Family of Brain-Injured Woman Faced Repatriation Ultimatum from Insurer

The family of a woman who sustained a severe brain injury while on holiday reports that they were compelled to choose between accepting her return to the UK against medical advice or facing the cancellation of her travel insurance policy. Jane Rubens, 73, from Edinburgh, was involved in a car accident in the United States earlier this month and remains in a coma. Her insurance company, AXA Partners, initially informed the family that Mrs. Rubens would need to be repatriated on Monday, despite several medical professionals advising against the transfer, her family told the BBC. Following a significant public reaction on social media, the insurers reversed their position, stating: “The welfare of Ms Rubens and her family remains our priority.” “We were already having the worst time,” her daughter Cat, 34, a lawyer, conveyed to the BBC. “Mum may not survive this, we just don’t know. And then to have to deal with all this.” Mrs. Rubens was visiting family in Missouri for a holiday when an SUV struck her in St. Louis on 1 November. She suffered severe brain injuries and multiple haemorrhages. Since then, she has been a patient at St. Louis University Hospital, where she has undergone five surgical procedures, including a craniectomy involving the removal of a portion of her skull. Her most recent surgery occurred on Thursday. The family states that prior to her trip, Mrs. Rubens secured a travel insurance policy through AXA Partners, which provided coverage for medical expenses up to £15 million ($19 million). On Friday, the insurer contacted her two children, Cat and Andrew, who are at her bedside, to inform them of their intention to mandate her repatriation to the Royal Infirmary in Edinburgh within the current week. On Saturday, the family dispatched a letter to AXA Partners, detailing the medical opinions they had gathered, not only from her treating physicians in Missouri but also from NHS specialists they consulted and the brain injuries charity Headway. All parties concurred that, from a neurological perspective, she required several additional weeks in the United States. The family reported receiving an email from the insurers on Sunday, which stated: “based on all the medical information which has been provided, it has been confirmed that your mother, Jane Rubens, is Fit to Fly via an Air Ambulance, with appropriate medical escorts with immediate effect. We have availability to proceed with the repatriation on 25/11/2024. If you do not accept our decisions and do not want to be repatriated, then we will not provide any cover.” Later that day, when Cat Rubens telephoned the insurers, she recounted being informed: “Getting from St Louis to Edinburgh is a long way,” Cat stated, adding, “But they couldn’t provide any details – how many stops would there be, what level of sedation would she receive. Nothing.” Subsequent to this call, one of Mrs. Rubens’ treating physicians in St. Louis also contacted AXA Partners but was unable to obtain further information, including the name of a clinician in Edinburgh with whom he could discuss his patient’s condition. On Sunday evening, the family reluctantly communicated in writing to the insurance company: “In the circumstances you have given us no choice but to agree to your repatriation plan. This has placed us in an impossible position. You have asked us to agree to a repatriation plan in respect of which we have no proper details, not even the name of her receiving physician in the UK.” Cat Rubens subsequently used the social media platform X to draw attention to their difficult situation, stating: “We were backed into a corner, I didn’t want to do it, but I felt I had no option but to post on X.” Ms. Rubens reported that following the social media post, AXA Partners contacted the family to offer an apology and assured them that no action would be taken without the consent of both the family and the treating and receiving hospitals. Cat commented: “We know that repatriation has to happen – it’s what we want for mum,” adding, “But it has to be based on the neurological opinion not just on whether she’s fit to fly from an aviation point of view. We weren’t being unreasonable – they just weren’t listening.” In a formal statement, AXA Partners expressed that they were “sorry for the distress Ms Rubens and her family have experienced when making a claim and we sympathise with their situation. We have spoken with Ms Rubens’ family and will remain in contact with them over the coming days to support them.” The statement continued: “Our medical team and Ms Rubens’ treating doctors will agree the best course of action going forward. We are considering all available options and the welfare of Ms Rubens and her family remains our priority.”