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OverrRyde

join:2007-04-10
Waterdown, ON
Reviews:
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reply to MaynardKrebs

Re: What happens when travel insurance rejects your claim

said by MaynardKrebs:

said by OverrRyde:

There is no loophole, we don't need to search for anything. It usually pretty clear. No one is paid to search for errors.

Policy is sold on a specific category (say from A to E). If you are an A, you are usually healthy, no pre-ex conditions. If you are an E, you probably shouldnt be travelling.

Just a question.....
Say you buggered your knee/ankle skiing years ago and had surgery to fix it. Your surgeon says it's fine post-surgery.

You go abroad years later and while walking down the street you step in a small pothole and your knee/ankle gets damaged as a result and you need hospital treatment abroad.

Is your knee/ankle surgery a deniable pre-existing condition or not?

What if you had a flu shot within 90 days of travel - is that disclosable or not? Will you be denied coverage if you don't disclose it and you have a heart attack?

What about women who are routinely placed on meds for hot flashes, or osteoarthritis as they get older? Are they forced to wait 90-180 days in order to become stable before they can travel with coverage? What if you're given antibiotics for an sinus/ear infection?



Your knee will be considered pre-ex but not excluded as this is beyond the 90 days stable clause. Unless there was a change I'm the last 3 months before you leave, this applies for any condition

As for the flu shot, yes, you are still covered for the heart as the shot is unrelated to the heart. You don't need to disclose anything to the insurance unless you have a questionnaire, just remember the stable clause.


dirtyjeffer
Anons on ignore, but not due to fear.
Premium
join:2002-02-21
London, ON
from what i gather from your statements (which makes sense), people fill out the form, leave things out, so they get the $300 insurance rate instead of the $1000 insurance rate...then if a problem happens, complain about the coverage being denied due to a pre-existing condition (or failure to disclose)...i realize that wasn't the case in peterboro's example, but i think in many others it could be.


Gone
Premium
join:2011-01-24
Fort Erie, ON
kudos:4
said by dirtyjeffer:

from what i gather from your statements (which makes sense), people fill out the form, leave things out, so they get the $300 insurance rate instead of the $1000 insurance rate...then if a problem happens, complain about the coverage being denied due to a pre-existing condition (or failure to disclose)...i realize that wasn't the case in peterboro's example, but i think in many others it could be.

I think that's an overly simplistic view. I suspect in a lot of cases people either don't remember, or don't know how to accurately answer. One shouldn't confuse malice with ignorance.


dirtyjeffer
Anons on ignore, but not due to fear.
Premium
join:2002-02-21
London, ON
i think you would be surprised at what people will say to "get their way"...from my 20+ in retail, i've heard and seen it all.


Styvas
Go Canucks Go
Premium
join:2004-09-15
Hamilton, ON
reply to Gone
Personally, I think that the insurance company should cover a claim but -- except in those cases where there is obvious fraud or attempt to misrepresent -- charge the difference between the premium they paid and the premium they should have paid.

In other words, if answering the questions accurately would have resulted in a $1,000 premium when they only paid $300, charge them $700. If accurate answers would have made them ineligible for coverage, then refund the premium and reject the claim.
--
"Moving your Tylenol to the low shelf in your medicine cabinet is not the way to prevent children from falling off a stool when reaching for the top shelf." (said by Savant, May 2008)


OverrRyde

join:2007-04-10
Waterdown, ON
Reviews:
·Start Communicat..
reply to Gone
said by Gone:

said by dirtyjeffer:

from what i gather from your statements (which makes sense), people fill out the form, leave things out, so they get the $300 insurance rate instead of the $1000 insurance rate...then if a problem happens, complain about the coverage being denied due to a pre-existing condition (or failure to disclose)...i realize that wasn't the case in peterboro's example, but i think in many others it could be.

I think that's an overly simplistic view. I suspect in a lot of cases people either don't remember, or don't know how to accurately answer. One shouldn't confuse malice with ignorance.

This is true, most of the times people just forget what they take their meds for. alot of people dont even know why they take certain meds, thats scary.

But there are some that do refuse to answer honestly and then get dinged, but it's a small number, rarely even, we can tell when someone lied just by their tone of voice when we confront them about it.


OverrRyde

join:2007-04-10
Waterdown, ON
Reviews:
·Start Communicat..
reply to Styvas
said by Styvas:

Personally, I think that the insurance company should cover a claim but -- except in those cases where there is obvious fraud or attempt to misrepresent -- charge the difference between the premium they paid and the premium they should have paid.

In other words, if answering the questions accurately would have resulted in a $1,000 premium when they only paid $300, charge them $700. If accurate answers would have made them ineligible for coverage, then refund the premium and reject the claim.

That is how it works actually. If you are a misrep, we do reimburse your premium. In some cases you are offered to buy the correct policy but the condition you had to be seen for is still denied.


Styvas
Go Canucks Go
Premium
join:2004-09-15
Hamilton, ON
said by OverrRyde:

said by Styvas:

Personally, I think that the insurance company should cover a claim but -- except in those cases where there is obvious fraud or attempt to misrepresent -- charge the difference between the premium they paid and the premium they should have paid.

In other words, if answering the questions accurately would have resulted in a $1,000 premium when they only paid $300, charge them $700. If accurate answers would have made them ineligible for coverage, then refund the premium and reject the claim.

That is how it works actually. If you are a misrep, we do reimburse your premium. In some cases you are offered to buy the correct policy but the condition you had to be seen for is still denied.

I understand that, as long as the denial is for something that never would have been covered, and not for an oversight on the application (again, I'm not excusing outright fraud here).

What I'm saying is that, other than cases of explicit fraud, the claim should be covered if it could have been covered, but at the correct premium. I realize that this is an unlikely business decision on the part of the insurance company. I'm saying that I think it SHOULD be that way, not that I expect it to be.
--
"Moving your Tylenol to the low shelf in your medicine cabinet is not the way to prevent children from falling off a stool when reaching for the top shelf." (said by Savant, May 2008)


elwoodblues
Elwood Blues
Premium
join:2006-08-30
Somewhere in
kudos:2
reply to Styvas
Why collect another $700 (your example) to pay out $1000's when they can just deny the claim? Not good business.


Styvas
Go Canucks Go
Premium
join:2004-09-15
Hamilton, ON
I made that point. Thanks for reading to the end of my post.


elwoodblues
Elwood Blues
Premium
join:2006-08-30
Somewhere in
kudos:2
My bad, I tend to skim over things...