In case you’ve ever had a travel insurance declare denied, you know the way irritating it may be to get a solution in plain language that tells you why an insurer received’t pay.
Initially, let’s get one fable taken care of: Insurers don’t routinely deny claims and pay solely these for shoppers who combat again. 95 % of all travel insurance claims submitted are paid.
However if you’re among the many unlucky few to obtain a declare denial letter and also you don’t perceive why, it’s best to ask for readability. It’s your proper.
What to do
Get proper again to the insurer, or the occasion that despatched you the denial letter (it could possibly be the insurer’s help firm), and ask for an in depth, written report which you can research at your leisure, or take to your physician. Ask to have key phrases—resembling “pre-existing condition,” “stable,” “condition,” “exclusion,” “eligibility,” and “non-disclosure,” clearly defined. And bear in mind, it’s the way in which these phrases are defined within the coverage that governs the phrases of your protection.
Acquiring a letter out of your physician saying your coronary heart rhythms or your COPD or your gastrointestinal signs are secure and you’re “cleared” to travel might not be adequate. Household physicians don’t at all times let you know all the pieces that’s in your medical charts, and they aren’t conscious of the definitions of these key phrases in your coverage. They could not need to burden you with one thing they will’t do a lot about, or they might not need to spoil your trip. And it might be simply that info that the insurer wants to have the ability to correctly asses the danger of insuring you.
The place to go
If the insurer’s clarification doesn’t reply your inquiries to your satisfaction, or in the event you nonetheless really feel you didn’t get a good response, ask for a overview and evaluation by the insurer’s designated ombudsman or dispute decision particular person. All insurers in Canada ought to have such a useful resource. At all times go there first. In case you don’t, or if you’re nonetheless satisfied you haven’t been handled pretty in line with the phrases of your coverage, you possibly can current your case to the OmbudService for Life and Well being Insurance coverage or the Canadian Life and Well being Insurance coverage Affiliation.
Know that the Ombudsmen Service and Canadian Life and Well being Insurance coverage Affiliation would require you to first cope with your insurer and/or the insurer’s unbiased ombudsman or decision service to deal with your case.
Some provincial governments may have dispute decision companies: in Ontario, for instance, the Monetary Companies Fee of Ontario (FSCO) has lengthy expertise in coping with travel insurance denial complaints.
Prevention is the very best treatment
Within the overwhelming majority of denials, the issue lies with the shopper’s failure to know the phrases of protection, the technical or medical language in purposes, and the coverage itself (which is an issue insurers must cope with). Canadian insurance regulators have directed them to take action, and there are indicators they’re making an attempt to conform.
Shopping for insurance is critical enterprise. You’re not simply risking a couple of hundred in premiums by shopping for one thing you don’t perceive. Denied claims can spoil your funds.
In case you have any medical historical past that requires medicine and even occasional visits to your physician, keep away from the simple, fast buy that guarantees the most cost effective attainable premium within the fewest attainable minutes.
Cope with a skilled agent who is aware of, ideally specializes, in travel insurance, and take your time.
Speak to your insurance supplier about choices in your pre-existing circumstances as we speak.