Doctors’ Opinions Don’t Overturn Travel Insurers’ Rules

Too often, travellers think their doctor’s “opinion” about their health is all it takes to qualify them for insurance coverage or reverse a claim denial for a pre-existing condition. And mostly, they are wrong. When seeking coverage, applicants have to play by the insurers’ rules.

Don’t make the mistake of thinking your doctor’s “clearance” to travel or “clean bill of health” is a guarantee you will be covered for travel insurance.

I have often heard clients complain that an insurer had been unfair in denying their claim for emergency medical services because they didn’t know their condition was pre-existing, or their doctor told them not to worry about it. And so, when asked to complete a medical questionnaire for travel insurance, they didn’t report their high blood pressure, or that slight heart murmur, or the shortness of breath they had been experiencing over the past few months.

Doctors don’t always tell their patients all the details about diagnostic tests or scans or other investigative procedures if they don’t consider them important or if there is nothing immediate they would do about them anyway. This isn’t necessarily bad judgment. But when doctors withhold information that is required to “completely and accurately” complete a medical application for insurance, it can have disastrous consequences for their patients, who now run the risk of having their claims denied for reasons of “non-disclosure.”

Unfortunately, many family doctors know very little about travel insurance and its requirements.

And so, though a doctor may consider a patient’s blood pressure, or diabetes, or gallstones to be “stable and controlled,” the insurer invariably has a definition by which “stable and controlled” will be measured. The physician may offer the subjective opinion that their patient’s condition is stable, but the insurer will consider it stable only if it has not revealed symptoms, or required treatment or a change in medication, or been referred for investigation. It is a definition based on measurable actions.

In the end, since it’s the insurer that’s going to pay the claim (or not), it’s insurer that defines pre-existing, or stable, or medical emergency, or acceptable risk.

You should have faith and trust in your doctor. But you should not be afraid or reticent about discussing the requirements you must meet when applying for insurance. Insist on getting complete and accurate information about any tests or investigations. Tell your physician what you risk if you fail to disclose your medical condition to your insurer. Take the opportunity to educate your own physician. You might very well know more about travel insurance than he or she does. And always remember the golden rule: When the insurer pays the bills, the insurer sets the terms.

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