Some of the Reasons for Claim Denial

Answer correctly to the Medical questions:
One of the main factors that can lead to a Claim denial is Improper answering to medical questions in Insurance application. While answering make sure you understand the questions well, If not ask the insurance agent. Use insurance company's help line to contact with experienced medical staff to clear your doubt. If you are not sure about your medical condition, then consult a doctor.

Recently a senior couple was billed $107000 despite having a travel health insurance only because of pre-existed heart condition, atrial fibrillation, which wasn’t disclosed on the insurance application.

So Never give incorrect answers to the questions, Always disclose any relevant information about your medical history while answering to insurance application. Failure to disclose can lead to some unfortunate surprises which may result in denial of your claim.


Understand Your policy
Usually travellers purchase Travel Health Insurance for peace of mind. First of all insured must understand the insurance policy that they had purchased. They should be aware of which all conditions are covered by the policy. Claiming for a medical condition or illness which is not covered by the policy can lead to denial of the claim.

Insured must make sure  which all pre existing conditions are covered by Insurance policy:
Pre-existing medical conditions attempt to address any medical condition that an insured had prior to travel, and therefore is not covered by the emergency nature of the travel insurance policy. Read my previous article to know about Pre-Existing conditions and its definitions.


Confirm the scope of your insurance policy:
Your provincial insurance policy will cover only a very small fraction of medical expense that could happen in an outside country trip. So make sure to insure yourself with a good travel insurance plan provided by a reputed and trust worthy private insurance company. Check how to choose the travel insurance.


Some Travel Health Insurance Tips

Do you have faith in travel insurance?

Here is a great example of a travel insurance company that is interested in one thing - profits!

Do you have faith in travel insurance?

If you read between the lines, you will see that terms of the policy were open to interpretation, and that where the medical term in the policy is being interpreted by a medical professional, ie doctor, the client is covered; whereas, where being interpreted by a lawyer with limited knowledge in the medical field, the claim is denied. Either way you read the article, it appears the claim should have been paid.

I have read other articles, however, that are more clear cut, and the insureds tried to use the media to corner the insurance companies, and force them to pay a travel insurance claim on a clearly deniable scenario. A great example of this is where the client gets drunk, falls off a balcony, submits a claim for his or her injuries, the claim is denied based on the level of alcohol in his or her blood, then goes to the media as a victim! Get serious. Does the insured not realize that they are only harming their image, and that for the most part the public will read between the lines and side with the travel insurance company that denied the claim in the first place?

That said, regarding the article, should you happen to read the comments from the readers on the travel insurance industry, it is evident that – regardless of the shameful act of the insurance company in this particular case – the readers haven’t a clue about what travel insurance is about and why a person of sound mind should purchase coverage.

Travel Insurance Coverage is for emergency health care, and it should not considered for the coverage of any pre-existing condition, routine medical review, or to expedite treatment of a condition in a foreign country where medical care is not accessible in Canada in a timely manner.

There are unique travel insurance companies, however, that promote the concept of coverage for stable pre-existing conditions. Whether through their regular travel insurance plan, or through a special underwritten insurance policy, always disclose all pre-existing conditions. Reputable plans will be able to offered coverage for most stable pre-existing conditions.

Travel insurance is a contract. And the contract in the case of travel medical insurance is contemplated for the coverage emergent medical conditions of sound people of sound mind. People that binge drink and that are alcoholics in reality cannot be considered of sound mind, and therefore coverage for alcohol abuse and alcoholism is never a covered term under any travel insurance contract. Alcoholism would be considered an unstable pre-existing condition, and therefore not covered.