (rus)’ to negative. through bancassurance and product innovation. In a blog about energy and the environment, Dr financiers. They are advising companies on how Charnchanavivat added: “Life insurance best to incorporate renewable energy Groupama’s combined UK operations have premiums have been growing steadily systems into their factory operations recorded a pre-tax profit of £13.7 million for the despite the weak economic environment of and offering property insurance first six months of this year. Group results showed an the last few years. The industry is expected that will pay not just to rebuild a increase in the company’s private motor account. to see improvements in net profits, given structure in the event of a loss like the recovery in asset prices, rising interest fire, but reconstruct it in a more Zurich has said it will remain cautious on rates and strong premium growth.” She environmentally friendly and energy takeovers, despite declining premiums across the added a word of caution to her optimism, efficient way.” insurance industry and enough capital to bankroll though, saying that life insurers in Thailand, Chairman of New York-based firm deals. along with other insurers in the Asia Pacific Solartech Renewables Todd Roberts region, continue to face the challenge of a said that the number of insurers Insurers in China are taking steps to deepen disparity between assets and liabilities, given offering warranty policies has increased and increase online sales, with the aim of turning the lack of local long-dated bonds. Also in the past 12 months from three to e-insurance into a major marketing channel and putting further pressure on life insurers’ 12, and a 25-year policy adds one per profit contributor, reports the Sino Cast Daily bottom lines are persistently low interest cent on to the cost of a solar panel, Business Beat. rates in the local market. but offers a real competitive edge.

International Travel Insurance Journal INSURANCEMATTERS 11

Marsh report identifies trends 2010 has seen trade A recent report from global brokerage firm Marsh into the region remained generally stable in the first half of been written into the regulation of member states. insurance activity Europe, the Middle East and Africa 2010 after several years of decline.” credit and financial The explosion of the Deepwater Horizon oil rig (EMEA) has found that most clients across the region According to Marsh, trade credit and financial and its dramatic consequences – both in terms of were able to secure premium rate reductions for institutions insurance were heavily impacted by the loss of life and pollution – is being closely monitored property and casualty classes of business in the first half global economic downturn and clients have had institutions coverage by the marine and energy markets. Finally, the of this year. It also pointed to the trend of new insurers to accept significant rate increases in these lines of report found: “Those companies with developing entering local markets in an attempt to diversify their business in recent years, as high loss ratios forced rates stabilise insurance markets, including certain African and books of business and access new opportunities, insurers to review their pricing and coverage on Central and Eastern European countries, have bringing additional capacity with them and further offer. However, the report found that 2010 has institutions, although it is thought that terms will now reported significant increases in premium volumes intensifying local competition, often allowing rate seen trade credit and financial institutions coverage begin to improve. as awareness of insurance and its benefits are reductions for clients. The report continued: “Insurers rates stabilise as underwriters have become The report also reported increasing demand for recognised. New market entrants will allow for are striving for rate increases but competition remains more comfortable with their exposure and new environmental insurance, which has developed continued development of these lines of business, intense, resulting in significant discounts for good insurers enter the market. It is still difficult to find as a consequence of a new European Union working with Marsh to support local clients in their quality risks in certain countries. Motor rates across adequate cover at reasonable rates for large financial Environmental Liability Directive, which has now risk management.”

Insurers ignore existing customers

According to a recent report from global accounting firm Ernst & Young, insurers in the Asia Pacific region have been neglecting their existing customer base in favour of attracting new customers. “In short,” says the report, “insurers and banks in the region are not engendering customer loyalty, which makes their customers prone to switch to their competitors, with concomitant effects on their growth. This is despite the fact that attracting new customers requires significant investment and effort for the insurer or bank.” A survey undertaken by Ernst & Young found that 55 per cent of insurance customers in the Asia Pacific region have more than one product that is not from their main provider, and, tellingly, are always on the look out for a better deal or new products, rather than staying with the company that provides the majority of their financial services. The same survey discovered that customers who do choose to have several products with one insurer or bank are under the impression that their provider does not really appreciate their loyalty. The wide-ranging survey covered nearly 10,000 general insurance and retail banking customers in Australia, China, Hong Kong, New Zealand and Singapore in May this year. The findings indicate that while nearly nine out of 10 insurance customers think that loyalty is important, 41 per cent of respondents feel their insurer does not recognise their loyalty. This ‘loyalty expectation gap’ is thus contributing to low advocacy scores in the Asia Pacific region – nearly 40 per cent of those surveyed said they would not recommend their main provider to a friend. Andrew Price, Oceania financial services sector leader for Ernst & Young, commented on the findings of the report: “Insurance customers are confused by the discounting programmes Andrew Price on offer and don’t see these as sufficiently rewarding their loyalty. Banks and insurers need to create more compelling reasons for customers to hold more products with them.” He added: “Customers want their main bank and insurer to recognise their loyalty and offer them timely and personalised products and services that are aligned to their current and future needs, using their preferred communications channel.”

www.itij.co.uk 12 INSURANCEMATTERS

M&A activity predicted Omega results hit NEWSWIRE The overhaul of global banking rules will be a in terms of embedded value. And there are plans by catastrophe losses major driver in the restructure of the insurance for further growth in the near future, according to sector, according to Swiss Re chairman Walter chief executive John Tiner, who gave nothing away Lloyd’s property and casualty insurer Omega Cost cutting efforts of insurance companies Kielholz. Although new rules for insurers are also when he described recent developments as ‘quite Insurance is in the red according to its first half financial in India over the past 12 months have paid off, being introduced, Kielholz believes that it is the interesting’. results, after suffering heavy catastrophe losses. It has resulting in several private insurers reporting profits new bank rules that will change the face of the Ben Cohen, a broker at London’s Collins Stewart, reported a pre-tax loss of $34.2 million in the first for the April to June quarter of this year. industry as they make it too expensive for lenders agreed that opportunities are still present in the UK six months of this year, which is especially significant to keep any insurance market: “A lot of shareholders when considered together with the profit of $22.9 A United Nations expert has called for operations, thus see rationale in consolidation million in the same period a year earlier. The results, yardsticks to rate extreme weather to guide parties leading to sales and in the UK or other mature though, were in keeping with expectations following such as insurance companies, according to Reuters. initial public offerings. markets.” He added: “The an earlier profit warning. Omega attributed the loss The call comes amidst a series of natural disasters He told a Frankfurt view shareholders are taking to high natural catastrophe losses – the company around the world. business journalist: is they would prefer better or was exposed to the earthquake in Chile and the BP “Changes in insurance more focused management Deepwater Horizon oil spill – and it also has significant Net profits at Japan’s three major non- regulation will have teams to look after bigger exposure in the Gulf of Mexico as hurricane season life insurance groups soared by 31 per cent in the less of an impact on business. There is a trend in continues, which is so far an active one, with four first financial quarter of this year to 111.2 billion insurance merger the UK towards separating named storms by 1 September. yen (US$1.29 billion). The groups are MS&AD and acquisitions life and non-life business.” Richard Peston, chief executive of Omega, Insurance Group Holdings, Tokio Marine Holdings (M&A) than changes Meanwhile, the rumour mill commented on the results: “These catastrophe losses, and NKSJ Holdings. in banking regulation.” He noted the sale of the is working overtime as a result of Aviva admitting that together with the lag that currently exists in 2010 insurance arm of Royal Bank of Scotland, but also it refused a £5-billion offer from RSA for its UK, Irish premium earnings, have had a major effect on our UK-based insurer Prudential has reported a said that banks in France, Italy and elsewhere will face and Canadian general insurance businesses. There half-year results.” He said that following the results, five-per-cent increase in its divided for the first half similar choices. are also reports that AXA could be interested in the company will now focus its energy on building the of this year, despite the millions of pounds spent on Meanwhile, according to John Hack, a partner at making a bid for Aviva. quality of its resources and infrastructure to manage its unsuccessful bid for the Asian business of AIG – buyout vehicle Resolution, the British insurance However, one analyst sounded a note of caution risks and return more efficiently. A review of the AIA. industry looks ripe for consolidation. He told The about the possibility of a flurry of activity in the near business’s underwriting, operations and governance Guardian newspaper: “You have a large amount of future. James Quin at Citi said: “While size may have structures has been done, with a further review A consortium of Chinese companies, cost and a lot of players chasing a small profit pool. some attractions, we struggle to find an example of planned for the second half of this year. Pexton said: including China Life Insurance, is reportedly planning Investors would like the industry to recalibrate itself. large-scale mergers and acquisitions in the non-life “We continue to monitor the rating environment to bid for a 30-per-cent stake in AIA. It would mean We’re very clear that scale really matters and if sector that has achieved its goals – indeed, both closely and maintain our selective and focused an investment of around US$10 billion. you’ve got a good management team you can make Aviva and RSA are themselves examples of where approach to underwriting. We do not believe now is great returns.” Entrepreneur Clive Cowdery set up this thinking has gone wrong. The most profitable the right time for significant growth – this is the time to South Korea’s insurance companies, led Resolution two years ago, with the specific aim of and highly rated operators – Admiral in UK motor, or position ourselves for a correction in the market.” by Samsung Life Insurance, are on course to report leading consolidation in the life insurance sector. Last Amlin in wholesale risks – are not successful because record-high earnings in the first quarter of this year, the company bought Friends Provident, and of scale, but because they are very good at what financial year. A strong rebound in economic activity this year has purchased AXA’s UK life insurance arm. they do. We see no correlation between size and has reduced the number of policy cancellations Currently, it is more than halfway towards achieving returns, and a negative one between size and stock while boosting the number of new customers. its aim of building a business that is worth £10 billion market rating.” Following a chain of destructive geological disasters across China, Beijing has announced plans to build its own geological warning system. Currently there is no monitoring system at all, other than relying on local people to keep an eye out.

The Roads and Transport Authority in the United Arab Emirates (UAE) has approved five insurers to process vehicle registration renewals for its clients – RSA, Fujairah Insurance, Oman Health Ministry to Insurance, AXA Insurance and Noor Takaful. The insurance market of the UAE posted establish standard year-on-year growth of premium income of 9.8 per cent last year, bringing in AED20.1 billion (US$5.5 costs billion), according to the Insurance Authority.

India’s Health Ministry has announced plans to For the six months ended 30 June this year, introduce common standards of medical treatment Ping An Insurance reported net profit of RMB9,866 for a number of common ailments, and to that million, up 27.9 per cent year-on-year. Net profit end has appointed a panel of experts to draw up a of non-insurance lines of business rose by over 180 treatment protocol that is expected to be introduced per cent. within the next three months, and be established at hospitals nationwide in the next two years. One The latest report from global brokerage official from the ministry said: “Initially, standardisation Marsh has found that insurance premiums in India will be done for 10 to 15 common critical ailments, continued to rise for the first six months of the year, such as those related to cardiology and nephrology.” even as a stabilising or decreasing trend has been TA Ramalingam, head of underwriting at Bajaj Allianz seen in other nations in Europe, Africa and the General Insurance, said the rate standardisation Middle East. would help the insurance industry: “Standardisation of rates across hospitals in a region would bring more The Tibetan arm of the China Insurance transparency to customers and insurers. This also Regulatory Commission has been inaugurated in helps in proving the product better than relying on Lhasa, the regional capital, amid rapid development only the insurer’s claims experience.” of the insurance industry in the remote mountainous The move to standardise the cost of medical region. procedures comes in the wake of India’s largest state-owned insurance companies withdrawing the British insurance and pensions firm facility for cashless payments for insured patients Standard Life is to cut 600 jobs over the next 15 at hundreds of hospitals across India. The insurers months as part of a major overhaul of its business. claimed that the hospitals were overcharging The axe is being wielded to streamline operations customers who had health insurance, leading to and shift the group’s focus to long-term savings significant loss ratios on medical policies for the products. insurance companies.

International Travel Insurance Journal HEALTHMATTERS 13

Jet lag consigned to Dengue in Delhi Cholera in Cameroon Mexican outbreak history? Health authorities in Delhi, India, have reported a A cholera outbreak has been reported in the north spreads further 26 new cases of dengue fever, taking the and far north of Cameroon, where severe flooding A study has found that a new drug can reset and total number of people affected by the mosquito- has taken place. The epidemic has currently claimed In the first week of September, Mexico’s top restart the body’s natural 24-hour clock, in research borne disease to over 900. The private Holy Family 341 lives and there are over 4,700 confirmed cases. epidemiological official reported a rise in the number that could mean the end of jet lag for frequent fliers. Hospital in south Delhi alone has reported 599 Health officials fear the outbreak might spread to of cases of dengue haemorrhagic fever (DHF) Professor Andrew Loudon from the University of cases of dengue fever among patients, although the other regions, due to students travelling across the throughout the Gulf Coast state of Veracruz. The Manchester, who performed the research, said: “It number of deaths is remarkably low. There has been country for the beginning of the academic year. disease is now moving towards Tamaupilas State can be really devastating to our brains and bodies one confirmed death due to the disease in Delhi; and There are regular cholera outbreaks between the and is getting closer to the US border. The recent when something happens to disrupt the natural three more deaths, suspected to be from dengue months of December and June, with Douala city, flooding in Mexico has been a factor in the increased rhythm of our body clocks. We’ve discovered that fever, have been reported, although authorities have Littoral province and the West and South West number of cases, with some 1,900 cases and 16 we can control one of the key molecules involved in yet to confirm the presence of the disease in these provinces the areas most usually affected. Tourists deaths being reported so far. setting the speed at which the clock ticks and in doing cases. have been advised that they should drink or use only Elsewhere, Europ Assistance has warned travellers so we can actually kick it into a new rhythm.” The problem of the spread of dengue fever has been boiled or bottled water and avoid ice in drinks; and if of a severe dengue fever epidemic in the Caribbean. The internal body timing system – the circadian clock made worse by the number of construction sites in they suffer from diarrhoea during a visit to Cameroon Health authorities in Guadeloupe and Martinique – is present in most living creatures and plants, driven the city building structures for the Commonwealth should seek immediate medical attention. are facing high numbers of dengue infection, by an enzyme called casein kinase one. Loudon Games. These sites became waterlogged as the which is unusual both in terms of scale and said: “Any change in casein kinase one activity, faster monsoon season has descended. According to DK duration. Since the start of the epidemic in or slower, would adjust the ‘ticking’ from 24 hours Sharma, medical superintendent at the All India late February, almost 22,000 people have to some other time period. Consider that if your Institute of Medical Sciences, the number of people contracted the virus in Martinique. The body suddenly starts working on a 23 hour or 25 suffering from dengue fever has been on the rise Antilles-Guiana Interregional Epidemiology hour clock, many of your natural processes, such as since July. He stated: “The number of dengue Unit (CIRE) said that 10 dengue-related sleeping and waking, could soon become out of step patients coming to the Institute this year, as a matter deaths have been recorded on the island, with day and night.” of fact in the whole of Delhi, is seven of which occurred in July. “With Dr Travis Wager, one of the other researchers who much more than last an estimated 3,500 cases in a week, the was part of the study, year.” The hospital is epidemic peak of 2001, which was the largest said: “Targeting the said to be overloaded seen during the last decade, has largely been inhibition of casein with patients, and exceeded,” said the CIRE in a statement. kinase one with small several of those who molecules may lead have been turned to the discovery of away are camping Peruvian plague novel drugs for the on the ground treatment of bipolar just outside. Dr The Peruvian Minister of Health has reported that as high as 75 per cent. So far, the cases in Peru have depression and Sharma said: a 14-year-old boy has died and that at least 31 been contained to the Northern coastal province other circadian “Once there others have become infected with the plague, with of Ascope, around 325 miles north west of Lima. rhythm is a surge in the vast majority of sufferers being diagnosed with The popular international resort of Chicama beach the number of bubonic plague. Although the plague is treatable is not far away, and the Health Minister has already dengue patients with antibiotics, the lack of timely intervention can ordered authorities to screen sugar, fish and meat and we have to be deadly. Untreated, mortality from the plague is exports from the region. admit some of these, naturally some other disorders. patients who The burden would normally of these disorders have got is enormous and admitted have new treatment to be deferred.” options are needed.”

