Truth or Dare: Don’t Kid Yourself, Or Your Insurer

We were raised to tell the truth. So we should be true to ourselves—and our insurer—before we take a trip outside of Canada.

Only while we are here at home do we have the protection of a tax-supported health care system, regardless of our age or state of health. Financial support for travel outside of our home province and country has limits. Basic travel medical policies will certainly cover the extra costs, but the policies are only designed to respond if the need for emergency care and transportation arises unexpectedly. So it could be particularly costly to leave the country when you know your health is not stable, or is unlikely to remain stable. Various clauses in the insurance policies could deprive you of coverage.

Related: Don’t Let Travel Insurance Trip You Up!

The Principle Of Utmost Good Faith

First and foremost, insurers rely on their policyholders to tell the truth, and to know enough about their own health to choose the appropriate policy and complete the application accurately.

Their corporate survival depends on accurately matching the risk of claims with premiums collected. The insurer’s obligation to avoid bankruptcy, and our obligation to tell the truth, are two sides of a principle known as utmost good faith.

So, if we do not tell the truth—and the insurance company can prove it—it will be within its legal rights to reject our claim for policy benefits. The insurer could rule that we didn’t reach a fair agreement and simply refund our premium.

Where To Find The Rules On Truth

Travel insurance policies will range in length and complexity, depending on the type of coverage. But the make-or-break rules in the contract are not hard to find. First, look for the Eligibility section near the front of the policy. You could be denied coverage due to the following:

  • your age
  • where you live
  • where you are travelling to
  • a terminal condition
  • your physician’s recommendation not to travel
  • a recent consultation with your physician about a condition that has not been resolved, or might not remain stable

Next, look for the section of the policy labelled Exclusions. There you will find rules about pre-existing conditions. You’ll find that you won’t necessarily be covered for expenses related to medical conditions or symptoms that arose or worsened within a set number of days before your departure date. The number of days can vary depending on your age, trip length, or medical history. Just as important, the stability requirement (e.g., how long your condition has remained stable before travelling) will vary from policy to policy. Make sure to review words like “stable” under the Definitions section on your policy to make sure your pre-existing condition is, in fact, eligible for coverage.

If you need to make a claim, you are required by statute to give the insurer an opportunity to interview (or examine) you and your medical records to determine the facts. Again, be prepared to answer truthfully.

Related: Making a Claim: Tips to help you get your money back faster

Do Your Homework

Before you purchase travel insurance, check your calendar or schedule book for the dates when you last saw your doctor, when you were diagnosed with a new medical condition, when you received a change of prescription, when you received a new prescription, or when you were referred to a specialist for tests or a diagnosis. If you’re not sure about these details or cannot remember, ask your doctor.

Related: Travel Insurance May Require Your Medical History: Tell Your Doctor.

Any of these developments could mean your condition is considered “unstable,” thus exclude your condition from coverage. This is information the insurer has a right to know before you travel. If you fail to disclose it, you risk being accused of misrepresentation. Misrepresentation can be a deal-breaker, as you will see when you read the General Conditions that are usually set out after the benefits are explained. Here is an example of a warning about the need for truth:

“The coverage under this Policy shall be ­void if you do not meet the eligibility requirements…(or) if, before or after any loss or claim, you or your representative conceal, misrepresent or fail to disclose any material fact or commit any fraud or false swearing pertaining to you or any claim.”

You might wonder how the insurer would discover a falsehood. But the moment you apply for coverage, you must give the insurer the right to obtain your medical history from any hospital, physician, person, or organization that might have the information.

Get It in Writing

Note that you are responsible for the truth whether you complete the application and claim documents yourself or leave the work to a representative. So check the completed forms carefully. If you do not feel up to the job, get some help. Your rights and obligations will be explained further under a section called Statutory Conditions (or something similar). It’s important to note that you can only demonstrate you have disclosed material facts if they are written down, either in the policy application or in answer to questions about your insurability. And always make sure something you knew to point out verbally has been written down as well.

The truth is vital on both sides of any agreement. So is the ability to prove what is true and what is not. Travel insurance is not a game, so avoid playing truth or dare—stick with the truth and you’ll come out a winner.

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