Sitting by the pool during a winter vacation in Florida, snowbird Robert Woodcock frets about travel insurance—particularly reports that insurers have refused to pay certain claims.
The 72-year-old Toronto man dreams of buying coverage from his home province, without any risk of a claim being denied. But even he doubts that this will ever happen. To help relieve his fears, we investigated whether he has any good reason to worry… yet.
We looked into his latest purchase of travel medical insurance for a trip in the summer. He had shopped around on his own, read the policy, and asked his family doctor about a medical question. He later discovered something he found odd about the policy.
First: The Good News.
We consulted Dr. Richard Heinzl, Medical Director at Ingle International, a Toronto broker that specializes in travel insurance and services. He confirmed that Woodcock is a good candidate for travel coverage. “He’s pretty healthy for 72,” said Heinzl. He looked through Woodcock’s medical records and at his doctor’s brief summary of past surgeries, medication, and physical examinations.
Heinzl noted that Woodcock has had hypertension for years, but his blood pressure is controlled by medication. The retired home renovator and hockey goalie has had a hernia stitched up, and a routine gallbladder operation. Five years ago, he had a swollen vein on the side of one leg (superficial phlebitis), but has had no problem with any veins since. He also takes medication for acid reflux, but his doctor says Woodcock has had no change of medication in the past 12 months.
Heinzl had also conferred with colleague Matt Davies, Product Specialist at Ingle. Together they went through Woodcock’s answers to the medical questionnaire for the President’s Choice Financial policy Woodcock purchased in the summer of 2013. In early October, they saw no reason that a claim would be denied due to an unstable medical condition or inaccurate answers on the medical questionnaire. So he could purchase that same policy again and answer the questions the same way. His answers would be accurate, as his health has been stable for 12 months. “Provided he met the stability definition for the required amount of time before he left for the US this past summer, the pre-existing medical condition exclusion in his PC Financial policy would not have applied to his medical conditions,” said Davies.
His gallbladder operation would have made him less of a concern to some insurers than if he still had the pain of gallstones, Davies noted. “Yes, based on the information we received,” said Heinzl, when asked if Woodcock would be covered by the PC Financial policy. Davies agreed. (Ingle does not sell that policy.) Woodcock meets the terms of the policy for the premium charged.
How insurable are you? Check our Snowbird Insurability Guide to find out.
Now: The Fine Print
That same day in October, however, Woodcock discovered something on the last page of the policy. “If my health changes prior to departure… I must notify PC Financial. I called today for a clarification and was advised that ANY health changes must be reported in order for PCF to decide if they would cover the “new” medical issue. If I broke my arm [after buying the policy and did not report it] a subsequent claim for ANY medical issue could be denied.”
Davies says it is not uncommon for insurers to require policyholders to report changes in health that arise before their departure date. They do not want to cover someone whose health is unstable. “But … the PC Financial policy is interesting because it does not go into much detail. I think it’s reasonable to assume that the insurer wants to be notified of any change in health (as opposed to only changes in health related to the medical questionnaire).” Policy wordings vary from company to company, which complicates the task of shopping for coverage without help. There are also exclusions for coverage unrelated to health, such as participating in dangerous activities.
Next: The Lessons
All things considered, Robert Woodcock did well. The policy he found on his own would cover him for his next trip to Florida, assuming nothing changes in the meantime. An independent doctor and insurance expert (neither of whom have anything to do with the marketer or insurer of his policy) say so. He has also learned on his own that he must inform the insurer of any health changes before he leaves, or risk having a claim denied.
Dr. Heinzl notes, however, that it would be costly for an independent doctor to read through his medical record, conduct a physical examination, and confirm his health status: Perhaps $1,000. (That’s why travel insurers do not perform individual underwriting of most policies, and only scrutinize medical records and the accuracy of applications at the time of a claim.)
But Heinzl said most family doctors could check the accuracy of an older patient’s answers to medical questions in about 10 minutes, often for free, as Woodcock’s doctor did. Patients could save their doctor time by paying for a copy of their own medical file to support their own memory. “It’s up to you to answer the questions,” says Davies. “You cannot pass that off on someone else…and they have to be accurate answers.”
Need to talk to your doctor about your health before a trip? Here’s how.
Where Do We Go From Here?
Next, we will explore how to appeal the denial of a claim. Later, we will look at the frequency of travel insurance claims, the reason for denials, and what could be done to reduce denials. Meanwhile, Woodcock is going to test whether he would feel more comfortable purchasing travel insurance after dealing with an experienced broker.
Stay tuned for part 4 of this series Claim Denied! How Sonja and Others Fought Back…