Training vital for safety

A new report from the Association of Corporate duty of care. The session was presented by Tony Travel Executives (ACTE) and International SOS Ridley, director of security services in the Asia Pacific has pointed to the need for better travel health for International SOS. and security training for business travellers in Asia. Based on a 12-question survey of 161 ACTE The report, entitled ‘Managing the risks of a global members in Asia and throughout the Pacific Rim, workforce’, is designed to ascertain perception and more than two thirds of respondents claimed their levels of risk for outbound business travellers from companies had contingency plans and security the Asia Pacific region, while serving as a benchmark programmes in effect, consistent with previous for duty of care practices. “Promoting, preserving, association research. However, the remaining third and advancing traveller health and security is a key said that their companies either did not have a strong part of our primary objective,” said ACTE president security policy or did not have any programme at Chris Crowley. “It has always been foremost in our all. The report notes that most of these companies recommendations to various government authorities, do not send employees into high-risk areas, but for and emphasised at each of our educational events. those that do, 75 per cent do not see the need to The report is yet another way in which ACTE is conduct travel health and safety training. working with industry experts to ask the questions, The report included recommendations and checklists get the answers, and raise traveller health and for evaluating security and contingency plans. One security consciousness.” recommendation focused on realistic budgeting as The report was accompanied by an educational a result of the fallout from the volcanic eruption that session that outlined how companies can take happened in April this year. In the aftermath of the advantage of technology to reduce their exposure eruption, an estimated 60 per cent of corporations to risks in the context of adopting a culture affected by the disaster spent their entire contingency of health, safety and risk management; cost budgets for the year by the beginning of the second management considerations in making the business quarter of 2010. A key conclusion of the report states case for a comprehensive travel risk management that companies need to assess their approach to travel plan; and the role of communication in exercising health and security in a more proactive manner.

www.itij.co.uk 14 TRAVELMATTERS

Mexican tourism thrives … or does it? NEWSWIRE As the number of murders connected to the drug Despite the bad press and the official warnings, world continues to rise in Mexico, officials in the figures from the Mexican Tourist Board (MTB) This June saw an 11-per-cent increase in the country have claimed that the violence seems to be show that the number of international tourists number of online searches for hotels in long-haul having little effect on the number of tourist arrivals, visiting the country in June was up 35 per cent on destinations from the UK, according to search with visitors continuing to flock to the pristine beaches the same month last year – although swine flu hit analyst Greenlight, compared to number of on offer. Even the bomb that exploded in a bar in 2009 numbers hard. The MTB claims that 820,000 searches performed in March. Cancun, a very popular tourist hangout, has failed to international visits to Mexico were made in June, seriously dent the number of tourists arriving in Mexico, roughly 573,000 of which came from the US – a Insurewithease.com is urging holidaymakers as the bar in question was frequented by locals and 23-per-cent increase on last year. MTB figures also in Rome to heed a stricter dress code being was in a low-income area of the city, far from the show that 41,000 Canadians visited Mexico in June, Corporate travel up, enforced by the Vatican City authorities, which main tourist promenades. The warning from the US up from 21,322 in June 2009. However, figures includes visitors to St Peter’s Square. Bare shoulders State Department that advised Americans to delay from the US Office of Travel and Tourism Industries tourism drops or legs are no longer allowed. unnecessary travel to the Mexican states of Michoacan show a different story – according to the Office, the and Tamaulipas, Sinaloa, Durango and Coahuila also number of US air passengers flying to Mexico so far Whilst leisure travel has taken something of a hit Budget airline easyJet has come under fire seems, by and large, to be being ignored. The same this year has declined by 2.5 per cent, while in 2009 in recent times, business travel is keeping business for preventing thousands of disabled people from warning from the State Department ordered children of the number fell by 11 per cent compared to 2008. strong in some areas, as has been shown by recently flying on its planes by refusing to allow most US Government employees to leave Monterrey after So, the official figures don’t correlate, but what of published trading results from UK headquartered powered wheelchairs onboard. The airline is blaming a spate of kidnappings there. The warning continued: travel agent experience? Genevieve Shaw Brown, InterContinental Hotels and the UK arm of health and safety rules that govern what weight a “Although narcotics-related crime is a particular concern a senior editor for online firm Travelocity, believes German tour operator Tui Travel. The hotel chain baggage handler can take. along Mexico’s northern border, violence has occurred that Cancun is still Mexico’s most popular resort, and has reported encouraging trading thanks to higher throughout the country, including in areas frequented currently ranks 13 among Travelocity’s most popular demand among business travellers, but at the same The US Government has proposed to by American tourists. US citizens travelling to Mexico domestic and international locations. In a statement time, Tui said that its hoped-for spending rebound fine American Airlines $24.2 million for alleged should exercise caution in unfamiliar areas and be to Fox News, Brown said: “Two of the reasons has failed to materialise, forcing the firm to be more maintenance violations that led to thousands of aware of their surroundings at all times … in recent Mexico remains popular are value and convenience. cautious in its outlook. flight cancellations two years ago. years, dozens of US citizens living in Mexico have been There are direct flights to Mexico’s major tourist Tui’s poor third quarter was blamed on several kidnapped and most of their cases remain unsolved.” destinations from nearly every major city in the US. factors, including the effect on consumer confidence Germany has introduced an aviation tax Competition among airlines [also] helps to keep as a result of the April Icelandic volcano eruption, the that will add e25 on to the price of flights to pricing down.” Marita Hudson Thomas of UK Government’s emergency budget and decent the UK. The move is part of a package aimed at Orbitz.com agrees that the drug violence affecting weather in the UK, which lead to consumers booking reducing the deficit in Germany. swathes of the country is not really affecting Mexico’s holidays later on in the summer. Paul Bowlett, Tui’s resort towns, and in confirmation of that, Cancun chief financial officer, said: “The volcano knocked the UK-based Barwell Travel has ceased trading was recently named the company’s top international stuffing out of the UK consumer’s behaviour, and we for the second time in two years. The operator destination for US travellers for the Labor Day don’t think it’ll be right of us to predict that that will specialised in holidays to Spain. weekend. change until 2011. We’re not getting a bounce in the fourth quarter either.” Meanwhile, InterContinental’s chief executive Andrew Cosslett said the group had seen delayed New ESTA fee Lengthy recovery bookings, with lead times of two to three weeks Caribbean shunned compared to three or four months in 2007. Travellers looking to visit the US have been urged to predicted However, while that has caused ‘low visibility’ ahead, apply for authorisation to enter the country as soon Hugh Riley, chief executive of the Caribbean Tourism it did little to dent his optimism after a half-year that as possible in order to save money, according to A new report from British market intelligence Organisation, has recently visited the UK to ask for saw occupancy rates around the world rise despite British consumer watchdog Which? The Electronic company Mintel has said that increases in VAT a drop in the amount of Air Passenger Duty (APD) price increases in some areas. Revenues per room System for Travel Authorisation (ESTA) is the web- combined with higher fuel costs will make holidays tax travellers are being asked to pay on long-haul for InterContinental rose by 2.2 per cent across based approvals system that replaced the old green significantly more expensive from 2011, which could flights to the Caribbean, after a 25-per-cent drop in the hotel chain’s business, and by double digits in form – a visa waiver document that tourists used to cause a further dip in the travel market. Although the the number of visits from UK residents. Riley said certain destinations that are popular with business fill in during their journey to the US. The purpose report did state that there was a small chance of a that although the decline in traffic from the UK varied travellers – Germany and Shanghai were highlighted of ESTA is to officially authorise holidaymakers’ jump in revenue for the industry as the UK emerges from island to island, several Caribbean nations had as particularly successful. temporary residence in the country. Made slowly from the recession, the company did admit been the victim of what he termed ‘devastating’ According to the latest quarterly survey by the compulsory for all nationals travelling to the US from that this possibility was unlikely, warning: “Recovery is drops in tourist numbers. Guild of Travel Management Companies (GTMC) Visa Waiver Program participating countries in January not a word that can be applied to the holiday market The higher rate of APD was introduced in in the UK, business travel transactions for travel last year, ESTA has been free to obtain up until now. in the coming five years. Higher holiday prices due to November last year, and since the beginning of 2010 management firms are on the up, although they From 8 September, however, anyone using the US high VAT will hurt the market as the costs of low-cost the Caribbean has seen an average 12.2-per-cent remain below levels seen in 2008. Figures from the Government’s ESTA website has had to pay US$14 flights are increased.” fall in the number of visitors from the UK. Riley was Guild show a 12-per-cent increase in the number for travel authorisation. Without authorisation from According to Mintel's report, overall spend on foreign realistic, though, adding: “I am not suggesting that we of business travel bookings over the same period in ESTA, a holidaymaker would not be holidays by UK travellers is forecast to increase by can pinpoint APD as the only reason for the decrease 2009. The survey, which covered the three months allowed into the US. 17 per cent over the next five years, which is more – there is also the economy and other factors to take to June 2010, showed that air travel, hotel bookings, than the rise seen between 2005 and 2010, but the into consideration – however, I am telling you that rail travel and car rentals were all ahead of figures rise will be as a direct result of higher holiday costs. the majority of Caribbean countries have seen larger from the same time last year. In particular, it noted The report continued: “In constant price terms, decreases from the UK than from anywhere else. that air travel performed better than was expected, expenditure on holidays will decline by 1.6 per cent APD must be a contributory factor in the decline in especially in light of the ash-related air space closure between 2010 and 2015. Changing exchange rates visitors from the UK – it is logical that if you increase and industrial action against British Airways. Despite and higher fuel costs will play a major role in holiday the cost of a product then you reduce demand.” the positive note from the report, the GTMC was prices in the coming years and higher prices will limit Under current plans, cautious, saying that the growth in volume growth.” though, it is more transactions has not been equalled On a more positive note, the report, entitled likely that there will by an increase in revenue, thanks Holidays – Attitudes and the Impact of the Recession be another increase in to a general move out of first – UK, found some good news for travel agents. APD before the end class coupled with a noticeable The recession has led to more people booking of the year. At the reduction in public sector Watch short breaks through high street agents rather than moment, passengers expenditure on travel. However, your wallet choosing to book independently online. Travel agents flying from the UK to Anne Godfrey, GTMC chief and tour operators became 'noticeably more popular' the Caribbean pay executive, was extremely upbeat Travel review website TripAdvisor has surveyed its in the last year than in previous years. The report between £50 and when commenting on the findings: users to try and discern the cities in which travellers are concluded: “In the coming years, while beach and £100, depending “The survey of transactions by most likely to be pickpocketed, and the bad news for family holidays will continue to dominate the market, on whether or not GTMC members shows clearly European operators is that every single city in the top more diversification will be seen in holiday types. they fly economy that the recovery, no matter 10 is in the European Economic Area. Taking the very Niche products and destinations will see the fastest or first class. From how fragile, is underway for UK top spot is Barcelona, which it claimed for the second growth.” It also predicted that the use of online social November, this could plc. The results are particularly year running. Next on the list was Rome, Italy; then media websites would increase over the coming rise to £75 for an encouraging when you factor in Paris, France; Madrid, Spain; Athens, Greece; Prague, five years, which are going to 'challenge traditional economy seat and the truly exceptional items of the Czech Republic; Costa Brava (Alicante), Spain; Lisbon, notions of brand authority and marketing'. £150 for first class. ash crisis and industrial action.” Portugal; Tenerife, Spain; and London, England.

International Travel Insurance Journal

16 IPMI NEWS

FitzPatrick named at CIGNA ALC enters UAE Hep B expats safe

CIGNA Corporation has named Maggie FitzPatrick vice-president at APCO Worldwide, where she ALC Health, the international private medical to stay as its chief communications offi cer. In her new managed corporate communications for Fortune insurance provider, has announced its partnership role, she will have overall responsibility for global 500 companies. with Arab Orient Insurance Company to underwrite New expatriate workers who are found to have communications, reporting to chief executive David Cordani said of the appointment: “Maggie its worldwide health plan for companies and hepatitis B when they undergo their medical test will not offi cer David Cordani and will also be joining has the knowledge and skills to lead CIGNA residents in the United Arab Emirates (UAE). be deported from Dubai any more, according to the CIGNA’s Enterprise Leadership Team. communications as we accelerate our growth The strategic partnership means ALC Health’s Ministry of Health; instead, the expatriate will be treated FitzPatrick is a communications executive with across the globe. Her experience working in products may now be sold in the region and for the illness. Expatriates already resident in Dubai will broad experience in corporation communications, diverse sectors and understanding of global further consolidates the company’s growth and not be asked to undergo the test for hepatitis B, while media relations, reputation management, mergers business trends make her the right person to lead development in the Arab tests for hepatitis C will and acquisitions and corporate social responsibility CIGNA’s communications in this time of change states. no longer be needed programmes. Previously, she was an executive and opportunity.” Arab Orient Insurance under new health rules. Company, based in Dubai, Those already in the is part of the Al-Futtaim UAE have also been told Group and is considered that they will no longer Claims service rewarded to be one of the leaders have to undergo tests in insurance development for tuberculosis – new International expatriate insurance specialist William rather than a call centre approach.” She added: “Our in the UAE. ALC Health’s arrivals, though, will be Russell has announced the half-yearly results of its claims assessors will normally deal personally with their Prima range of products, tested for pulmonary customer health claims survey 2010, which reveals client throughout the duration of their claim, and we which are designed to TB and those who have that 96 per cent of members report that they were received many excellent testimonials for the dedication offer fl exibility to suit the disease will not be satisfi ed with the service they received from the team and care shown by our team members. But, there is no individual needs, will granted a residential when making a claim, and the same proportion of room for complacency and we will continue to work now be available to the visa. Dr Mahmoud Fikri, members stated they were satisfi ed with the length hard to ensure that our service is of the highest possible expatriate community. executive director of of time taken to settle their claim. The claims survey standard, consistently into the future.” Andrew Apps, director of Andrew Apps health policies in the is sent to members of William ALC Health, commented UAE, said that the new rules Russell’s international health plans on the announcement: “We are delighted to partner have been put in place to protect both expatriates and who make a claim on their policy, with Arab Orient Insurance, one of the best general locals, making the UAE a disease-free place to live. and the statistics were calculated insurers in the region, allowing us, and our broker Minister of Health Dr Hanif Hassan had earlier told from all returned surveys within the partners, to enter this fast-growing expatriate media that the changes in the medical check-up period January to June this year. market. This new and exciting strategic alliance offers system for expatriates will cover any gaps that had Claire Parrott, international claims companies in the UAE comprehensive international previously been identifi ed in the system, especially manager at William Russell, said: insurance plans for employees and their dependants, with the number of foreign workers entering the “The real test of an insurance both at home and abroad.” region being on the up once more. He added company is when you need to make that, if needed, the Ministry was willing to increase a claim. Our claims team members the number of medical centres that perform the are highly trained and extremely health checks. customer focused. We want to offer For those who do test positive for hepatitis B, our clients a very personal service, ACM accredited by they will need to take three doses of the relevant vaccination and show proof that this has been carried URAC out, with workers needing to show the vaccination certifi cate Akeso Care Management (ACM), the specialised at the time of renewing their medical management division of International Medical visa. The category of workers Group (IMG), has been awarded Health Utilisation who will have to undergo Management Accreditation by US-based URAC, tests for hepatitis and syphilis a leading healthcare accrediting organisation that include nannies, housemaids, establishes quality standards for the healthcare industry. nursery and kindergarten ACM provides medical management services to supervisors, beauticians and domestic and international insurance carriers, self- barbers, health club workers insured employers and third party administrators. and food handlers. If a person The services include utilisation reviews, large case proves to have syphilis, they management, emergency medical evacuations, will now be treated for the discharge planning and medical bill review, all designed disease rather than deported. to provide appropriate and cost-effective patient care. Female workers, especially Carolyn Tinslet, executive vice president and chief maids, nannies and drivers, operating offi cer, commented on the award: “We are will also be asked to undergo honoured to receive the Health Utilisation Management a pregnancy test. If the test is accreditation from URAC. The full accreditation is truly positive, it is left to the sponsor a refl ection of the quality work that we provide to our of the expatriate to decide whether to allow her to customers and assures them that we meet leading work or to send her back to her country of origin. national standards in the industry.” Alan Spielman, URAC president and chief executive, said: “By applying for and receiving URAC Utilisation Health Management accreditation, Akeso Care Management has demonstrated a commitment IPMI PROVIDER to quality healthcare. Quality healthcare is crucial to our nation’s welfare and it is important to have organisations that are willing to measure themselves against national standards and undergo rigourous evaluation by an independent accrediting body.” In related news, IMG has announced that its US headquarters received confi rmation of its continuing Interglobal certifi cation to ISO 14001:2004. Joseph Brougher, president of the company, said: “I am extremely CONTACT: Peter Rousseau - Group Business Devlpmt. Director proud of our team for their enthusiasm and efforts Woolmead Hs East, The Woolmead, Farnham, in achieving our objectives and complying with the Surrey, GU9 7TT UNITED KINGDOM ISO standards. We demonstrated that we have taken tel: +44 (0)1252 745 900 active steps to fulfi l our responsibilities, [and] we fax: +44 (0)1252 745 920 email: [email protected] remain committed to reducing our environmental web: www.interglobalpmi.com footprint and to provide an atmosphere for our employees that is clean, healthy and safe.”

International Travel Insurance Journal IPMI NEWS 17

CIGNA acquires Apollo Munich launches policy

Vanbreda The Apollo Group of Hospitals in India, together and do not wish to undergo a health check before with insurer Munich Health, have formed a purchase. Another plan is Easy Health, which offers International joint venture under the name of Apollo Munich comprehensive cover available in three variants, Health Insurance. The company is only the each of which has certain benefits that are unique Global health services firm CIGNA has second standalone health insurer in India. The to it. The Maxima Health plan is an all-round acquired Vanbreda International, based in main motive of the firm, said a spokesperson, is health insurance plan that is designed primarily to Antwerp, Belgium, giving CIGNA a new to simplify the healthcare system in the country provide customers with cover against inpatient and reach in expatriate benefits and further – in order to achieve this end, the company outpatient medical costs. Finally, Optima Cash is a accelerating the company’s growth strategy. provides its customers with plans specifically daily hospital cash plan that has been designed to Privately owned, Vanbreda International designed to provide complete coverage. They enable policyholders to cope with the extra costs specialises in the provision of worldwide are written in plain English, making them easy to that are incurred during hospitalisation. The benefits medical insurance and employee benefits to understand for the average insurance consumer. of the Optima Cash plan can be selected for either intergovernmental and non-governmental There are four different health insurance plans 90 or 180 days and the plan provides lump sum organisations, including humanitarian available: Insure Health, which is an inpatient plan amounts to insured individuals during the period of operations, as well as corporate clients. intended for those who wish to buy quick cover hospitalisation. Representing the largest customer base of globally mobile employees working on assignment in virtually every country in the world, together Vanbreda International and CIGNA care for more than 700,000 expatriate customers worldwide. William Atwell, president of CIGNA International, said of the deal: “The acquisition demonstrates CIGNA’s growth strategy to go deep into existing segments, to go global – seeking worldwide opportunities to diversify our earnings stream, build on strengths and serve customer needs – and to go individual, as Vanbreda International has a growing portfolio of international individual business.” Atwell also stressed the ‘strong cultural fit’ that exists between the two companies. Under the Vanbreda International brand, the company will continue to operate as an independent business under the existing leadership of chief executive officer Rudi Bertels and chief operating officer Wouter Reggers. Bertels said of the deal: “As we join forces with CIGNA, we look forward to building on our proud legacy of service and adding enhanced capabilities for our customers, such as CIGNA’s leading suite of health and wellness offerings.”

