When travel insurance claims are denied based on non-disclosure or failure to provide accurate medical information, it can easily generate tension or mistrust between the customer and the agent who sold and “processed” the policy.
This is especially so if the medical questionnaire is done verbally over the phone (or online) and the customer is unfamiliar with the medical terms used, or is unfamiliar with his or her own medical records, or simply unaware of the consequences of non-disclosure.
A claim denial comes as a shock to any insured person and the first reaction will often be to deflect the blame—to the doctor for not sharing pertinent medical information, to the wife for not properly completing her husband’s medical questionnaire, or to the agent who didn’t “take the time” to explain the medical terms or didn’t emphasize that any change in health status prior to the effective date of coverage had to be reported.
Fewer and fewer busy travellers manually complete their applications by themselves at their kitchen table. It’s much easier to do it by phone or online.
But convenience sometimes comes at a price. And if a claim is disputed, that price can be a damaged trust between agent and customer.
How can agents and brokers protect that trust?
- Before administering any application, emphasize the penalties for providing inaccurate or incomplete information and warn your customer that the non-disclosed symptom or condition does not have to be related to the cause of the claim in order to invalidate the terms.
- When administering a questionnaire, stick to the script and the questions as they are crafted. Have the applicant confirm, preferably by signature, that they understand the questions and terminology. Show them where they can find definitions and advise them to call their doctor if they are unsure about how to answer any of the questions.
- Emphasize that they must examine the completed questionnaire and confirm, preferably by signature, that the answers they have given have been properly recorded, and that they understand the consequences of non-disclosure.
- Explain that it is their responsibility to tell you or the insurer of any change in their health status before the policy goes into effect—that means any new or recurring symptoms, tests, medications, medical referrals or other changes in their health status. And keep precise notes of any such notification. Record their call if you can. It’s not enough to explain what procedure you normally use in recording such post-application notifications. Be specific about the case in question: did they notify you, when, how, and what was said? Contemporaneous notes, or better yet a recorded phone call (properly disclosed), carry weight should the case be elevated to ombudsman review or legal action.
- The bottom line your client must understand is that the application being submitted is their application. You may have assisted, but the information provided is their responsibility.
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