Among the most frequent stories I hear from Canadians who have had their travel insurance claim denied are: “My doctor never told me I had a heart murmur” or “he didn’t say that heart pill was for atrial fibrillation” or “my CT scan didn’t show anything abnormal”—so why would they have reported any of this on their application?
Why? Because it’s up to you to know what’s in your medical record when filling out an insurance application—and if your claim is denied for non-disclosure or because you had a pre-existing condition that wasn’t “stable,” you are the one who will have to pay the bill.
And no matter how strongly your family doctor protests your denial in a letter after the fact, you are still responsible for providing accurate and up-to-date information to the insurer. The decision to pay your claim or deny it will be made on the basis of your doctor’s official medical records—those notations that doctors makes in their charts when you visit them for a consultation, not necessarily any letters of support they might send if your claim is denied.
What that means for you is that you need to be forthright in asking your doctor to explain the results of every test, the outcome of every consultation, and the reasons why you’re taking certain medications or undergoing tests.
True, doctors are busy people. But it’s up to you to slow them down just enough to explain that when you apply for insurance, accuracy and timeliness are important when giving an inventory of your medical history to the medical underwriters who have to make the decision about covering you, and under what terms.
Doctors don’t always understand that, even though many of their patients are snowbirds, or families who travel frequently. They have many priorities, and perhaps understanding travel insurance policies and how they are designed is not one of them. But the bottom line is that when you sign a contract with an insurer, you agree to abide by the insurer’s rules, and definitions, and conditions of coverage. They are there for you to read and it’s not a bad idea to ask your physician to read them too. And if you have some chronic conditions that need medications, or if you have unexplained symptoms, or you’re being referred for tests, ask your doctor to help you with your medical application.
In effect, educate your own doctor about travel insurance. It’s not something they study in medical school—though if they specialize in family medicine, they probably have some snowbirds or frequent travellers on their patient rosters.
The history you provide on your medical questionnaire is the only source of information medical underwriters have about you. There are no other records they can consult at the time you apply—although claims examiners will investigate your doctor’s medical records after the fact to make sure your application was correct and complete. Keep that in mind when doing your application or responding to an agent’s questions if you’re applying by phone or online.
Insurers are not trying to trap you, although sometimes their wording and use of medical terms in the questionnaires can be baffling to mere civilians. That’s why you should not feel embarrassed about asking your selling agent to explain terms if you don’t understand them, or asking your doctor to look over your application after you have filled it out to make sure it matches his or her records.
Play it straight. Be forthright and honest. Be sure of your information. And peace of mind will follow.
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