Regulatory concerns in the UK

Mike Izzard, former chairman of the Association of Medical Insurance Intermediaries and managing director of private healthcare firm Premier Choice Healthcare, has said that the private healthcare industry in the UK needs a major overhaul to prepare for stricter rules from the Financial Services Authority (FSA). Izzard believes that the financial services watchdog will soon be channelling all of its energy into the regulation of retail finance products as it is soon to be dismantled, with most of its power being transferred to a subsidiary of the Bank of England. Izzard said: “There is a worry that the FSA will be diluted by the Bank of England, which will take on the macro-prudential regulation. But I think the FSA will keep the same number of people at the moment and metamorphose to look primarily at the retail sector, so its focus on healthcare will be more intense.”

www.itij.co.uk 18 CROSS BORDER CARE

PATA advisory force to launch Indian backlash over new superbug

The Pacific Asia Travel Association (PATA), a up the advisory force: has a window of around 10 years before NDM1 membership association that acts as a catalyst for the “We are keen to identify becomes fully resistant to antibiotics. responsible development of the Asia Pacific travel both the opportunities There have been reports that some of the people and tourism industry, has announced its intention and challenges in this who contracted the bug did so while undergoing to set up a healthcare travel advisory task force. niche for our members treatment at hospitals in India, but the Ministry of The task force is to be set up in conjunction with and potential new Health has strenuously denied such claims, and has MEDICO Services International of Bangkok, through members. Medical protested at the name given to the bacteria. In a press volunteers and contributions from PATA members tourists are customers release issued by IndiaTourism Toronto, the director with experience of the medical tourism market. for airlines, hotels, tour general of the Indian Council for Medical Research Dr The group will meet periodically and comprise of operators and insurance VM Katoch called associating the bacteria with India between 10 and 15 members from many different companies, as well as ‘misleading’ and ‘unfair’. He added: “The Government sectors of the tourism industry. hospitals and wellness of India has strongly refuted the naming of this enzyme The two parties, PATA and MEDICO Services spas.” Moving on to the as New Delhi-matallo-beta-lactamase and also International, have already identified several key role the group will play, refutes reports that hospitals in India are not safe for issues that they say need to be addressed. These Duffell added: “This new treatment, including medical tourism.” include liability issues surrounding medical tourism; advisory task force will Dr Prafull Pawar, chief executive of Apollo Hospitals, guidelines to create specific medical tourism conduct surveys, gather said that while some patients from the UK might now destinations; medical travel insurance; the need for opinions, enable debates, think twice before heading to India for their medical increased co-operation across this niche market; and and push for solutions to A new superbug has emerged from India – New treatment, the overall medical tourism industry networking and data exchange for medical tourism share with the industry at large … We also envisage Delhi metallo-beta-lactamase (NDM1) – which has would not be adversely affected: “It is not that the specialists. a programme of specialised conferences and concerned doctors around the world after the first superbug news will stop people from the UK or US Greg Duffell of PATA commented on the plans to set workshops for industry stakeholders.” death due to the bug was confirmed in Belgium. from coming to India for treatment. There have been Meanwhile, Dr Timothy Walsh, a medical professor at Cardiff MRSA and other difficult bugs prevalent in the UK representative of University in Wales, first identified NDM1 after a as well.” He added, though, that Indian authorities MEDICO Dr Zadok Swedish man who was hospitalised and treated should review its policy on antibiotics where free Lempert added: unsuccessfully for pneumonia and E-coli infection availability and use of antibiotics is contributing to a “Medical tourism in India returned home with the antibiotic-resistant higher drug resistance among patients. Dr Bhavini is quickly gaining bacteria. Upon investigation, Professor Walsh Shah, an infectious diseases control consultant and awareness in consumer discovered the bacteria were carrying a common microbiologist, said that the emergence of NDM1 markets. Over the gene, NDM1, which is an enzyme that is highly is now a reality, and that hospitals should invest past decade, Asia has resistant to carbapenems, a class of antibiotics more money and research into infection control. He been the preferred considered as treatment of last resort for bacterial added: “It is a fact that this superbug exists. We have destination for many infections such as E-coli. known this all along. The right approach would be people seeking Most of the cases of NDM1 infection noted so to invest more on checking infection in hospitals.” less expensive, but far worldwide have been in India, Pakistan and Since the article in medical journal The Lancet was high quality medical the UK, with several more appearing in the US, published, researchers in India have said that they treatments.” Sweden, the Netherlands, Australia and Canada. knew of the existence of the bacteria as long ago as Although the two cases in Canada recovered, March this year – their research found 22 incidences medical scientists have voiced their concern that of NMD1 between August and November last year. the antibiotics used to treat the infection could The team from the Hinduja Hospital said in the soon become ineffective. Professor Walsh told one Journal of the Association of Physicians of India: “This British newspaper: “In many ways, this is it. This is high number in a relatively short span is a worrisome potentially the end. There are no antibiotics in the trend. The growing incidences and also the diversity pipeline that have activity against NDM1-producing of carbapenemase-producing strains is therefore of Enterobacteriaceae.” In Walsh’s opinion, the world major concern.”

Singapore in swing

Figures collated by the Singapore Tourism Board Arabic TV channels, during their hospital stay.” have shown that the island has witnessed an average Formerly, Singapore sold its medical services on annual increase of 20 per cent in the number of quality rather than price, but thanks to increased medical tourists from the Middle East. The most competition, prices have gradually started to come common procedures or treatments required by down, which is aiding the government in its bid to the Middle Eastern visitors are live donor liver attract the millions of foreign patients it hopes to transplants, in-vitro fertilisation, heart procedures, cater to. Malvinder Mohan Singh, chairman of Fortis stem cell transplants and cancer treatments. Healthcare, has said he has grand plans to turn Jason Ong, spokesman for the Singapore Tourism Singapore into a pan-Asia healthcare hub, despite Board, said: “Middle East populations are realising his failed bid for hospital operator Parkway. Singh the benefits of travelling to Singapore for a wide said that the quality of medical education and the range of medical procedures, which has resulted public healthcare system makes the city-state an ideal in year-on-year double-digit growth in the number healthcare destination. of regional medical tourists. Middle East patients can be certain that they will receive the highest quality of treatment and follow- up care in Singapore, which has repeatedly shown itself to be on a par with the best in the world. They can also be certain that their cultural and religious needs are attended to with Arabic-speaking service personnel, Halal food and even CROSS BORDER CARE 19

Surgery Mexican Health Travel Association formed

Overseas In order to cater to the growing health travel industry for all of Mexico.” asked to conduct monthly webinars over the next number of US and Canadian medical He went on to outline his plans for the future of year that highlight capabilities and opportunities starts up tourists wishing to go to Mexico for the Association: “We are implementing a wide- in the emerging Mexican market. Maria Todd of healthcare procedures, the Mexican reaching education strategy to highlight Mexico’s Mercury Healthcare commented on the formation A new website, Health Travel Association has been travel health market, [and] Mexico must plan and of the Association: “In today’s global environment, SurgeryOverseas.com, formed, with Carlos Arceo at its helm. design strategies to promote medical, scientific, many organisations and US insurers seek information has been launched Arceo said of the move: “As US insurers technological and tourist efforts to position itself at an on quality, affordable medical options.” While Jim at a medical tourism take notice of US consumer interest in international level as one of the top destinations in Arriola of Sekure Healthcare said: “When the first conference in Sao Paulo, Brazil. It offers medical having costly medical procedures performed abroad medical tourism. Mexico could become the favourite US insurers received regulatory approval to sell tourism providers high conversion rates due to being due to prohibitive costs and long waits, Mexico is destination among US citizens leaving their country cross-border healthcare coverage in California 10 able to target patients based on the procedure or an attractive medical setting. The past three years and searching for medical attention in the next three years ago, addressing quality assurance was arduous treatment they are seeking. The site enables users are remarkable for Mexico as there are now eight years, due to its geographical vicinity and its costs, for insurers and state regulators. I expect more US to research procedures either in their country of hospitals with Joint Commission International (JCI) which are generally 30-per-cent cheaper.” insurers will extend benefit coverage into Mexico as residence or abroad, then connects the user with accreditation and 71 private hospitals with national Mercury Healthcare of Denver, Colorado, and accreditations and certifications demonstrate quality vetted medical companies that match that person’s certification. Our association is a platform for the Sekure Healthcare of San Diego have both been and minimise risk management concerns.” requirements. The business has launched with an already robust portfolio of clients, according to co- founder and chief executive Rob Passmore. Clients include Angeles Health, Travel for Care, Croatian Medical Tourism, Debson Medical Tourism and Health Travel Guides. Passmore said: “We’ve listened very hard to what the international healthcare community has been asking for from its marketing and we heard two key things. Firstly, a desire for a more cost-effective marketing solution than Google Adwords; and secondly, a desire to not share patient enquiries with competitors, unlike those working with lead generation companies.” Herb Stephens, chief executive of Health Travel Technologies and a launch partner, commented on the new company: “SurgeryOverseas.com is a groundbreaking marketing solution for international healthcare companies seeking better efficiency and effectiveness of their online marketing dollars. Health Travel Technologies is proud to be a strategic partner with SurgeryOverseas and I’m certain [the company] will gain prominence in the stable of marketing tactics employed by medical travel stakeholders.”

SimpleCare World Health starts service

A new medical tourism agency with offices in Miami, Florida, and Malaga, Spain, has begun to offer its services to international medical travellers. SimpleCare World Health offers access to hospitals in Spain for non-acute operations and medical procedures, such as orthopaedic surgery, hip/knee replacements, cardiac surgery including coronary artery bypass and heart valve replacement. According to SimpleCare, even with the travel costs involved for US citizens, they will still be able to save significant amounts of money in Spain compared to how much they would have to pay in their own country. The package on offer from SimpleCare includes flights to and from Spain; a pre-paid mobile phone so the patient can stay in touch with family back in the US; a consultation with the appropriate specialist; booking into a hospital for the operation; accommodation and concierge services for the patient and their companion; and arrangements for aftercare while the patient remains in Spain. 20 AIRAMBULANCENEWS

Waypoint AirMed & Rescue 2010, our inaugural combined conference, exhibition and airshow, was held on the 8th and 9th September at London Oxford Airport, UK. The event saw fi xed and rotary-wing air ambulance aircraft and crews come together with military search and rescue personnel to network, share experiences and discuss the latest industry developments. The stands in the exhibition hangar gave delegates the opportunity to meet and greet representatives from a range of aeromedical and air rescue providers, along with manufacturers and suppliers of medical equipment, avionics and aircraft. Further attractions in the hangar were the Waypoint AirMed & Rescue Challenge stage and the dedicated networking area (conveniently located next to the bar). 8-9 September Alongside the hangar were the aircraft display areas, for an up- close-and-personal look at some of these lifesaving machines. London Oxford Airport, UK The conference sessions, held in the airport’s pilot training academy, were well attended and the wide variety of topics covered by speakers from various industry sectors prompted plenty of discussion afterwards – you can read all about it in the following round-up of the sessions. Thanks to all the delegates, speakers, sponsors and exhibitors for making this such a successful debut. And a special thank you to the team at Waypoint and Voyageur Events for their hard work behind the scenes. Here’s to a bigger and better event in 2011!

With thanks to Eurocopter UK & CHC Search & Rescue for supporting the event

With thanks to Aircraft display FAI rent-a-jet Exhibition for supporting the On display at Waypoint AirMed & Rescue 2010 Ambulance and AirMed UK also proved very popular networking area were a fully kitted out EC135 helicopter from the with delegates, many of whom had not seen the Thames Valley and Chiltern Air Ambulance Trust, inside of a modern fl ying intensive care unit before. a BK117 from East Anglian Air Ambulance Trust, Delegates were treated to the sight of the Thames and a Falklands War vintage Westland Wasp. The Valley and Chiltern helicopter taking off and landing fi xed-wing air ambulances on show caused a stir for missions on a number of occasions over the among participants, with crowds of people examining course of the conference, serving as a reminder Cega’s Beechcraft King Air, while the state-of-the-art of the vital nature of the work air ambulance medically equipped Learjet 35As from European Air crews perform.

A Learjet 35A from The exhibition area in the aircraft AirMed UK, which is hangar was busy throughout the based at the airport course of the conference, with around 20 different companies showing their wares to delegates. Representatives from all areas of the aeromedical industry were present, from avionics A CEGA Air Ambulance manufacturers to air ambulance King Air, showing the charities and private companies patient loading system The networking area, sponsored by FAI rent-a-jet, was also a popular attraction. The stage for the Waypoint AirMed & Rescue Challenge was also in the exhibition area, with many delegates combining a visit A dedicated air ambulance Learjet 35A from to the booths with a look at how European Air Ambulance, the paramedics were coping with with plastic wall panels for their given scenarios. enhanced hygiene

International Travel Insurance Journal AIRAMBULANCENEWS 21 Conference Sessions The Waypoint AirMed & Rescue 2010 conference sessions took place over both days of the event in the Pilot Training Academy at London Oxford Airport, and were moderated by editor of Waypoint, James Paul Wallis. The sessions were well attended, with plenty of debate following each presentation. Details of the selected sessions follow below: Conference Session Moderator: James Wallis – Editor, Waypoint AirMed & Rescue Magazine DEVELOPMENTS IN AIR MEDICAL TRANSPORT AND CREW RESOURCE MANAGEMENT

ith the broad subject of air medical clinically necessary. As outside sources, such as the industry as a whole can improve financial and leads to enhanced customer service, fewer complaints transport developments, Martin national governments clinical decision-making, conduct clinical research, and a reduced risk of litigation. The roots of best focused his presentation on training, and the World Health and better plan for the future. Such co-operation practice, said Martin, are: all staff members should W medical ethics and standards. The Organization, continue to may best be fostered by organisations partnering work together and know what each others’ jobs are, aeromedical industry includes a wide variety of decline to take a lead role with providers elsewhere in the world with a similar in order to form a cohesive team; research, which organisations and mission profiles, from short-hop in aeromedical research fleet and/or mission type in order to learn from each strengthens education and forms the principals for primary mission helicopter flights, to medium-range and setting standards, others’ experiences. creating standards; aeromedical standards – in general, interhospital transfers, to long-haul repatriations on the solution has to come aviation aspects are well regulated, but from a medical fixed-wing aircraft. Advances and improvements in from different providers, Priorities point of view, standards may not exist or may not be the industry are being held back by the fact that data including assistance and In terms of the priorities for aeromedical providers, compulsory depending on a provider’s location. is not shared between organisations. Research into insurance companies, Martin observed that medical ethics are increasingly Martin observed that access to relevant education the most efficient and effective working methods overcoming the coming to the fore as a priority. One recent innovation is increasing, with a growing number of university- is badly needed, he said, as this is a relatively new barriers to co-operating Dr Terry Martin is the use of ‘boot camp’ style training, where recruits based programmes and academic distance learning industry, but it is hindered by a lack of information (technology, time, staff, Course Director, are put through a training course, with only those courses being offered worldwide. However, and data on air medical missions; Martin noted he money and commercial CCAT who perform well being employed. The importance literature remains scarce, although he expects this to often hears of patients being airlifted when it is not competition), so that of ‘best practice’ is being recognised, which, he said, improve in the next decade.

INNOVATIVE CONCEPTS IN SETTING UP NEONATAL MECHANICAL VENTILATION AIR TRANSPORT SERVICES

ecent pandemics, such as SARS, bird flu does cause a fall in blood pressure, countered with n Scotland, an effective patient air transport space limits the care that can be delivered during and swine flu, all had in common that the medication or by increasing blood volume. Before use, service is a must, as patients are often separated flight. For example, when installed in the helicopters, main impact was on the lungs of those a Doppler ultrasound scan is needed on the femoral from appropriate treatment centres by long the end door of the incubator cannot be opened to R affected, and Buchsein predicted that the artery and vein to check they are large enough to Idistances, mountainous terrain or water access the baby if reintubation is required. next pandemic is likely to share this characteristic. accept cannulas. The use of ECMO is not a complete crossings. Most National Health Service neonatal The work to begin flights included consultation with This, and the trend for increasing numbers of older replacement for mechanical ventilation, but rather units, Wilson noted, are located in a central belt a range of regulatory

patients, means that air ambulance providers are allows a reduction in the pressure, volume and FiO2 where most of the population is found. Babies bodies – the National likely to see increasing numbers of patients with levels on the ventilator to reduce lung injury. requiring treatment in more rural areas will need Health Service, the severe lung failure. Of around 500 cases per year rapid transport to reach these centres of care, European Aviation Safety that FAI sees, around 23 per cent require mechanical either by fixed-wing or helicopter air ambulance Agency, the Health ventiallation. For dealing FAI rent-a-jet recently depending on the location. and Safety Executive, with such cases, Buchsein completed its first transport In the past, before the neonatal air transport service healthcare services’ stressed the importance was set up, neonates were typically transported trade unions and the of having well-trained onboard a Learjet with the by Ministry of Defence helicopters. Although large Ministry of Defence. staff and carrying a blood Novalung ECMO device enough to take incubators, these aircraft lacked An incubator system gas analyser in flight. electrical power or medical gas supply, and were had to be designed and Implementing an in-flight expensive, with a minimum charge of £25,000 per certified that could be Anne Marie Wilson bronchoscopy capability Buchsein advised that staff training is essential, which flight made to the Scottish Ambulance Service. With carried by fixed-wing Transport is also worth considering. in FAI’s case included practising the techniques on a the development of a dedicated loading system and aircraft, helicopters and Co‑ordinator for North and West When even advanced pig. He added that although the mission was a success flight-adapted incubator kits, neonates can now be ground ambulances, Scotland Neonatal mechanical ventilation and the team now feels confident in the technique, transported using the Scottish Ambulance Service’s with each transfer Transfer Service Thomas Buchsein techniques are no for the next mission, a perfusion will probably be King Air planes and EC135 helicopters. The powered between vehicles taking Medical Director, FAI Scotland longer sufficient for the taken onboard. loading system was needed for the King Airs, as the a maximum of five rent-a-jet gas exchange required Overall, ECMO is a viable technique for air ambulance incubator is too heavy to handle manually. With both minutes. by a patient, devices companies, even on smaller aircraft, and Buchsein the planes and the EC135s, patients are stabilised as for extra-corporeal expects demand to rise in the future. much as possible before take-off as restricted cabin Equipment oxygenation may be an appropriate solution, he said, The system comprises referred to variously as extra-corporeal membrane a metal framework that houses the incubator. oxygenation (ECMO), extra-corporeal lung Other medical equipment is housed so it is secure assistance (ECLA) or pumpless extra-corporeal lung and accessible. A collapsible base, which had assistance (PECLA). ECMO is largely a hospital-based to be compatible with all the above vehicles, is procedure, as the equipment needed to take arterial transported with the incubator to allow unloading blood outside the body, add oxygen and remove at the destination. The overall size of the system carbon-dioxide, then return it to body via a vein, is was dictated by the EC135 cabin space, with a low typically of a considerable size. height to allow rear loading. Contributing to the design were Bond Air Services, Aerolite, Rotortech, FAI’s approach Paraid, the Scottish Ambulance Service and the The large version of the set-up can be housed in a neonatal retrieval team members. road ambulance or large aircraft such as a Dornier 328, As nitrous oxide cylinders are often carried, legal but FAI rent-a-jet recently completed its first transport requirements for the transport of dangerous goods onboard a Learjet with the Novalung ECMO device and pressurised equipment had to be met, and produced by Intervention Lung Assist. This consists of procedures developed in case of leaks. In one of the a small box that houses the gas-transfer membrane, helicopters, the escaped gas is removed by opening small enough to be secured between the patient’s legs a window, but a leak occurring in one of the planes during flight. No pump is required, as the system is would mean diverting to the nearest airport and driven by the patient’s own blood pressure; but this possible ground transport to the nearest hospital.

