6 Common Reasons Travel Insurance Claims are Denied and How to Prevent it from Happening to You

Transcription

1 6 Common Reasons Travel Insurance Claims are Denied and How to Prevent it from Happening to You 1

2 A denied travel insurance claim is never what you want as a souvenir from a holiday and unfortunately it happens more often than people realize. Of course, you never travel with the expectation that you ll become sick or sustain an injury while you re away, but that doesn t mean you shouldn t be fully protected with a robust policy. It s very important to note that a travel insurance policy can save you a tremendous amount of money when you need to rely on it. We ve created this guide to help you get the most out of your insurance policy when you need it and avoid the common pitfalls that prevent travellers from successfully getting their claims paid. Here are six important tips that could make all the difference when it comes to you successfully receiving the payout that you deserve. Of all travel claims submitted, 95% are paid. The other 5% can be appealed through the travel insurance ombudsman. Honest Answers About Your Medical History When you re completing your travel insurance questionnaire, you ll be asked if you have any illnesses or pre-exsiting conditions. It s always best to give the honest answer even if you worry that it could impact the price of your coverage. If you don t answer to the best of your knowledge, your insurance company can deny your claim. Leaving out information on your questionnaire is one of the most common reasons that a claim is denied. Even something as simple as a visit to your doctor to determine if you are suffering from an illness can be considered a pre-existing condition by your insurance company. In many cases, you might have to pay slightly more for your coverage but you ll be glad that you were forthcoming with your medical history should you need to make a claim. 2

3 Understanding Stable Pre-Existing Conditions A stable pre-existing condition can range from something as small as an ear infection to an on-going condition like diabetes to a significant illness like a heart attack. It s something you ve been diagnosed with or have suffered from prior to booking your insurance. Insurance companies tend to define stable as not needing to see a doctor or not making any changes to your prescription medication, unless they are improvements. In most cases, the length of time required to demonstrate stability is 90 days, or three months, for people under 62 and 180 days, or six months, for people 63 and over. If you have any doubt about whether your pre-existing condition will be covered, it is wise to request a medical questionnaire from your insurance company and have your doctor complete it on your behalf. Your insurance company will determine whether or not that specific condition would be covered. If it is not covered, you can choose to have your insurance cover everything else but that. Doctors Sign-Off is not Insurance Company Approval Often, we hear of travellers whose doctors approved them for a trip after an improvement in their health, who then require emergency treatment elsewhere abroad. These stories tend to end with the traveller having their claim denied for either not disclosing an event in their medical history or for not waiting the duration of the stability period prior to travelling. In the majority of cases, the confusion lies in the stable pre-existing conditions clause or thinking that a doctor s sign-off is sufficient for the insurance company to approve your coverage. 3

4 There are countless cases in which a claimant had a doctor s sign-off to travel after an illness, surgery or similar event and assumed it that was sufficient for their insurance policy to cover them. However the unfortunate truth is that a doctor s approval to travel is not always enough for many insurance companies to approve you to travel. For example, if your doctor says you can travel two weeks after a sinus infection but your insurance policy requires a 90 day stability period, you ll have to wait 90 days even if you think your pre-existing condition is minor. Existing Health Policy or Credit Card Coverage Might Not Be Enough Relying on the travel coverage you might have with your credit card or with your health insurance policy can have similar implications as travelling and relying on governmental coverage: travellers often assume that it is generous and all-encompassing when in actuality it covers very little. The coverage that you might assume that you can draw on might be contingent on several factors, such as trips of under a certain duration or which were purchased specifically with the credit card in question. Some credit card travel insurance also requires that you first exhaust all other sources of coverage prior to being able to access their benefits. Often, because credit card travel insurance does not require a medical questionnaire, there are more opportunites ways for claims to be denied. Some personal health insurance policies include very limited emergency travel health insurance, but this coverage will not be as generous or extensive as a dedicated travel insurance plan. 4

5 Higher Risk Activities Aren t Always Covered If you re going on vacation to enjoy some activities you do not have the chance to participate in at home, such as snowboarding or trying your hand at a water jet pack, you might find that injuries sustained during these activities will not be covered by your policy. Many policies have stipulations about how they treat extreme or higher risk activities. Some require certifications, such as those you would get if you were a trained Scuba diver. In this case, it s very important to know what your policy will cover and what it won t especially if you re set on participating in certain activities. Understanding the Length of Travel Your Policy will Cover Travel insurance policies most often only cover injuries or illnesses sustained during a trip of a specific duration, such as up to 14 days or under 30 days. For example, if you travel for business and need to be out of the country for longer than that, any help you require after that 30 day period will not be covered by your policy. Similarly, if you re planning to travel to somewhere warm during the winter, you will need to be sure that your policy covers the entire length of your trip. Make certain to purchase your policy for the entire duration of your travel. If you think you ll need to travel longer than the original policy duration, you should investigate top-up insurance to lengthen your coverage period instead of travelling uninsured for a few days or weeks. In some case, you can even invalidate you policy for travelling longer that your coverage period even if you get hurt during the time your policy is valid. For example, if you take out coverage for 14 days, and travel for 21, you might not be eligible for coverage for an injury sustained on day six. 5

6 Relying on the Canadian Government Many people don't know that even travelling outside of their province of residence can cost them money if they get injured away from home. Although the provinces have reciprocal agreements with each other, the coverage you receive outside of your home province will only be the equivalent of what you'd receive if you faced the same emergency inside your province's borders. For example, if your province doesn't cover emergency medical transportation, you'll have to pay for that out of pocket. Different rules apply when you travel abroad. When you're injured or become ill outside of Canada, your province only covers a very small sum of what it would pay for if you were hurt or injured at home. Every province has its own rate of compensation for foreign hospitals (on average around $500 per day) so anything over that amount is your responsibility to cover. Further, for anything that your province does not cover, like emergency dental work, x-rays or other diagnostic tests, you'll have to foot the bill yourself. Finally, your province only covers trips up to a certain duration, so if you're travelling for an extended stretch, you won't be covered after the initial short period expires. Each province and the Canadian government strongly recommend that travellers make their own arrangements. In this case, it's easy to see why securing a personal travel insurance policy has so many benefits. 6

7 We d always recommend that if you have any questions about a specific aspect of your policy or are concerned that a pre-existing condition, brief illness or anything else might jeopardize the likelihood of a successful claim, call your insurance company directly. Although you might pay slightly more when you disclose your detailed medical history or travel plans, it will be significantly less than a bill from a foreign hospital. For most people, the cost of paying for emergency treatment out of pocket can be very difficult and in some cases even impossible. Being able to draw on travel insurance if you become ill or injured away from home can have a huge impact on your financial security and that is why the Canadian government recommends that you always arrange dedicated travel insurance, even if you re travelling to America for just one day. If you re ready to discuss the best insurance policy for you or you would like to have help completing your questionnaire, simply set up your FREE consultation with our team. We re here to help and want to be sure that the policy you choose is accessible to you when and where you need it. Call now / or Roy for a FREE personalized quote today! 7