School is winding up for the year and families are preparing for summer vacation. For many familes that means trips to the United states or somewhere else outside of Canada. careful parents usually include travel health insurance on their “to do” list when getting ready for family travel.
But does travel insurancce protect you the way you think it does?
Travel Insurance Company Denies Couples Huge Medical Bill Claim
Donna and John McShane are “devastated” after the travel medical insurance policy they bought through the Alberta Motor Association has denied their claim for $114,000.00 in medical expenses resulting from a five day hospital stay in Arizona.
The McShane’s purchased the travel medical insurance policy before their annual trip to Arizona. However, after the couple got to the States Donna McShane developed a severe cough resulting in a five day stay in the hospital while physicians investigated whether she had tuberculosis.
When the couple returned to Canada they submitted their claim to their travel insurance company. They subsequently received a letter denying the claim because Donna McShane had mistakenly answered “no” when asked if she had “taken and/or been prescribed six or more prescriptions medications” in the last four months.
In fact, McShane’s medical records indicated she had nine prescriptions. But Donna McShane said she answered the question truthfully because some of the prescriptions had never been filled and two of the prescriptions were for drugs that she had not taken for months including an antibiotic that she never took.
Post Claim Underwriting
Donna and John McShane’s dilemma results from an insurance practice called post claim underwriting. In my 25 years as a personal injury lawyer I have reviewed many cases where tourists have become ill while travelling outside of Canada and, when they returned home their claim was rejected.
Travel medical insurance companies ask customers to fill out an application form. When a claim is submitted the insurance company conducts a detailed investigation into the client’s medical history.
The problem arises because the application forms used by travel insurance companies contain questions about the client’s health or medical history that may be vague or confusing. If the question is answered incorrectly (at least incorrectly in the eyes of the insurance company) the insurer uses that misstatement as a basis to deny the claim.
What adds to the apparent unfairness is that insurers can deny a claim on the basis of misrepresentation even if the mistake that was made has absolutely nothing to do with the illness in the medical expense claim.
Tips when buying travel medical insurance
Full Disclosure: First and foremost you must answer all questions honestly. Even if you do not think a past medical condition or medication is relevant to your current health you should disclose it. Whenever applying for travel medical insurance it is better to provide more information than less information.
Pre-Existing Conditions: Most travel medical insurance policies will not cover pre-existing condition. However the definition of what is a pre-existing condition is different in every insurance policy. Read this section carefully.
Medical Evacuation: If you are seriously injured you may need to be transported back to Canada by air ambulance. These costs can be significant (in one case I was involved in this cost was more than $100,00.00) Make sure that the policy that you are looking at includes coverage for travel costs to return to Canada for medical care.
Medical Escort: Again, if you are seriously injured you may need to have a nurse or physician travel with you when you return to Canada. Make sure that the policy that you are looking at includes provisions to allow for payment for medical escort.
Exclusions and Limitations: This is the section of the policy that tells you what the insurance company will not cover. It is important for you to know what is and is not covered. If you have any questions about whether the insurance policy covers, or does not cover, a possible condition that you may have call the insurance companies help line that is usually found on the application form.
See your Doctor: If you have any questions about how to answer any of the questions on the travel insurance application form make an appointment with your family doctor and take it with you so that your doctor can help to answer those questions.
Safe travels!
As we approach warmer weather, during the summer months more and more Canadians will be travelling out of the country for summer vacation. Here is hoping that you all have a safe, happy and injury free vacation.