www.itij.co.uk 22 AIRAMBULANCENEWS

HOW HIGH DO WE FLY? CHOOSING THE CORRECT ALTITUDE FOR THE PATIENT

arwick’s presentation stemmed Pneumocephalus skull monitored during the fl ight experienced no harmful. However, one research paper from 2001 from a background of his company Turning to pneumocephalus (the presence of air or gas signifi cant issues. Although the report did not state looked at patients with a gas volume of 15 to 20-per- receiving regular requests for the in the skull), Warwick stated that around 75 per cent what the cabin pressure was and did not include cent of the eye. A control patient with no gas present W transport of patients at sea-level of the cases that fi xed-wing air ambulance operators evidence from any long-term follow-up of the patients maintained a constant eye fl uid volume when cabin pressure. In many cases, he said, see are due to skull fractures, compared to a control group, the study suggests that exposed to a pressure equivalent to cabin pressure this is an unnecessary precaution based although other causes include the traditional dogma should be reviewed. at cruising altitude. In the patients with gas bubbles, on perceived wisdom rather than pituitary surgery and ear-nose- fl uid volumes increased as the ambient pressure clinical need, and can have a detrimental and-throat surgery. He questioned fell (equivalent to aircraft ascent), but returned to effect on the patient as increased fuel the traditional view that sea-level normal when the pressure levelled off (equivalent to consumption means more fuels stops, transport is required for all patients in most cases, it’s likely maintaining cruising altitude). As pressure was then take-offs and landings, which sick patients with pneumocephalus where the gas that adult patients with gradually increased to a sea-level value (equivalent to ‘do not like’. Abdominal distension, for is not under pressure, citing a clinical intraocular gas do not aircraft descent), volumes fell before again returning example, is unlikely to be a signifi cant study from the US military. The study require sea-level pressure to normal. In only one patient were problems issue in most adults, as ‘you can fi t a lot group consisted of 21 patients fl own experienced and the experiment aborted. These of gas in an abdomen’, though risks are on fi xed-wing aircraft at standard results suggest that in most cases, it’s likely that adult greater for neonates. Many articles list cabin pressure, representing a range patients with intraocular gas do not require sea-level gas gangrene as a contraindication to Jonathan Warwick, of causes of injury and initial volume Intraocular gas pressure unless the bubble is more than around 50 Medical Director, fl ight, said Warwick, but cases are rare of air inside the skull – determined Intraocular gas, where an air bubble is present in the per cent of the eye fl uid volume. AirMedical UK Ltd due to improved surgical techniques and by a computerised tomography eye, is another condition where sea-level transfers In summary, Warwick advised that each patient penicillin, and a patient with gas gangrene (CT) scan. None of the group are requested – but is this always needed? Where should be assessed on an individual basis and that severe enough to require a sea level transport will exhibited neurological deterioration during transfer, there is a large volume of gas inside the eye, animal decisions are best left to the clinical escort team, probably be too ill to fl y. and three patients who had the pressure inside their studies have shown that aircraft cabin pressure is rather than relying on traditional dogma.

DEVELOPING INTERNATIONAL STANDARDS OF AEROMEDICAL CARE BOTH IN THE UK AND AUSTRALIA

rier’s missions is essential, noted Grier, due to the trauma and crew resource management. One of experience particular nature of these calls. For example, one of the diffi culties of working the diffi culties of working on scene is coping with is mainly working in a hospital is very different from on scene is coping with onlookers; onlookers, so the simulation exercises on the G in the responding to a scene call, such as a person trapped course are carried out with plenty of bystanders to southeast UK, and under a train, or working at height or in darkness. the simulation exercises on the create an ‘audience effect’. The exercises include he is currently clinical course are carried out with trauma patients, stroke/intracerebral haemorrhages, lead for the Essex Air HEMS Crew Course plenty of bystanders to create an life-threatening asthma and meningococcal Ambulance charity. He went on to give an overview of the HEMS ‘audience effect’ septicaemia. Grier stressed the importance of Training specifi c to Crew Course (HCC), developed by the Great HEMS medical crew members learning how to primary air ambulance North Air Ambulance Service, University of Teeside trauma and medical topics. There are lectures, make decisions on the best places to take patients, and London’s Air Ambulance. The course runs over including the epidemiology of trauma, traumatic often choosing between nearer, lower levels of care Dr Gareth Grier, Clinical Lead, seven days and covers pre-hospital anaesthesia, coagulopathy, mechanisms of injury, maxillofacial or more distant, specialised centres. Essex Air Ambulance & London HEMS

aving attended the HCC discussed air medical team is the ICU, said Mazur. locations. The James Cook University importance of the audience effect, but there are by Grier and developed a course Transport times in the country can be up saw that the course that had already differences, such as the need to study the effects in Australia, Mazur is aware of the to three hours. been developed could form the of altitude due to the prevalence of fi xed-wing H similarities and differences between Healthcare in Australia is run by the basis of a postgraduate qualifi cation. ambulance aircraft in Australia. training in the two countries. The aeromedical individual states, which each decide how Students taking the course gain Having university recognition for the course, said transport environment in Australia differs signifi cantly to set up retrieval services. The nation points towards a postgraduate Mazur, has had a signifi cant positive effect, creating from the densely populated UK, he said, noting is host to a range of different retrieval qualifi cation in aeromedical retrieval demand from other air medical providers such as the the Australian concept of ‘retrieval medicine’ is companies, which all carry out their own or a masters degree in public health. Royal Flying Doctor Service. Looking to the future, defi ned as ‘the utilisation of medical, nursing, and/ training with no overall agreed standard. There are a mixture of delivery James Cook University is currently writing a new or paramedical personnel to facilitate the clinical approaches, including online learning, module on neonatal care in the air. management and safe transport of a patient(s) University recognition teleconferences and assignments. Dr Stefan Mazur, from one location to another’. This includes both The course Mazur has been involved Three core units cover topics such Emergency and primary and secondary missions, though only about with originated from CareFlight as crew resource management, having university recognition for the Retrieval Physician, course has had a signifi cant positive 10 per cent are primary. A lot of calls are ‘modifi ed Queensland’s need to train a group Medstar (South extrication, anaesthesia, splinting, winch primaries’ – for example, where a patient is ‘scraped of registrars that the company could Australian Retrieval rescue, survival and fl ight physiology. effect, creating demand from other off the road’ and taken to a nursing station with only deliver distance learning to, as the Service) Similarities to the UK course include air medical providers low-level care available. In such a case, the arriving registrars were to be based in several the medical simulations and the

International Travel Insurance Journal CONFERENCE AGENDA 2010

MEETING ROOM 1 MEETING ROOM 2

Monday, 8th Nov 10:00 - 13:00 Registration and lunch 14:00- 15:00 Hygiene on board an air ambulance 14.00-17.00 Sightseeing Tour sponsored by Rowland Brothers Int. 15:30 - 17:00 Fitness to fl y: who makes the decision?

Tuesday, 9th Nov

10:00 - 11:00 The expected changes and 10:00 - 11:00 Permit Requirements including 5th developments to healthcare when & 7th Freedom Flights Turkey joins the European Union. 11:00 - 13:00 Case Studies: Cost containment Turkey 1: Mogadashi 2: Response to Disaster: Haiti 11:00 - 13:00 Mobile Technology - how apps can 3: War zones work for you and new marketing opportunities 14:00 - 15:30 Major disasters - are we prepared? 15:30 - 17:00 Air Ambulance Focus Group - 14:00 - 15:30 Assistance world markets - Our IAAA update presenters give a detailed look at their regions: Japan, Jordan & Turkey 15:30 - 17:00 Ten suggestions for clinicians and insurers to live happily ever after...

Wednesday, 10th Nov

10:00 - 11:00 UAE provider fraud from a Western 10:00 - 11:00 Assistance medicine; Case Study perspective. - Polytrauma in Djibouti, the synergy between assistance & air 11:00 - 12:00 Cashless outpatients ambulance co. Centres of excellence, where are 12:00 - 13:00 Product differentiators - an aid these new centres and why are to cost containment and insurer the considered to be leaders? member servcie or just nice to have? 11:00 - 13:00 Assistance medicine - Changes in 14:30 - 15:30 Product development repatriation with the change of client, focusing on the elderly and 15:30 - 17:00 Medical Directors Forum obese passenger. 2 14:30 - 15:30 Assistance in countries with a big territory: specifi cs and challenges.

Thursday, 11th Nov 0

10:00-11:00 Correct policy wording for US 1 hospital healthcare

11:00 - 13:00 Cost containment and medical bills - 0 Spain ITIJ Awards and fi nale dinner 8th-11th November Ritz-Carlton Istanbul For full details & registration please visit www.itic.org.uk/istanbul

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Marketing Campaign of the Hospital/Medical Provider Cost Containment company Insurer/Underwriter of the year year (judged independently) Baptist Health South Florida of the year of the year ADAC International Services Charge Care International Mapfre Assistance Global Excel BUPA Cromwell Hospital Marm Assistance PTI United Health International Xanit Olympus RBS Insurance

In a highly competitive marketplace, the three For the last 15 years, MAPFRE companies in the running for this prestigious ChargeCare International ASSISTANCE award have demonstrated their innovation has, through its extensive is the youngest and originality through their advertising. medical providers entity within networks, consistently MAPFRE S.A., the A D A C - A m b u l a n c e reduced and controlled the largest insurance, Service’s foundation in costs of medical expenses r e i n s u r a n c e , 1973 put ADAC’s air rescue Baptist Health South Florida International for insurers. CCI’s record fi nancial, and system on an international Division is one of the largest hospital-based in terms of enforceability and sustainability of services activity company in Spain and basis. ADAC-Ambulance international programmes in the US. Our its cost reduction is exemplary. The local and Latin America and top 10 in Europe. Service organises and specially trained multilingual staff personally international knowledge of CCI professionals MAPFRE ASSISTANCE is a multinational carries out patient assist our international guests with their based in the UK, Greece and Spain focus on insurance, reinsurance and services transport worldwide on ground and by air. medical and travel needs, offering the quality fi nding effective solutions to clients’ specifi c company operating in four continents – Highly qualifi ed medical staff specialised in they deserve as recognized by the US needs. Clients and medical providers, where Europe, America, Asia and Africa with emergency medical assistance, intensive government study, scoring Baptist Health ever they are, can confi dently and quickly direct presence in 40 countries, and more care and fl ight medicine accompany these above most of the hospitals on the US News access their claims via CCI web-based systems, than 3,700 employees. transfers. ADAC-AmbulanceService attends and World reports honour roll list. We’re also keeping them in close touch with the process. MAPFRE ASSISTANCE´s integration of to approximately 40,000 patients per year committed to developing relationships with CCI is a dynamic and innovative company, keen underwriting, assistance activities and claims and carries out some 15,000 transports - international physicians, medical associations to share its ideas and expertise to develop new handling in one single provider offers a on ground and by air. Depending on the and hospitals to become the institution products with visionary partners. centralized, integral and effi cient solution to patient’s diagnosis, air-bound transport may an international physician looks to when a our clients and their fi nal customers. also involve additional transport options like patient requires medical care. stretcher, sleeper and PTC.

Established in Marm Assistance was founded in 1986 with 1996, Global Excel the aim of providing assistance services Bupa Cromwell Hospital was established to international assistance and insurance Management Inc. is Professional Travel Insurance Company in 1981 and acquired by Bupa, the leading companies as an extended arm in Turkey highly specialised Limited (PTI) is an established name as healthcare company, in March 2008. It is and neighbouring countries. Our service line, in services related specialists who implement and manage renowned for being the fi rst hospital to invest to name a few, incorporates medical and to the Canadian, insurance programmes for niche groups and in some of the UK’s leading edge equipment technical assistance, organization services, American, Mexican markets. Formed in 1989, our fi rst undertaking and cancer services. Based in West London, it treatment abroad and cost containment. We and Caribbean healthcare systems.Offering was to create a global travel and personal has over 400 consultants, mainly drawn from have developed a unique cost containment a ‘complete solution’ to all our customers, accident programme for the International London’s teaching hospitals, covering over programme to provide the best possible Global Excel is a market leader in the Airline Passengers Association (IAPA) on 70 specialities including cancer care, cardiac cost containment services with reasonable provision of assistance, cost containment, behalf of its members. The Collinson Group services, paediatrics, surgery, neurosciences pricing. We are a pro-active organisation case management and claims adjudication Limited acquired PTI in 1997 and provided and diagnostics. Outpatient services include playing a key role in maintaining a quality services for over 110 clients located in more the resources to support the expansion of PTI private GPs, health screening and a walk- standard in the cost containment market. than 26 countries around the world. We offer into new products and markets. The company in family medicine centre. The hospital has Our cost containment efforts not only focus our clients telephone assistance 24 hours a was then able to expand its reach, garnering a 128 beds and boasts a large and loyal UK on the incurred costing, but also aim to get day, 365 days a year and by not outsourcing reputation with IAPA, Columbus Direct, Club and international clientele, admitting self- the best quality standard of treatment at the this important aspect of our offering – Direct, Trinity, Mediquote and Insure For All. the service – we are able to maintain an pay, embassy sponsored patients and those right medical facility for a reasonable price. exceptional level of customer service. funded by medical insurance.

Xanit International Olympus began UnitedHealth Hospital, a reference operations in 1994, Inter national among private and was a pioneer is focused on medical centres on in developing providing global the Costa del Sol, is network health network access, insurance solutions fi tted with the most management and administrative services to individuals and advanced healthcare solutions for international healthcare payors. groups. CBS provides exclusive access to the technology. Its 450 multidisciplinary, From that base, Olympus has evolved into a UnitedHealth Network of preferred providers, professional staff work together to offer the leading independent provider of healthcare RBS Insurance is the second-largest travel delivering the most extensive and lowest-cost best care. claims administration and cost management insurer in the UK, with nearly four million in-force network in the US. CBS facilitates products The hospital offers a wide range of healthcare services, utilising both traditional services policies. RBS Insurance provides underwriting and services for travellers, expatriates, services including all medical and surgery and unique solutions. services and direct insurance policies through its indigenous populations, and medical tourists. specialties, with three special units: the Heart As an accredited ISO 9001:2008 company, own brands, such as Direct Line and Churchill, These services are supported by UnitedHealth Unit; the Oncology Unit; and the Neurosciences Olympus is committed to ensuring the highest as well as through partner brands including Group companies and our strategic partners Unit. quality service standards for its products and many respected household names. These worldwide. UnitedHealth Group is a Fortune Xanit International Hospital, which also has services. Our clients receive precise client partnerships offer travel insurance through a 100 company identifi ed as the fi rst or second a Medical Centre in Fuengirola, has a fl eet of management, around-the-clock access to our wide variety of fi nancial and consumer brands, most admired company in the healthcare fi ve ambulances and our International Services call center; on-staff medical professionals, including Santander, RBS, Coutts, Natwest, industry by rankings, as published in Fortune Department provides quality, multilingual, provider networks and EDI enabled Ulster Bank, Nationwide, Prudential, BMW, Mini magazine since 1995. professional care to all our patients. technological capacity. and the AA. www.itij.co.uk 26 FEATURE

Fair’s fair Complaints upheld by the Ombudsman are on the rise, so what can insurers do to put things right? – asks Roger St Pierre

Computerisation and the digital age have brought of the value of inclusive cover, good service and matters. and June this year. This would seem to indicate that untold benefits to commercial enterprises and the the resultant mutually beneficial value for money The net result is increasing levels of customer unfair treatment of claims is currently rife. general public alike, creating the so-called ‘global relationship, reflects the disturbing gap currently dissatisfaction and therefore more referrals to Comments Phillipa Cook of the FOS: “Our helpline village’ in their wake. But IT’s greatest strengths can existing between too many insurers and their the financial ombudsmen services around the has dealt with a 28-per-cent increase in travel also be its biggest weakness. Removing the human policyholders. world, who are increasingly finding in favour of insurance-related enquiries for the first six months element from so many aspects of day-to-day business Basing sales efforts almost exclusively around the claimants – a trend that should be extremely of 2010, compared to the last six months of 2009, has undoubtedly improved efficiency in manifold bargain basement premium rates has inevitably led worrying to an industry that deals in invisibles, and it is a trend that looks likely to continue. Over ways, but the emergence of a largely one-size-has- to a hardening of claims’ settlement policies and a making goodwill and a sound reputation for the same time frame, we have seen a 10-per-cent to-fit-all business model has caused considerable weakening of customer service that is not helped by fair dealing critical elements of success. Loss of increase in travel insurance-related matters being breakdown in the mutually satisfying customer sent to our adjudicators as formal complaints for us relationships that should be the cornerstone of any to resolve.” The public appears unconcerned about successful commercial enterprise. the emergence of a largely one-size-has-to-fit- the sales approaches used by the industry however: So what if one potential customer in 10 is a round “The extension of our remit in January 2009 to peg that will not fit into your square hole? Let him all business model has caused considerable enable us to look into complaints about the way in go elsewhere, runs the mantra, for satisfying his or which travel insurance is sold alongside a holiday her needs is not seen as a cost-effective proposition. breakdown in the mutually satisfying customer or other travel has resulted in only a small Unfortunately, this philosophy ignores the awesome number of complaints,” reads the FOS annual power of word of mouth and the enormous damage report. It’s when it comes to the settlement a single dissatisfied customer can wreak through relationships of claims that bad blood sets in: “Almost all this most potent of all sales’ – and sales’ deterrent the cases we see relating to travel insurance channels – media. involve disputes over the settlement of everything moving online – great for those square consumer confidence in the industry is today a very claims, such as for the cancellation or Price focus pegs in square holes. But a nightmare for those real and potentially disastrous scenario. curtailment of a holiday, lost or stolen This applies in the travel insurance industry as much with complex questions that can only really be dealt The statistics are starkly worrying. As reported in items of luggage or medical-related as in any other commercial arena. That insurance with by proper human interaction. Long telephone ITIJ, the UK’s Financial Ombudsman Service (FOS) claims,” continues the report. advertising on TV, online and in the press is all waiting times, call centres that are often abroad and found in favour of the customer in more than half focused on the role of low prices as a magnet for staffed by people who have poor linguistic skills and of the 553 serious complaints about travel insurance Problems proliferate new business, while scant mention is ever made only basic policy knowledge only serve to exacerbate products and services that it handled in April, May The sheer wordage and International Travel Insurance Journal complexity of most insurance policies is part of the complaints. The figures do not, for example, include UK insurers detected some £5 million in attempted justification for turning a claim down but do problem, with exclusions buried away in the small issues triggered earlier this year by the fall-out from travel insurance frauds against the £200 million they make enough effort to ensure that people print. “Yes, it’s in there somewhere but you just try the Icelandic volcanic ash cloud.” we paid out for legitimate claims. It’s crucial to taking out their insurance properly understand finding it,” says Brussels’ based travel consultant We live today in a more and more sophisticated be vigilant in verifying claims because fake claims the full implications of that term? It often arises Alain Lefevre, adding, “it doesn’t help that most environment in which consumers are increasingly result in everyone else paying more for their cover. that someone has lived with some minor chronic travel insurance is taken out at the time of booking aware of their right to complain. The continued rise It’s inevitable that some who believe their claims ailment for many years and no longer sees it as any the trip, when the client is more concerned about of the litigious society should give insurers due cause to be legitimate will feel they have been harshly kind of problem so does not declare it – sometimes dealt with and will end up taking their case to the through pure oversight and sometimes because Ombudsman.” they don’t think it is serious enough to count.” He Australian consumer Janice Eden took out her policy went on to say: “The second area of concern for the UK’s Financial Ombudsman Service (FOS) online and was emailed the policy details: “It was consumers arises when the insurer makes what the in ridiculously small print, very difficult to read policyholder considers a harsh or inflexible decision found in favour of the customer in more than and the wording was very convoluted and difficult over some aspect of the claim, leading to a fractious to understand anyway. Nobody has the time or the exchange. In too many cases, complaints are handed half of the 553 serious complaints about travel patience to plough through something like that, insensitively, leading to further frustration. so you take the ads at face value and think you are “To my mind, it should be incumbent on insurance products and services that it handled well covered.” As it happens, the Melbourne-based the insurer to ascertain that the insured fully designer had her complaint upheld by the Australian understands what is meant by ‘pre-existing Financial Ombudsman Service: “I won, but it left a condition’ and what will be the effect of non- bad taste,” she reflects. “When you think of it, if the declaration. It’s all about communication. Yes, we other aspects of the planned trip. A lot of my clients to look at how they treat their policyholders. As it is, insurers played fair, the Ombudsman would not need now have the benefit of a regulated product – and are very busy executives, working in European huge losses caused by the Icelandic incident and other to exist.” that’s a good thing – but I don’t think that the Union institutions or big business, and they simply natural disasters have caused a perceptible hardening What can and what shouldn’t be considered as a pre- current level of regulation is particularly effective do not have the time to plough through endless in claims’ settlement strategies across the industry. existing condition – a prime reason for claims being in getting its message across.” He does believe there policy documents.” He added: “On the other hand, According to a recent BBC Radio report, some turned down – is a murky issue: one UK insurer is a way out of the ongoing pre-existing problem, vacationers are focused on discussing the ins and outs insurers are now demanding production of purchase refused to pay for a cancelation caused by a chest though: “To my mind, the industry could stand the of their holiday package and just sign up to travel receipts for every item that is claimed for under the infection, on the basis that the insured had earlier whole ‘pre-existing condition’ issue on its head and insurance as an afterthought. Policies need to be lost baggage clause of their policies. complained to his doctor about a cough. When use it as a marketing opportunity to educate the concise, to the point and crystal clear about what is Canadian businessman Bill Oakley, who was the matter was referred to the Ombudsman, the consumer into the line of thinking that in insurance, and what isn’t covered.” burgled while on a business trip in Tobago, was The numbers of reported serious complaints are even asked to provide the serial numbers of each relatively small but is it merely the tip of a massive of the banknotes contained in his stolen wallet: “I iceberg of customer discontent? Says the UK’s had Canadian dollars, US dollars, East Caribbean Canadian businessman Bill Oakley, who was Financial Ombudsman, Bill Prasifka: “I believe dollars and even a few euros,” he recalls. “Cash goes that could be the case. The figures are only part of in and out of my wallet on a daily basis, as I expect burgled while on a business trip in Tobago, was the story because they do not take account of the it does with most people. You know how much seemingly growing number of people who have you’ve got at any moment but have you ever heard even asked to provide the serial numbers of each to battle with their insurers but win the argument of anyone who keeps a record of the numbers? – the before it ever reaches us, nor the many who are banks don’t even do that. But it took a ruling from of the banknotes contained in his stolen wallet unaware of our existence and the Ombudsman before I finally got my services and simply give claim settled.” up the fight as an unequal struggle. Vigilance is key insurance company lost. as in so many other things, one glove does not fit It’s hard to As in all things, there’s Consumer director Frank Brehany and his team all. Disagreements can arise in all aspects of life pinpoint another side to the at holidaytravelwatch.com – a partner in the UK but good communicators are able to resolve issues specific story. Comments Foreign and Commonwealth Office’s ‘Know Before quickly and to mutual satisfaction.” So, what can reasons Malcolm You Go’ campaign – have been looking after insurers do to halt the flood of complaints? “Insurers for the Tarling, of the consumer interests for the past 15 years and deal need to explain clearly and logically how their travel recent Association with travel insurance and other holiday-related insurance policies work and how complaints can be rise in of British complaints from people located as far afield as the fairly and efficiently handled, long before the matter Insurers: US, Australia, Korea, South Africa and Europe. ever gets to the Ombudsman. Clear information “Last “There are two main problem areas,” says Frank, and logical explanations should be the aim. Then, year, “insurers often use ‘pre-existing condition’ as a and only then, will consumer confidence return.” One brighter note: travel insurance problems relate to just four per cent of all general insurance complaints dealt with by the UK Financial Services Ombudsman, compared to a massive 62 per cent for payment protection cover and 12 per cent for car insurance. n 28 FEATURE

Law of the piste

Injuries on the slopes cost travel insurers a substantial sum each year; a situation that has led to increased legal proceedings. UK-based Barrister Darren Lewis advises claimants on how to prepare for a case

it is worth the insurance industry reviewing the evidence that claimants have to produce if they are to prove someone is at fault in a court of law should a legal case arise following an injury on the slopes

International Travel Insurance Journal International Travel Insurance Journal FEATURE 29

There seems to be an impressive focus amongst those members of the travel insurance industry who I have spoken to on assessing the value of alpine sports claims, as well as an admirable focus on rehabilitation. (Of course, we’re referring to ‘claims’ in the litigation sense – with a ‘claimant’ suing a ‘defendant’ in legal proceedings). Post Office Travel Insurance data recently revealed that medical expenses accounted for 75 per cent of all ski holiday insurance claims last season, so it is worthwhile for insurers to try their best to claw back some of their expenses from a potentially guilty or negligent party. Furthermore, recent research from Bupa Travel Insurance shows the cost of treating common ski injuries varies by more than 1,000 per cent depending on which country the skier was holidaying in. For example, torn knee ligaments – the most common injury among skiers and boarders – would cost around £670 to have treated in France, but would cost a massive £2,280 in the US. Thus, it is worth the insurance industry reviewing the evidence that claimants have to produce if they are to prove someone is at fault in a court of law should a legal case arise following an injury on the slopes. This article considers the evidence that a court will expect to see, focusing on the three main areas that a winter sports claim will usually fall into: collisions, inadequate supervision, and faulty or inappropriately installed equipment. It is firstly necessary, however, to understand the differences between ‘jurisdiction’, ‘choice of law’ and ‘evidencing standard of care’. Each will affect the necessary evidence to be obtained.

Letter of the law Jurisdiction: This refers to the legal area where a court has a right to hear a case. The normal rule is that a case will be heard where an accident happened, but there are special exceptions for EU countries that allow for people to be sued in another country if strict requirements are met – such as, if the defendant is domiciled in another jurisdiction or consents to be tried in another country. Furthermore, for example, it is much harder to establish the jurisdiction of English courts where the accident happens outside the EU. Choice of law: Just because a case takes place in one jurisdiction does not mean that the national laws of that jurisdiction apply. A case could be heard in British County Court but the law that it applies could be Austrian or French as appropriate. In order to sue someone, there must be a breach of a rule or provision that creates duties between two people. In skiing claims in England and Wales, that is likely to be the law of negligence and maybe the Occupiers Liability Act 1957 or nuisance. In France, there are specific provisions like Article 1382 of the Civil Code, which touches on excessive speed, and Article 1384, which makes the skier responsible for damage caused by objects under his control, for example skis and poles, which has often been interpreted as meaning there is no requirement to prove fault. The main rule for UK insurers to bear in mind is that a court will apply the law of where the injury occurred; but where an accident occurs in the EU and where both skiers are English it can apply English law (EC Regulations 864/2007). Local law is a matter of fact, which is usually proved by obtaining local lawyers’ reports on the law. Standard of care: Regardless of which court has jurisdiction or what duty of care is to be applied, the court will always apply the standard of care of the place where an accident happens. The simplest way to explain this is by

www.itij.co.uk thinking of drivers in identical situations. In the UK and Germany, I have a duty to drive at a reasonable speed for the road conditions in order to avoid a collision (that is the duty of care). In order to measure whether I meet that duty (the standard of care) we might look at speed limits. If I drive down an English motorway at 80mph, I am speeding and acting in a way that breaches my duty to you, but if driving at 80mph on the Autobahn 90 in Germany, I am driving at the advised (non-mandatory speed). The same is true of alpine sports from country to country, and sometimes resort to resort. Claimants will ultimately have to show that the defendant acted in a way that contravened the normal practice on that slope. This often requires costly expert evidence, such as from local ski instructors.

Collisions Collisions are evidentially the easiest form of alpine accident to deal with. English courts use the Federation Internationale de Ski (FIS) Rules of Conduct in a similar way to how they use the Highway Code. However, breach of an FIS rule is not negligence but evidence of negligence. Some of the most frequently cited FIS rules in relation to collisions are: • Respect for others – a skier or snowboarder must behave in such a way that he does not endanger or prejudice others. • Control of speed and movement – a skier or snowboarder must move in control. He must adapt his speed and manner of skiing or snowboarding to his personal ability and to the prevailing conditions of terrain, snow and weather, as well as to the density of traffic. • Overtaking – a skier or snowboarder may overtake another skier or snowboarder above or below and to the right or to the left provided that he leaves enough space for the overtaken skier or snowboarder to make any voluntary or involuntary movement.

Perhaps the most useful FIS rule for lawyers and strengthened the Claimant's case. insurers looking for evidence and most frequently Supervision cases will more often than not involve ignored by skiers is: contributory negligence, where the injury is partly • Identification – every skier or snowboarder and the fault of the supervisor and also of the skier. witness, whether a responsible party or not, Insurers should grapple with this early, as a sensible must exchange names and addresses following Part 36 offer to settle on liability will often save costs an accident. in the long run. A good example of contributory fault Where an independent witness has given your is the case of Anderson v Lyotier [2008] EWHC insured their name, every effort should be made to 2790 (QB), a case where a mixed ability group was contact them and take as full a note of their evidence taken through increasingly difficult off-piste terrain, as possible. which pupils were finding particularly challenging. Ultimately, the Claimant collided with a tree. The Inadequate supervision English court found that an instructor should not have Cases where someone is injured and alleges that led a relatively inexperienced skier off-piste where it is due to inadequate supervision present their there was a foreseeable risk of them hitting a tree; own evidential difficulties. As claimant or defendant, but the student was under a duty to speak out if he it is important at a very early stage to get a report felt he was being asked to do something beyond his from an independent ski instructor at the resort in ability. The Claimant was found one third responsible question. This will let you know whether it is more for not speaking out. cost effective to settle or at least make an offer. Tools of the trade The recent case of The most common Gouldbourn v. Balkan form of injury under the Holidays Ltd & Another Collisions are evidentially ‘defective equipment [2010] EWCA Civ 372 and failure to properly demonstrates the pitfalls in the easiest form of alpine install’ heading is due this area. This case involved to binding not properly a relatively inexperience accident to deal with releasing. The biggest skier who was provided evidential difficulty with a ski instructor who is preserving the told her to follow him; evidence. she attempted to mirror most of his manoeuvres If there is an alleged defect with a product that your but ultimately fell and was injured. The UK’s Court insured owns or an alleged defect with its installation, of Appeal recognised that the FIS rules imposed a which results in an injury, the insured should be duty on instructors to never allow pupils to take warned to preserve the product in the condition it a risk beyond their capabilities, but the rules did was in at the time of the accident. Where it is hired not mandate how that duty was to be met. In the by the insured, often the equipment will be taken absence of any evidence from a local source that back and recalibrated. Where the insured believes a such duty had not been met, the claim failed. A defect caused an accident, they are best advised to report from an independent local instructor saying he warn the hirer that the equipment is valuable evidence would not have asked the claimant to have followed and should be preserved, as a claim is likely. Even him on the slope in question might have easily where this happens, ‘errors’ are often made and

www.itij.co.uk FEATURE 31

Claimants will ultimately have to show that the defendant acted in a way that contravened the normal practice on that slope

the equipment goes back into circulation. With or • Main rule: law of country in which the claimant is a manifestly clearer connection to one Darren Eurwyn without the equipment itself, expert evidence will had his habitual residence if the product was country’s legal system than another, the law of Lewis is a Barrister based still be necessary to describe the cause of the failure, marketed in that country; the former. at St John’s Chambers in Bristol, UK, but with such as in the case of Rochead v. Air Tour Holidays • The law of the country in which the product a national practice. He Ltd (2000) (Unreported), where in the absence of was bought if it was marketed there; failing that; Conclusion specialises in injuries the equipment in question, the UK court accepted • The law of the country where the injury Hopefully, this article is of some assistance in in travel, alpine sports, the expert’s analysis of the fall as described by the occurred, if the product was marketed there. considering some of the evidential difficulties foreign, aviation and claimant. • BUT if the defendant can prove that they could relating to alpine sports injury claims. It is a varied maritime accidents. He is Direct Access Qualified In cases of faulty or inadequately installed not foresee the marketing of the product in any and complex area, where the insurance industry and can act for insurers equipment resulting in injury, establishing which of the countries above, the law applicable will is well advised to instruct lawyers early when the directly without the need law is applicable and the standard of care to be that of the defendant’s habitual residence. insured or a third party makes a claim in order to to instruct solicitors. be evidenced is essential. There are specific • Finally, where the facts of the case show there assist in the process of properly analysing risks. n exceptions to the general rule on choice of law: 32 ASSISTANCE&HEALTHCAREWORLDMARKETS

Portuguese citizens enjoy good health and increasing life expectancy, although lower than many other western countries

Portugal steps up

With tourism to the beautiful country to Macau. While many Misericórdias have since of Portugal helping to shape healthcare disappeared, the capital, Lisbon, is still home to infrastructure in recent years, Tatum Santa Casa da Misericórdia, one of Portugal’s Anderson investigates just how far the most prestigious public hospitals. Actually, most industry has come with regards to the of the best hospitals are located in or around processing of international patients Lisbon, and the quality of care available is of an international standard. Here, we take a closer Portugal’s tradition of formal healthcare extends look at how visitors to the country can access back centuries. The fi rst charitable hospitals, healthcare – for both general medical needs and Misericórdias, appeared in 1498 and later spread for emergency care – and we analyse the nature throughout the Portuguese empire from Sri Lanka of the relationship between assistance companies operating in the country and local hospitals.

International Travel Insurance Journal ASSISTANCE & HEALTHCARE WORLD MARKETS 33

Portuguese citizens enjoy good health and increasing life expectancy, although lower than many other western countries

Taking the strain few failings of the NHS in Portugal. There have Generally, Portuguese citizens enjoy good health been shortages of physicians due to an uneven and increasing life expectancy, although lower distribution across the country too. “Many than many other Western countries. In fact, times, in a state hospital, patients have to stay Portugal spends less on health per person than in a corridor on a stretcher, as there are no any other Western European country. That was beds available, and then the insurance company around US$2,151 on health per capita in 2006, may opt for the patient to be transferred into a the most recent fi gures available, and this lack of private facility,” says Silva. That’s why companies investment seems to have had an impact on the such as Luzdoc, a private clinic group and local country’s national health system (NHS). assistance partner, say they use the private sector The European Observatory on Health Systems for tourists. “We prefer to use private hospitals as and Policies in 2007 concluded that crowded we can refer the patient to a known and trusted hospital emergency departments and long facility and a physician who will keep us informed waiting lists for surgical procedures are just a of the progress of the patient,” she adds. “It

www.itij.co.uk 34 FEATURE

deals with the situation faster and in a more suitable environment.” Administration can be difficult in public hospitals too, explains Silva. In public hospitals, she says, there are no dedicated ‘international departments’. As a result, public hospitals are generally only interested in getting the patient well and then discharging them to free up an acute bed. “The doctors and nurses do not comprehend that there are logistical problems for international patients, such as having to fly home (fitness to fly), and being discharged to a hotel that may not have suitable conditions for a recovering patient,” she says. The public sector sometimes also has difficulty processing foreign patients, adds Silva, with language barriers posing a particular problem. This isn’t just an issue in Lisbon. Down south in the ever popular Algarve, services in public hospitals can reach capacity at peak season too. “It can get very difficult, and tourists put a lot of strain on [the system] and they are short of staff, nurses and beds. People are well-looked after but you do hear stories of people waiting in corridors before they are diagnosed,” says Angela Barden of Lloyd & Whyte, an international travel and medical insurance broker. The result is that although Portugal runs an NHS that is funded through taxation, there is a huge demand for private healthcare facilities from tourists, expats and Portuguese citizens. This demand exists despite the fact that the private sector does not generally provide more specialist services than the public sector, and that state-of-the art specialist treatments are still the preserve of government academic hospitals. The public Santa Maria de Lisboa and Hospital Universitario De Coimbra, near the Coimbra University, come recommended as general hospitals. Lisbon’s Cruz Vermelha, too, serves both private and public patients. These three hospitals also the rest of Portugal. Examples of good specialist Oncologia, a cancer hospital which has branches in well, rather than risk being seen by a doctor who house trauma units. Patients that require specialist hospitals in the capital include the Hospital Dona other major cities in the north, Porto and Coimbra. may have fewer language skills. But better language treatment, including tourists, have traditionally been Estefania for paediatrics, the Maternidade Alfredo da There is also a good reported standard of heart care skills and shorter waiting times come at a price. transferred to Lisbon from the district hospitals in Costa for maternity cases, and Instituto Portugues de in these three cities. Private services are very expensive. On the whole, But things are changing, says Dr Maria Alice Silva, the private institutions recommended for touristic medical director at Luzdoc: “Presently, [transfers to use are large hospitals and not clinics, and they Lisbon] are happening less and less, as the district generally provide 24-hour emergency and trauma hospitals are beginning to develop many more care. Larger private hospitals in Lisbon include specialised services themselves.” With its expansive British Hospital, Hospital da CUF, Hospital Particular southern and central coasts that have become a de Lisboa and Hospital SAMS, and they all have magnet for tourists and expats, there has been a intensive care or emergency departments. There is large rise in the number of both public and private also some consensus about hospitals in the Algarve, healthcare facilities in both the Algarve and Albafeira. with most providers recommending the same ones: Until a few years ago, for instance, coronary cases in Hospital Particular do Alvor, Hospital Particular the Algarve, such as angioplasty and stenting, were Gambelas-Faro, Hospital Particular São Camilo. transferred to Lisbon. Now, there are two dedicated cardiovascular units in Faro – Hospital Distrital de Tourists in need Faro and the private Hospital Particular Faro, which is Although there are no dedicated tourist drop-in part of the Alvor hospital group. health centres, Portugal’s hotels do usually maintain a list of both public and private providers. “This is also Private growth helpful if the client requires a home call as the hotel “Over the years, because of the influx of tourists should know of the doctors in their area that provide to the Algarve, the hospital and clinic system has this service,” says Luzdoc’s Silva. got a lot better,” agrees Barden. “Today, there are Tourists accessing the public system can opt for a more private centres in the Algarve that are aimed Centro de Saúde (CS) primary health centre, which at the English-speaking and German-speaking expat deal with non-urgent situations and are normally communities here.” In fact, many people choose to open during working hours on weekdays. They act bypass the national health system altogether. Indeed as GP surgeries but also deal with minor accident the majority of specialist consultations take place and emergency cases. in the private sector and it is possible to go straight For more serious cases, local hospitals run 24-hour to a specialist in Portugal rather being referred by a accident and emergency services, called Permanent gatekeeper at the public primary care level. Specialist Attendance Service – Serviço Atendimento consultancy costs anything between e80 to e200. Permanente (SAP). These have more recently begun It’s unsurprising, then, that the private sector is operating a triage system. Experts warn, however, growing rapidly, with both larger central hospitals and that a few SAPs do close earlier in some regions. smaller clinics owned by private companies. Apart Tourists with a European Health Insurance Card from a faster service, a major reason that tourists and (EHIC) are treated as Portuguese citizens. That expats use private health services is that they are able means some services are free, but others require to choose a doctor who speaks English or German some form of co-payment (EHIC also enables

“Over the years, because of the influx of tourists to the Algarve, the hospital and clinic system has got a lot better,”

International Travel Insurance Journal

36 ASSISTANCE&HEALTHCAREWORLDMARKETS

International Travel Insurance Journal ASSISTANCE&HEALTHCAREWORLDMARKETS 37

discounts on some private services). Children up to The number of doctors and nurses to serve 1,000 the age of 11, pregnant women and the elderly are people is vastly different too. In 2004, there were six usually exempt from all charges. For everyone else, doctors and six nurses per 1,000 people in Lisbon visiting GPs at a Centro de Saúde costs a nominal and Porto, but just 1.6 doctors and 2.4 nurses in fee of around e2. Consultant services are usually 2005 in Alentejo (although the relative number of free but diagnostic tests, from x-rays to blood tests, doctors nationally is above average, the relative can vary between e80 and e200 a go. Similarly, number of nurses in Portugal is well below that of ambulance services are subsidised and top-up other countries). “Services in the Alentejo (region) payments are calculated based on distance. are very limited. People usually travel to Lisbon and Co-payments have been increasing over time, and the Algarve,” says Barden. pharmaceutical products can be expensive too. The island of Madeira, in contrast, has three Indeed, Portuguese patients pay the highest amount hospitals and many health centres. Some are out-of-pocket (OOP) on health in Europe. Including equipped with emergency service facilities. Some of cost-sharing within the national health system the private clinics also provide emergency services and direct payments for private sector services, too and there are many English-speaking doctors OOP was around 23.5 per cent of total health and dentists, say experts. expenditure in 2004. Despite these variations in care, and despite the Quality of healthcare also varies geographically. strains on the public health system, some aspects of Generally, urban coastal regions have much better the NHS are improving. With better training, a new healthcare services than rural interior regions. Health generation of health workers is now learning many resources are concentrated in the capital, Lisbon, and more languages or studying abroad, say experts. Porto, and there are many facilities along the coasts. And an investment programme in recent years has In contrast, there are no tertiary or specialist hospitals focused on poorer regions. New hospitals have in the Alentejo region in the rural interior. opened, such as Santiago do Cacém in Alentejo, for

Tourists accessing the public system can opt for a Centro de Saúde (CS) primary health centre, which deal with non-urgent situations and are normally open during working hours on weekdays

www.itij.co.uk 38 ASSISTANCE&HEALTHCAREWORLDMARKETS

the service announced crisis measures in June, with plans to ground the helicopters as part of cost-cutting measures. These plans have not yet been put into action, however, and a pay-off is thought to have been made to various ambulance and emergency response vehicle operators in an overtime payment settlement. Assistance companies say they tend to use international companies to provide air ambulances or repatriation. However, SOS International says it often uses OMNI, a Portguese-owned company, for intra-national ambulance flights, but it has also used SATA Air Açores (SATA), a state-owned airline that operates from the Azores, as well as Mayoral Aviation, a Spanish company.

Future development Private health insurance is being actively promoted to offset the deficiencies of the public system, say the authors of the European Observatory report, Pedro Pita Barros of the Universidade Nova de Lisboa and Jorge de Almeida Simões at the Universidade de Aveiro. Indeed, around a quarter of the 10.7 million- strong Portuguese population has private health insurance coverage through work-based health insurance schemes and private voluntary health insurance. It is not at all unusual to find patients who access healthcare through all three kinds of coverage – public, work-based and voluntary private too. By law, companies must offer work-based despite improvements in the public system, new forms of private health insurance to their employees. The largest occupational health scheme, Assistência a Doença managed care are being experimented with in Portugal dos Servidores do Estado (ADSE), covers civil servants – or almost 10 per cent of the population. example, and the government has also struck public- contractual arrangements with the NHS. the level of overcharging is comparable to Spain. In addition, some companies now also offer an private partnerships to upgrade various hospitals. But what of some of the other reported issues, such “Medical standards can vary from facility to facility,” he additional optional health insurance perk that covers And in an effort to reduce the backlog of waiting lists, as over treatment or overcharging, that are so rife in says, “and some private facilities may have a tendency general sickness, rather than just work-related injuries. many procedures are carried out on state patients other European countries? Luzdoc reckons there is to over treat and over charge.” It is usually purchased as a group policy and employees in a private setting. That’s why certain diagnostic not an issue of overcharging or over treatment here often pay for their own families to be included. services, renal dialysis and physiotherapy treatments in Portugal. However, Juan Carlos Cortiletti, manager Emergency services Needless to say, policies vary. Some employees are so often carried out in the private sector under of SOS International’s International Network, says Emergency services are largely run as a public may pay around e12 to e15 to see a doctor while service. The Portuguese fire department runs general others contribute 10 per cent of the total cost of transportation services for patients, while the National cover. “Over the last ten years, there have been Institute of Emergency Medicine (INEM) also has more schemes here that work within a network of ambulances that carry doctors and nurses for more providers that provide a certain number of hospitals acute emergency situations. That said, private facilities and doctors,” says Lloyd & Whyte’s Barden. do use their own ambulances and often contract Médis is an example. It operates a network of public ambulances to transfer patients to private healthcare providers, for instance, with over 6,000 entities, and such services are paid for on the spot. doctors, 1,500 auxiliary diagnoses test facilities, 600 The INEM is the Ministry of Health organisation, clinics and 90 hospitals. It offers outpatient treatment, responsible for co-ordinating the Integrated Medical hospitalisation, physiotherapy and diagnosis. Emergency System in Portugal, and is called into So, despite improvements in the public system, action by the national emergency number – 112. new forms of private managed care are being Emergency calls are usually transferred to one of experimented with in Portugal. Managed care four centres: Lisbon, Porto, Coimbra and Faro, companies such as Médis use medically trained call which assess the gravity of the emergency and centre employees to provide a 24-hour service determine whether ambulances, motorbikes or to each policyholder and direct them to the most helicopters are most appropriate. INEM provides appropriate healthcare service. That, say experts, two emergency helicopters – based in Lisbon and reduces administrative costs and unnecessary Oporto – but despite calls for more helicopters, consumption. It’s a model many are watching. n

International Travel Insurance Journal CATEGORY KEY CLAIMS MANAGEMENT INSURERS AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMM. AIRLINE AIR AMBULANCE INTERIOR COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDER AIRCRAFT PERFORMANCE SOLUTIONS CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENING ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE CATASTROPHIC CLAIMS SPECIALIST HEALTHCARE CLINICS TRAVEL AGENTS COST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES 40 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

Air Ambulance International ) CareFlight International Mr Peter Veazey – CEO Paul Smith – National Manager P.O. Box 1044, Magnolia. Texas 77353, USA Westmead Hospital Campus, PO Box 159, Westmead, NSW 2145, AUSTRALIA

tel: +1 832 934 2390 email: [email protected] tel: (+61) 2 9893 7683 email: [email protected] (AFRICA) fax: +1 832 934 2395 website: www.airambulanceinternational.com fax: +61 2 9689 2744 website: www.careflight.org

Air Ambulance Network European Air Ambulance AUSTRALASIA

Kirk Pacheco – President ( Patrick Schomaker – Director Sales & Marketing AIR AMBULANCE AIR AMBULANCE 905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689, USA 175A, rue de Cessange, L-1321, LUXEMBOURG

24hr tel: + 1 727 934 3999 email: [email protected] 24hr tel: +49 711 7007 7007 email: [email protected] fax: + 1 727 937 0276 website: www.airambulancenetwork.com fax: +49 711 7007 7009 website: www.air-ambulance.com

AMREF Flying Doctor Service Flying Doctors Asia Dr Bettina Vadera – Medical Director Prithpal Singh – CEO , Director 313 Old Bird Cage Walk, #01-15/02-16, Seletar Airport, Wilson Airport, LangataRoad, PO Box 18617, Nairobi, KENYA SINGAPORE tel: +254 20 6000 090 email: [email protected] 24hr tel: +65 9297 7757 email: [email protected] fax: +254 20 344 170 website: www.amref.org fax: +65 6483 5407 website: www.flyingdoctorsasia.com

European Air Ambulance Hope Medflight Asia Pte Ltd Patrick Schomaker – Director Sales & Marketing Dr Charles Johnson – Medical Director 175A, rue de Cessange, L-1321, LUXEMBOURG 2 Loyang Lane 03-01, Singapore 508913, SINGAPORE

24hr tel: +49 711 7007 7007 email: [email protected] 24hr tel: +65 6100 1911 email: [email protected] fax: +49 711 7007 7009 website: www.air-ambulance.com fax: +65 6400 5254 website: www.hope-flight.com

Netcare 911 Aeromedical Medical Wings Wayne Thomson – Flight Operations Manager Dr Sommart Somsiri – Medical Director 222 Room 3259, Donmuang Int Airport Moo 10, Viphavadee-Rangsit Rd, Sikan, Riverview Park, Janadel Avenue, Midrand, SOUTH AFRICA Don Muang, Bangkok 10210, THAILAND tel: +27 10 209 8387 email: [email protected] tel: +662 247 3392 email: [email protected] fax: +27 10 209 8405 website: www.netcare911.co.za fax: +662 535 4355 website: www.medicalwings.com

Skyservice Air Ambulance Skyservice Air Ambulance David Ewing – VP International Market Development David Ewing – VP International Market Development YUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), H9P 1A2, YUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), H9P 1A2, CANADA CANADA tel: +1 514 497 7000 email: [email protected] tel: +1 514 497 7000 email: [email protected] fax: +1 514 636 0096 website: www.skyservicebas.com/airambulance fax: +1 514 636 0096 website: www.skyservicebas.com/airambulance

West African Rescue Association South Pacific Air Ambulance Florian Zagel – Managing Director Scotty Watson – Managing Director Klotey Cresent 6, North Labone, Accra, GHANA NEW ZEALAND AUSTRALIA SINGAPORE

24hr tel: +233 243 666 111 email: [email protected] tel: +64 9256 9000 email: [email protected] tel: +233 302 781 258 website: www.westafrican-rescue.com fax: +64 9256 9111 website: www.spaa.co.nz ) AeroMed Asia Inc. ADAC-Ambulance Service Cindy Wong / Lorraine Paul – International Account Management Robert Glueck – Marketing & Sales Director SINGAPORE BANGKOK THAILAND NEW Am Westpark 8, 81373 Munich, GERMANY

tel: +603 7965 3883 email: [email protected] (EUROPE) tel: +49 89 76 76 52 85 email: [email protected] fax: +603 7629 8810 website: www.aeromed-asia.com 24h Alarm: +49 89 76 76 50 05 website: www.adac.de/ambulance AUSTRALASIA ( Air Ambulance International Air Ambulance International Mr Peter Veazey – CEO Mr Peter Veazey – CEO P.O. Box 1044, Magnolia. Texas 77353, USA P.O. Box 1044, Magnolia. Texas 77353, USA

tel: +1 832 934 2390 email: [email protected] tel: +1 832 934 2390 email: [email protected] fax: +1 832 934 2395 website: www.airambulanceinternational.com fax: +1 832 934 2395 website: www.airambulanceinternational.com

Air Ambulance Network Air Ambulance Network Kirk Pacheco – President Kirk Pacheco – President 905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689, USA 905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689, USA

24hr tel: + 1 727 934 3999 email: [email protected] 24hr tel: + 1 727 934 3999 email: [email protected] fax: + 1 727 937 0276 website: www.airambulancenetwork.com fax: + 1 727 937 0276 website: www.airambulancenetwork.com

AirMed International LLC Air Medical Ltd Jeffrey T Tolbert – President Glenn Salt – Flight Operations Manager Airport World Trade Center, 1 Sky Plaza Road, Oxford Airport, Kidlington, Oxfordshire OX5 1QX, UK Hong Kong International Airport, HONG KONG tel: +852 3756 3680 email: [email protected] tel: +44 1865 842 887 email: [email protected] fax: +852 3756 3681 website: www.airmedasia.com tel: +44 1865 370 642 website: www.airmed.co.uk

CareFlight Group AirMed International LLC Medical and Tasking Centre Jeffrey T Tolbert – President PO Box 5078, Robina Town Centre, Queensland, 4230, AUSTRALIA 1000 Urban Center Drive, Suite 470, Birmingham, AL 35242, USA

24hr tel: +61 7 5553 5955 email: [email protected] tel: +1 205 443 4840 email: [email protected] fax: +61 7 5553 5914 website: www.cmsairambulance.com fax: +1 205 443 4841 website: www.airmed.com call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 41 ) Augsburg Air Ambulance ) Medilink International Air Ambulance Roland Schoberth – Director Martin Farrugia – Business Development Manager Roseggerstr 17, D-86368, Gersthofen, GERMANY 99 Mill Street, Qormi, QRM 3100, MALTA

tel: +49 821 299 1020 email: [email protected] tel: +356 2278 5400 email: [email protected] EUROPE EUROPE ( tel: +49 821 299 2030 website: www.ambulanzflugdienst.de ( fax: +356 2278 5700 website: www.mi-aa.com

Capital Air Charter North Flying a/s Lisa Humphries – Sales Director Jesper Kragelund – Sales Manager AIR AMBULANCE AIR AMBULANCE Exeter International Airport, EX5 2BD, UK North Flying Terminal, Aalborg Airport, DK-9400, Nørresundby, DENMARK

tel: +44 845 055 2828 email: [email protected] tel: +45 9632 2900 email: [email protected] fax: +44 1392 350 039 website: www.capitalaircharter.co.uk fax: +45 9632 2909 website: www.northflying.com

European Air Ambulance Redstar Aviation Patrick Schomaker – Director Sales & Marketing Mustafa Atac – CEO 175A, rue de Cessange, L-1321, LUXEMBOURG Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY

24hr tel: +49 711 7007 7007 email: [email protected] tel: +90 216 588 0216 email: [email protected] fax: +49 711 7007 7009 website: www.air-ambulance.com fax: +90 216 588 0225 website: www.redstar-aviation.com

Euro Link Air Ambulance Skyservice Air Ambulance Dr. Friedrich Renner – Medical Director David Ewing – VP International Market Development YUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), H9P 1A2, Putzbrunner Str. 114, 81739, München, GERMANY CANADA 24hr tel: +49 89 613 72103 email: [email protected] tel: +1 514 497 7000 email: [email protected] fax: +49 89 613 72106 website: www.FlyEuroLink.de fax: +1 514 636 0096 website: www.skyservicebas.com/airambulance

FAI – rent-a-jet AG Swiss Air Ambulance / Rega Volker Lemke – Director Sales & Marketing Peter Meierhans – Director of Sales Flughafenstrasse 100, D-90268 Nuremberg, GERMANY PO Box 1414, Zurich Airport, CH-8058, SWITZERLAND

tel: +49 911 36009 31 email: [email protected] tel: +41 333 333 333 email: [email protected] fax: +49 911 36009 59 website: www.rent-a-jet.de fax: +41 44 654 3590 website: www.rega.ch

German Red Cross Air Ambulance Service Tyrol Air Ambulance Andreas Speich – Managing Director Jakob Ringler – Managing Director Aufm Hennekamp 71, 40225 Düsseldorf, GERMANY PO Box 81, A-6026, Innsbruck Airport, AUSTRIA

tel: +49 228 2300 23 email: [email protected] tel: +43 512 224 220 email: [email protected] fax: +49 228 2300 27 website: www.grcairambulance.de fax: +43 512 288 888 website: www.taa.at

Greek Flying Doctors Aero Jet International Dimitris Kanellis – Manager Stuart Hayman – President 3 Doukisis Plakentias Str, 152 34 Halandri, Athens, GREECE 4631 NW 31st Avenue, #220 Ft Lauderdale, FL 33309, USA

tel: +30 210 674 0600 email: [email protected] tel: +1 954 730 9300 email: [email protected] fax: +30 210 674 0634 website: www.greekflyingdoctors.gr fax: +1 954 485 6564 website: www.aero-jet.com

IAS Medical Air Ambulance International George Ditchburn – Operations Manager Mr Peter Veazey – CEO (NORTH AMERICA) 145-157 St John Street, London, EC1V 4PY, UK P.O. Box 1044, Magnolia. Texas 77353, USA

tel: +44 870 042 1465 email: [email protected] tel: +1 832 934 2390 email: [email protected] fax: +44 870 042 1480 website: www.iasmedical.com fax: +1 832 934 2395 website: www.airambulanceinternational.com

IFRA Air Ambulance Network Dr Christian Steindl – Director Kirk Pacheco – President Bahnhofplatz 13/5, POB 160, 3500 Krems, AUSTRIA 905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689, USA

tel: +43 2732 825 610 email: [email protected] 24hr tel: + 1 727 934 3999 email: [email protected] fax: +43 2732 851 01 website: www.ifra.at fax: + 1 727 937 0276 website: www.airambulancenetwork.com

Jet Executive International Charter Air Ambulance Professionals, Inc. Irena Dimitrijevic – Marketing & Sales Brian L. Weisz – President Mündelheimer Weg 50, D-40472, Düsseldorf, GERMANY Ft. Lauderdale Executive Airport, 1535 South Perimeter Rd, “Homebase FRA & MUC” Hangar 36B Ft. Lauderdale, Florida 33309, USA tel: +49 211 602 7775 email: [email protected] tel: +1 954 491 0555 email: [email protected] fax: +49 211 602 77766 website: www.jetexecutive.com fax: +1 954 491 6114 website: www.airambulanceprof.com

Mayoral Executive Jet Air Ambulance Specialists Juan Carlos García Caparrós – Commercial Director Tom Cox – Director of Business Development Dominguez Toledo S.A., 118 La Orotava, Malaga 29006, SPAIN 345 Inverness Drive South, Suite A110, Englewood, Colorado, 80112, USA

tel: +34 952 048 609 email: [email protected] tel: +1 720 875 9182 email: [email protected] fax: +34 924 048 612 website: www.mayoralaviation.com fax: +1 720 875 9183 website: www.airaasi.com

Medic’Air International CATEGORY KEY CLAIMS MANAGEMENT INSURERS AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMM. AIRLINE Dr Herve Raffin – General Manager AIR AMBULANCE INTERIOR COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDER 35 rue Jules Ferry, 93170 Bagnolet, Paris, FRANCE AIRCRAFT PERFORMANCE SOLUTIONS CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENING ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE tel: +33 141 72 1414 email: [email protected] CATASTROPHIC CLAIMS SPECIALIST HEALTHCARE CLINICS TRAVEL AGENTS fax: +33 148 57 1010 website: www.medic-air.com COST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES 42 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

AirMed International LLC Global Excel Management Jeffrey T Tolbert – President Michael Drew – Vice-President Sales 73 Queen Street, Sherbrooke, QC J1M 0C9, CANADA 1000 Urban Center Drive, Suite 470, Birmingham, AL 35242, USA 17548 Deer Isle Circle, Winter Garden, FL 34787, USA tel: +1 205 443 4840 email: [email protected] tel: +1 866 566 1130 email: [email protected] fax: +1 205 443 4841 website: www.airmed.com fax: +1 819 566 8335 website: www.globalexcel.ca (AMERICAS) European Air Ambulance On Call International Patrick Schomaker – Director Sales & Marketing Michael J. Kelly – President & CEO AIR AMBULANCE

(NORTH AMERICA) 175A, rue de Cessange, L-1321, LUXEMBOURG One Delaware Drive, Salem, NH 03079, USA

24hr tel: +49 711 7007 7007 email: [email protected] tel: + 888 289 0567 email: [email protected] fax: +49 711 7007 7009 website: www.air-ambulance.com fax: +1 603 328 1770 website: www.oncallinternational.com ASSISTANCE COMPANIES ASSISTANCE Global Jetcare, Inc. OneWorld Assist Bart Gray – President Taka Katsube – Director Assistance & Cost Managment 16479 Runway Drive, Brooksville, FL 34604, USA 10th Floor, 6081 No.3 Road, Richmond, BC V6Y 2B2, CANADA

tel: +1 352 799 7771 email: [email protected] tel: +1 604 303 2113 email: [email protected] fax: +1 352 799 7776 website: www.globaljetcare.com fax: +1 604 276 4593 website: www.oneworldassist.com

JET ICU SelectCare Worldwide Mike Honeycutt – President Magdi Riad – President 2561 Rescue Way, Brooksville, FL 34604, USA #1201, 438 University Avenue, Toronto M5G 2K8, CANADA

tel: +1 352 796 2540 email: [email protected] tel: +1 416 340 7265 email: [email protected] fax: +1 352 796 2549 website: www.jeticu.com toll free: +1 866 261 6718 website: www.selectcareworldwide.com

LIFESUPPORT Patient Transport Asia Assistance Partners Graham Williamson – CEO Siriporn Wongurai – International Operations Director 184/235 Forum Tower, 36 Flr Ratchadapisek Rd Huaykwang, Bangkok 10320, #9-1009 Allsbrook Road, Parksville, British Columbia, V9P 2A9, CANADA THAILAND tel: +1 866 554 3817 email: [email protected] tel: +662 645 3733-5 email: [email protected] fax: +1 877 288 2908 website: www.LifeSupportTransport.com fax: +662 645 3732 website: www.aapartners.net

Skyservice Air Ambulance Assistance Online (AUSTRALASIA) David Ewing – VP International Market Development Bertrand Guichoux – CEO YUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), Zendai Cube Edifice 6/F, 58, Changliu Road, Pudong, 200135 Shanghai, CHINA H9P 1A2, CANADA tel: +1 514 497 7000 email: [email protected] tel: +86 21 6104 9500 email: [email protected] fax: +1 514 636 0096 website: www.skyservicebas.com/airambulance fax: +86 21 6104 9484 website: www.assistanceonline-china.com

AIMS Customer Care Pty Ltd Bernadette Breton – Managing Director Louise Heywood – Business Development & Marketing Manager Private Bag X5, Benmore Gardens 2010, Johannesburg, SOUTH AFRICA Level 3, 60 Miller Street, North Sydney 2060, NSW, AUSTRALIA

(AFRICA) tel: +00 27 11 783 0135 email: [email protected] tel: +612 9202 8222 email: [email protected] fax: +00 27 11 783 2950 website: www.aims.org.za fax: +612 9202 8220 website: www.customercare.com.au

AMREF Flying Doctor Service To have your company listed in our service directory Dr Bettina Vadera – Medical Director Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA contact the sales department now: tel: +254 20 6000 090 email: [email protected] [email protected] or telephone: +44 (0)117 922 66 00 fax: +254 20 344 170 website: www.amref.org ASSISTANCE COMPANIES ASSISTANCE

Interhealth Technologies Dynamiq Kevin Thomas – Director - International Janine Benson – Director of Emergency Assistance NEW P O Box 3058, Bedfordview 2008, SOUTH AFRICA Level 5/33 York St, Sydney 2000, NSW, AUSTRALIA

tel: +27 11 622 8010 email: [email protected] tel: +61 (0) 2 9978 6600 email: [email protected] fax: +27 11 622 8264 website: www.interhealth.net fax: +61 (0) 2 9888 3609 website: www.dynamiq.com.au/assist

Netcare 911 International Assistance First Assistance Brenda Durow – International Assistance Manager Mary-Jo McDonald – General Manager Riverview Park, Janadel Avenue, Midrand, SOUTH AFRICA PO Box 17-310, Greenlane, Auckland, NEW ZEALAND

tel: +27 10 209 8387 email: [email protected] tel: +64 9 356 1650 email: [email protected] fax: +27 10 209 8405 website: www.netcare911.co.za fax: +64 9 525 1278 website: www.firstassistance.co.nz

West African Rescue Association Global Assistance & Healthcare Florian Zagel – Managing Director Mario Babin – Chief Executive Officer Cilandak Commercial Estate - # 111 GC, Jl. Raya Cilandak KKO, Klotey Cresent 6, North Labone, Accra, GHANA Jakarta 12560, INDONESIA tel: +233 244 312 496/7 email: [email protected] tel: +62 21 299 78 999 email: [email protected] fax: +233 21 781 259 website: www.westafrican-rescue.com fax: +62 21 299 78 9555/66 website: www.global-assistance.net

Emergency Assistance North America Inc. South Pacific Air Ambulance Jaime Perez – Operations Manager Scotty Watson – Managing Director 580 St. Andrews Pl., West Vancouver, B.C., V7S 1V8, CANADA NEW ZEALAND AUSTRALIA SINGAPORE

tel: + 1 604 922-4443 email: [email protected] tel: +64 9256 9000 email: [email protected] fax: +888 572-9956 website: www.eanorthamerica.com fax: +64 9256 9111 website: www.spaa.co.nz call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 43

ADAC-Ambulance Service Save Assistance France Robert Glueck – Marketing & Sales Director Franck Molinier – Director of Business Development Am Westpark 8, 81373 Munich, GERMANY 19 rue de Provence, 78310 Maurepas, FRANCE

tel: +49 89 76 76 52 85 email: [email protected] tel: +33 13062 6752 email: [email protected] (EUROPE) (EUROPE) 24h Alarm: +49 89 76 76 50 05 website: www.adac.de/ambulance 24 tel: +33 13062 1122 website: www.saveassistance.com

Altas Assistance Savitar Arvydas Bebravi˘cius – Managing Director Lydia Semchenkova – Business Development Manager Lentvario Str. 7, Lt-02300 Vilnius, LITHUANIA 25/1, 7th Floor, Trubnaya Str., Moscow, 127051, RUSSIA

tel: +370 5 264 4020 email: [email protected] tel: +7 495 987 1775 email: [email protected] fax: +370 5 264 4021 website: www.altas-assistance.lt fax: +7 495 987 1776 website: www.savitar-gr.com ASSISTANCE COMPANIES ASSISTANCE ASSISTANCE COMPANIES ASSISTANCE AP Companies SOS International Natalya Butakova – Business Development Manager Helle Drager Sandahl – Communications & Marketing Manager str. 9, dom 5/7, ul. Nizhnyaya Syromyatnicheskaya, Moscow 105120, RUSSIA Nitivej 6, DK-2000 Frederiksberg, Copenhagen, DENMARK

tel: +7 495 989 1120 email: [email protected] tel: +45 7010 5055 email: [email protected] fax: +7 495 989 1130 website: www.ap-companies.ru fax: +45 7010 5056 website: www.sos.eu

ARC Europe SA TBS Team 24 d.o.o Hans Biekmann – Network Director Edvard Hojnik – General Manger Avenue des Olympiades 2, 1140 Brussels, BELGIUM Ljubljanska Ulica 42, 2000 Maribor, SLOVENIA

tel: +32 2 706 6660 email: [email protected] tel: +386 2618 2301 email: [email protected] fax: +32 2 706 6601 website: www.arceurope.com fax: +386 2618 5800 website: www. tbs-team24.com

CNAS CONNEX Assistance Middle East Carole Luisy – Managing Director Lara Helmi – International Network Director 80 rue des alliés, 38100, Grenoble, FRANCE Office 703, Block B, Belrasheed Towers, Qusais, Dubai, UAE

tel: +33 438 49 83 49 email: [email protected] tel: +97 14 257 82 84 email: [email protected] fax: +33 438 49 83 40 website: www.cnas-assistance.com fax: +97 14 257 82 85 website: www.connexassistance.com (MID. EAST) (MID.

DRK Assistance Dr Colin Plotkin & Sons Consulting INC. Andreas Speich – Managing Director Dr Colin Plotkin – Managing Director Aufm Hennekamp 71, 40225 Düsseldorf, GERMANY 27-3088 Francis Road, Richmond, British Columbia V7C 5V9, CANADA

tel: +49 211 2711 2020 email: [email protected] tel: +1 604 241 9677 email: [email protected] fax: +49 211 3018 0527 website: www.drkassistance.com fax: +1 604 241 0733 website: www.plotkinconsulting.com

Global Assistance a.s. To have your company listed in our service directory Petr Bold – General Manager CATASTROPHIC Dopraváku˚ 749/3,184 00 Prague 8, CZECH REPUBLIC contact the sales department now:

tel: +420 266 799 770 email: [email protected] CLAIMS SPECIALISTS [email protected] or telephone: +44 (0)117 922 66 00 fax: +420 266 799 797 website: www.1220.cz

Global Voyager Assistance - Russia AIMS Costas Danilenko – CEO Bernadette Breton – Managing Director PO Box II, 125124 Moscow, RUSSIA Private Bag X5, Benmore Gardens, 2010 Johannesburg, SOUTH AFRICA

tel: +7 495 775 0999 email: [email protected] tel: +00 27 11 783 0135 email: [email protected] (AFRICA) fax: +7 495 775 0998 website: www.gvassistance.com fax: +00 27 11 783 2950 website: www.aims.org.za

Global Voyager Assistance - Black Sea Interhealth Technologies Olga Turubarova – General Manager Kevin Thomas – Director - International 77-79 Nezhinskaya Str., 65023, Odessa, UKRAINE P O Box 3058, Bedfordview 2008, SOUTH AFRICA COST CONTAINMENT tel: +38 048 7373 441 email: [email protected] tel: +27 11 622 8010 email: [email protected] fax: +38 048 7373 442 website: www.gvassistance.com fax: +27 11 622 8264 website: www.interhealth.net

Greek Flying Doctors ChargeCare International Dimitris Kanellis – Manager Christiane Burniston – Managing Director 3 Doukisis Plakentias Str, 152 34 Halandri, Athens, GREECE Monument Business Park, 1D Park Offices, Warpsgrove Lane, Chalgrove, Oxford, UK

tel: +30 210 674 0600 email: [email protected] (EUROPE) tel: +44 1865 400 007 email: [email protected] fax: +30 210 674 0634 website: www.greekflyingdoctors.gr fax: +44 845 003 9923 website: www.chargecareinternational.co.uk

Marm Assistance Marm Assistance Jill Atac – CEO Jill Atac – CEO Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY

tel: +90 216 588 0588 email: [email protected] tel: +90 216 588 0588 email: [email protected] fax: +90 216 588 0602 website: www.marmassistance.com fax: +90 216 588 0602 website: www.marmassistance.com

med con team GmbH Medical Claims International Spain Michael Weinlich – Managing Director Fatima Guillen Grande – Managing Director Gerhard-Kindler-Str.8, 72770 Reutlingen, GERMANY C/Ciudad de Aguilas No.2, Local 2A, Madrid 28030, SPAIN

tel: +49 7121 433 660 email: [email protected] tel: 00 34 913 016 145 email: [email protected] fax: +49 7121 433 619 website: www.medconteam.com fax: 00 34 913 016 160 website: www.mcimanager.com 44 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

Global Excel Management Star Healthcare Michael Drew – Vice-President Sales Gigi Galen – President 73 Queen St, Sherbrooke, QC J1M 0C9, CANADA 850 7th Avenue, Suite 803, New York, 10019, USA 17548 Deer Isle Circle, Winter Gdn, FL 34787 USA tel: +1 866 566 1130 email: [email protected] tel: + 1 212 581 8228 email: [email protected] fax: +1 819 566 8335 website: www.globalexcel.ca fax: + 1 212 581 8272 website: www.starhealthcarenet.com

Global Medical Management To have your company listed in our service directory Raija Itzchaki – COO

(NORTH AMERICA) 7901 SW 36th Street, Suite 100, Davie, FL 33328, USA contact the sales department now:

tel: +1 954 370 6404 email: [email protected] COST CONTAINMENT [email protected] or telephone: +44 (0)117 922 66 00 fax: +1 954 370 8613 website: www.gmmusa.com CLAIMS MANAGEMENT

Olympus Managed Healthcare LIFESUPPORT Patient Transport Steven Jacobson – CEO Graham Williamson – CEO 777 Brickell Avenue, Suite PH70, Miami, Florida 33131, USA #9-1009 Allsbrook Road, Parksville, British Columbia, V9P 2A9, CANADA

tel: +1 305 530 8600 email: [email protected] tel: +1 866 554 3817 email: [email protected] fax: +1 305 530 0766 website: www.omhc.com fax: +1 877 288 2908 website: www.LifeSupportTransport.com SPECIALISTS OneWorld Assist Voyageur Aeromedical Travel Taka Katsube – Director Assistance & Cost Managment Marc Lucas – General Manager 10th Floor, 6081 No.3 Road, Richmond, BC V6Y 2B2, CANADA Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK

tel: +1 604 303 2113 email: [email protected] tel: +44 (0)117 927 3554 email: [email protected]

fax: +1 604 276 4593 website: www.oneworldassist.com COMM. REPATRIATION fax: +44 (0)117 925 5940 website: www.voyageur24.com

SelectCare Worldwide ADAC Magdi Riad – President Christoph Ullrich – Director of Purchase / International Network #1201, 438 University Avenue, Toronto M5G 2K8, CANADA Am West Park 8, 81373 Munich, GERMANY

tel: +1 416 340 7265 email: [email protected] tel: +49 89 7676 2912 email: [email protected] toll free: +1 866 261 6718 website: www.selectcareworldwide.com 24hr Alm: +49 89 7676 5005 website: www.adac.de/ambulance TRANSPORT Star Healthcare Lufthansa Medical Services Gigi Galen – President Doris Ehring – Manager Sales & Marketing Lufthansa German Airlines, Lufthansa Base, FRA SX/M, D-60546, 850 7th Avenue, Suite 803, New York, 10019, USA Frankfurt/Main, GERMANY tel: + 1 212 581 8228 email: [email protected] tel: +49 (0)69690-20904 email: [email protected] fax: +49 (0)69690-58147 website: www.dlh.de

fax: + 1 212 581 8272 website: www.starhealthcarenet.com PATIENT CARE CRITICAL

UnitedHealth International Albin Repatriation Ltd Philip Brun – Vice President of Sales & Service Emerson De Luca – General Manager 3100 SW 145 Avenue, Miramar, FL 33027, USA 83 Westbourne Grove, Bayswater, London W2 4UL, UK

tel: +1 954 378 0694 email: [email protected] tel: +44 20 7313 6920 email: [email protected] fax: +1 954 378 0771 website: www.uhgi.com fax: +44 20 7313 6999 website: www.albininternational.com

Global Assistance & Healthcare ANUBIS International Repatriation Mario Babin – Chief Executive Officer Fabrice Kana – Development & Quality Manager Cilandak Commercial Estate - # 111 GC, Jl. Raya Cilandak KKO, Tour Pleyel, 93200 Paris, Saint Denise, FRANCE Jakarta 12560, INDONESIA

tel: +62 21 299 78 999 email: [email protected] FUNERAL DIRECTORS tel: +33 149 195 960 email: [email protected] fax: +62 21 299 78 9555/66 website: www.global-assistance.net fax: +33 149 471 901 website: www.anubisgroup.org

Global Excel Management Funeral Home AURIGA Ltd. Michael Drew – Vice President of Sales Helen Pradova – Chief of International Department 73 Queen St, Sherbrooke, QC J1M 0C9, CANADA B. Nmcové Street 1052/1, 412 01 Litomerice, CZECH REPUBLIC 17548 Deer Isle Circle, Winter Gdn, FL 34787, USA tel: +1 866 566 1130 email: [email protected] tel: +420 724 257 899 email: [email protected] fax: +420 416 735 800 website: www.funeral-assistance.cz CLAIMS MANAGEMENT fax: +1 819 566 8335 website: www.globalexcel.ca

To have your company listed in our service directory Funeralcare International Louisa Killen – Repatriation Specialist contact the sales department now: Murray House, 50 Whitta Road, Manor Park, London, Essex E12 5DA, UK [email protected] or telephone: +44 (0)117 922 66 00 tel: +44 20 8788 5303 email: [email protected] fax: +44 20 8788 2525 website: www.co-operativefuneralcare.co.uk

Interhealth Technologies John Allison Monkhouse Co., Ltd (Thailand) Kevin Thomas – Director - International Apple Kaewprasert – General Manager President Park View Tower, 99/243 (30B) Pine Tower, Sukhumvit soi 24, Klongton P O Box 3058, Bedfordview 2008, SOUTH AFRICA Klongtoey, Bangkok, THAILAND tel: +27 11 622 8010 email: [email protected] tel: +66 2382 5345-7 email: [email protected] fax: +27 11 622 8264 website: www.interhealth.net fax: +66 81 584 5942 website: www.monkhouse.com.au

SelectCare Worldwide Lutece International Magdi Riad – President Zouhaier Hertelli – Repatriation Specialist #1201, 438 University Avenue, Toronto M5G 2K8, CANADA 56 rue Olivier de Serres, 75015 Paris, FRANCE

tel: +1 416 340 7265 email: [email protected] tel: +33 1 56 08 00 23 email: [email protected] toll free: +1 866 261 6718 website: www.selectcareworldwide.com fax: +33 1 56 08 00 43 website: www.pflutece.com call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 45

Rowland Brothers International Medic’Air International 每递安国际 Melanie Walkling – Partner Dr Huaqun Gao – Medical Director 299-305 Whitehorse Road, West Croydon, Surrey CR0 2HR, UK 885 Renmin Road, Huaihai China Building, Room 808, 200010 Shanghai, CHINA (ASIA) tel: +44 20 8684 2324 email: [email protected] tel: +86 2163 558289 email: [email protected] fax: +44 20 8684 8000 website: www.rowlandbrothersinternational.co.uk fax: +86 2163 558285 website: www.medic-air.com

Servilusa AMREF Flying Doctor Service Vanda Castro – Manager International Department NEW Dr Bettina Vadera – Medical Director Agencias Funerarias SA, International Dept. Rua do Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA Entreposto Industrial, 8-2 Esq, 2610-135 Amadora, PORTUGAL tel: +35 121 470 6300 email: [email protected] tel: +254 20 6000 090 email: [email protected] FUNERAL DIRECTORS fax: +35 121 470 6499 website: www.servilusa.pt fax: +254 20 344 170 website: www.amref.org

BUPA Cromwell Hospital To have your company listed in our service directory Shams Maladwala – Commercial Director Cromwell Road, London SW5 0TU, UK contact the sales department now:

tel: +20 7460 2000 email: [email protected] (AFRICA) [email protected] or telephone: +44 (0)117 922 66 00 (EUROPE) fax: +20 7835 2444 website: www.cromwellhospital.com HOSPITALS HOSPITALS Xanit Hospital de Benalmadena Greek Flying Doctors Dr. Juan Bosco Rodriguez Hurtado – Director Dimitris Kanellis – Manager

Avda. Los Argonautas, Benalmadena, 29630 Malaga, SPAIN AIRLINES COMMERCIAL ON ESCORT MEDICAL 3 Doukisis Plakentias Str, 152 34 Halandri, Athens, GREECE

tel: +34 952 367 190 email: [email protected] tel: +30 210 674 0600 email: [email protected] fax: +34 952 367 191 website: www.xanit.net fax: +30 210 674 0634 website: www.greekflyingdoctors.gr

Baptist Health Int. Center of Miami Redstar Aviation Yohandra Fuentes – Finance Manager Mustafa Atac – CEO 8940 North Kendall Drive, Suite 601-E, Miami, Fl 33176, USA Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY

tel: +1 786 596 2373 email: [email protected] tel: +90 216 588 0216 [email protected] (EUROPE) email:

(AMERICA) fax: +1 786 596 5979 website: www.baptisthealth.net/international fax: +90 216 588 0225 website: www.redstar-aviation.com

Integrated Healthcare Services Voyageur Aeromedical Travel Brenda Escobar - International Program Coordinator Marc Lucas – General Manager 450 E. Las Olas Blvd., Ft. Lauderdale, FL 33301, USA Voyageur Buildings, 43 Colston Street, 43 Colston Street, Bristol BS1 5AX, UK

tel: + 1 305 222 6750 email: [email protected] tel: +44 (0)117 927 3554 email: [email protected] tel: + 1 305 222 6751 website: www.hcaeastflorida.com fax: +44 (0)117 925 5940 website: www.voyageur24.com

Jackson Memorial Hospital International Air Ambulance Network Luis Felipe Arango – Vice President of International Business Kirk Pacheco – President Jackson Medical Towers, East Tower, Suite 829, 905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689, USA 1500 NW 12th Avenue, Miami, FL 33136 - 9998, USA 24hr tel: + 1 305 355 1212 email: [email protected] 24hr tel: + 1 727 934 3999 email: [email protected] tel: + 1 305 355 5544 website: www.jmhi.org fax: + 1 727 937 0276 website: www.airambulancenetwork.com (N AMERICA) University of Miami Health System AMREF Flying Doctor Service Jose Quesada M.D., M.B.A. – Director Finance & Operations Dr Bettina Vadera – Medical Director 1099 N.W. 14th Street, Miami, Florida 33136, USA Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA

tel: +1 305 243 9100 email: [email protected] tel: +254 20 6000 090 email: [email protected] fax: +1 305 243 9101 website: www.uhealthinternational.com fax: +254 20 344 170 website: www.amref.org

To have your company listed in our service directory StandbyMD Alex Sánchez – Managing Director contact the sales department now: 777 Brickell Avenue, Suite 1370, Miami, Florida 33131, USA MEDICAL PROVIDER [email protected] or telephone: +44 (0)117 922 66 00 tel: +1 305 459 4882 email: [email protected] fax: +1 305 421 5575 website: www.standbymd.com

CareFlight Group Voyageur Aeromedical Travel Medical and Tasking Centre Marc Lucas – General Manager PO Box 5078, Robina Town Centre, Queensland, 4230, AUSTRALIA Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK TRAVEL TRAVEL

24hr tel: +61 7 5553 5955 email: [email protected] AGENTS tel: +44 (0)117 927 3554 email: [email protected] fax: +61 7 5553 5914 website: www.cmsairambulance.com fax: +44 (0)117 925 5940 website: www.voyageur24.com

CareFlight International V Creative Design Sue Robshaw – Co-ordinator Steve Annette – New Media Director Westmead Hospital Campus, PO Box 159, Westmead, NSW 2145, Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK AUSTRALIA

MEDICAL ESCORT ON ON ESCORT MEDICAL tel: +61 1300 655 855 email: [email protected] tel: +44 (0)117 929 4636 email: [email protected]

COMMERCIAL AIRLINES COMMERCIAL fax: +61 2 9689 2744 website: www.careflight.org fax: +44 (0)117 925 2040 website: www.vcreativedesign.co.uk WEB & MEDIA MEDIA & WEB ADVERTISING

Medical Wings CATEGORY KEY CLAIMS MANAGEMENT LEGAL SERVICES AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMM. AIRLINE Dr Sommart Somsiri – Medical Director AIR AMBULANCE INTERIOR COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDER 222 Room 3259, Bangkok Int Airport, Viphavadee-Rangsit Rd, Sikan, Don Muang, AIRCRAFT PERFORMANCE SOLUTIONS CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENING Bangkok 10210, THAILAND ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE tel: +662 247 3392 email: [email protected] CATASTROPHIC CLAIMS SPECIALIST HEALTHCARE CLINICS TRAVEL AGENTS fax: +662 535 4355 website: www.medicalwings.com COST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES 46 REGULARS GRAPEVINE • GRA PEVINE VINE G RAPEVINE GRAP EVINE

GRAPEVINE • GRAPEVINE • GRAPEVINE GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • Grapevine Teddy travel their soft toys on holiday to the UK and elsewhere. The service provided involves taking customers’ agent teddy bears to famous landmarks and taking a photo of their holiday adventures as mementos for the A German woman has given up a successful teddies’ owners. Bohmler explained: “It might sound career in sales to become a travel agent crazy but people love their soft toys and want to give catering to the teddy bear market. Ulrike them the best. I accompany the toys on their tour Bohmler says her firm, Teddy-In, has been and although people might laugh at it [surely not?! – besieged with hundreds of enquiries from Ed], a lot of people genuinely love their teddy bears curious customers who want Bohmler to take and want the best for them.”

• GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE GRAPEVINE • GRA PEVINE VINE G RAPEVINE •

Million-dollar hairdo

Lloyd’s of London has issued an insurance policy worth US$1 million – to cover the long flowing locks of an American football player. Troy Polamalu, who plays for the Pittsburgh Steelers, is well known for his luscious head of hair, and promotes Head & Shoulders shampoo. Procter and Gamble, the manufacturer of the shampoo, is so impressed with Troy’s hair that they have taken out a £650,000 insurance policy for the duration of the football season. A spokesperson for Procter and Gamble said of Lloyd’s: “They’ve created the first ever insurance policy to protect his iconic mane for the entire NFL season.”

Testicle festival

Tourism officials in Serbia are hoping to attract more tourists than ever before, through inviting them to attend the country’s annual testicle cooking competition – the hope is that the cookery event will do for the country what whisky has done for Scotland. The World Championship of Testicle Cooking is taking place for the seventh year running, and is open to cooks from all over the world. Dishes are made from the testicles of bulls, wild boar, horse, shark, ostrich, kangaroo, donkey, turkey, goat, reindeer and elk. Festival organiser Ivo Mokovich said: “The importance of a recognisable brand to sell a region cannot be underestimated – look at how many people go to Scotland because of their whisky or how many people know Switzerland because of their cheese and chocolate. We are now hoping that the many famous and varied testicle dishes that we have created in the region will become world- famous and attract people who appreciate good food from all over the world.”

• GRAPEVINE • GRAPEVINE • GRAPEVINE • International Travel Insurance Journal ONTHEMOVE 47

Wood heads to Aon Benfield hires Mondial names Experian chooses Bupa UK Myers Godlin as MD head of insurance

Bupa Health and Wellbeing UK has appointed Tony Aon Benfield has appointed Chris Myers as head of Mondial Assistance has announced that Beth Godlin Experian, the global information services company, Wood as its new sales director, responsible for sales its Rating Agency Advisory for its UK, Europe, Middle has been promoted to managing director of Mondial has announced the appointment of Sandy to personal, small/medium enterprise (SME) and East and African regions. Based in London, Chris Assistance USA. Beth has more than 25 years of McPherson as head of insurance for UK and corporate customers. Tony joins Bupa UK from the will guide reinsurers through the ratings process and experience with the company, Ireland. Sandy will be responsible for driving the firm’s Australian arm, where he has held the position advise them on the financial, operational and strategic most recently as executive company’s insurance market strategy across its of sales director since Bupa Australia’s merger with issues that influence a company’s financial strength vice president, chief sales and broad portfolio of products and services. MBF in 2008. Tony spent five years with MBF, initially rating. Chris is also head of Aon Benfield’s Enterprise marketing officer. In her new Sandy brings with him over 20 years of joining the company as national sales manager in Risk Management position as managing director, experience in the insurance industry – in the 2003. Prior to this, he enjoyed success in both sales (ERM) practice globally she will be responsible for past, he has worked for leading insurers such as and service in the AMP Group, a leading wealth and was previously overseeing the day-to-day Aviva, Standard Life and Scottish Widows, and management company operating in Australia and based at the firm’s operations of the company. has for the last three years held the position New Zealand. New York office. As She will continue to report to of marketing director at PaymentShield, the Announcing the appointment, Dr Natalie-Jane head of ERM, Chris Jon Ansell, who will remain largest provider of general insurance to the Macdonald, managing director of Bupa Health will continue to direct president and chief executive intermediated mortgage sector. and Wellbeing UK, said: “Tony has a wealth of efforts assisting re/ of the company. Charlotte Hogg, managing director of UK experience, which will be invaluable in his new role. insurers with ERM Ansell commented: “I cannot Beth Godlin and Ireland for Experian, commented on the He will play a key part in providing integrated and framework support think of anyone better suited appointment: “Deregulation, market complexity tailored healthcare solutions to our customers and and related analytics. than Beth to assume this role. With more than 25 and growing competition have changed the ensuring that their health and wellbeing remains at Kelly Superczynski, years with the company, she has been instrumental in traditional working patterns of insurance organisations the heart of our business.” Chris Myers global head of Aon the development and execution of growth strategies and modern companies need new solutions to Commenting on his new role, Tony said: “I am Benfield’s Analytics’ that have helped propel us to our current position manage risk, control costs and improve customer delighted to be joining Bupa Health and Wellbeing Rating Agency Advisory, said: “As business dynamics as the country’s leading travel insurer.” Beth was experience. Experian’s data, software and analytics UK at such an exciting time. It is a very strong and rating agency criteria continue to evolve, re/ instrumental in creating the initial plan that launched the capabilities are proven to be hugely beneficial to our business, with clear aspirations to be a recognised insurers need to stay abreast of the metrics that Access America brand of travel insurance in 1985 – the insurance clients and Sandy’s extensive experience leader in healthcare. I look forward to building matter most to their companies’ ratings. Chris’s insurance is now sold by leading airlines, online travel will be crucial in our efforts to drive development and on Bupa’s solid relationships with its intermediary unique combination of ERM expertise and rating agencies and tour operators across the US. growth in this important sector.” partners and customers by securing and extending agency experience will truly differentiate Aon Benfield contracts with leading multinationals and SMEs and to Analytics’ capabilities in the UK and EMEA and enable offer leading edge health and wellbeing products and our clients to optimise their financial ratings.” services to individual customers.” Claims team named Groupama Insurances has confirmed the line up for has been with Groupama for three years, has been Crisis Survivor its new senior claims management team, reporting to appointed head of claims development. Last but not Sepp chosen as Phil Bird, claims director. Capitalising on the extensive least, Daryn Hughes has been given the role of head chooses Walker claims expertise within the business, the four key of operations, and is responsible for managing the chief claims officer appointments have been made as the company Portsmouth claims centre. His role will be focused Business continuity specialist Crisis Survivor has completes the centralisation of commercial and on the operational management of both personal Zurich Financial Services Group has announced the appointed Michael Walker, a former executive with personal claims to its state-of-the-art claims centre insurance claims and commercial insurance claims, appointment of Thomas Sepp to the position of Prudential Financial, as its new chairman. Richard in Portsmouth, UK. Bird said: “This team has the along with the personal injury fast track unit. chief claims officer. He succeeds Christian Orator, Vardy, a former company secretary to both Union plc knowledge, experience and clear lines of responsibility who was appointed chief administrative officer and and Investec Group plc, has also been appointed as a to support our vision of creating a robust member of the group executive committee. In this board director. In conjunction with the management and highly professional claims operation, new position, team, they will be responsible able to handle any size of claim. This is all Thomas will for implementing the company’s about making our claims function efficient, be responsible development strategy and driving adaptable and future proof.” for leading the the business forward. The senior claims team includes company’s global Tony Gimple, managing director of Karl Parr, who has been appointed network of claims Crisis Survivor, commented on the head of large and complex loss, with professionals and appointments: “We are currently responsibility for managing a team of driving continuous looking to develop the business technical claims handlers. Elsewhere, improvement in and drive it forward on a new former head of claims planning Steve the group’s claims level. Michael and Richard both Caffrey has been appointed head of capabilities and have great vision and an incredibly technical claims, responsible for the customer service. Thomas Sepp impressive track record. They will technical direction of personal and He will report to each bring their own special brand commercial claims handling and the Mario Greco, chief executive of general insurance, of expertise to the business and we are delighted to management of delegated authorities. and will be located in Zurich, Switzerland. have them onboard.” Darren Wills, a claims professional who (l-r) Steve Caffrey, Karl Parr, Daryn Hughes, Darren Wills, Phil Bird

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