The bad press when paying insurance claims
Every insured person has already heard it said that the insurance companies do not always properly repay when an accident occurs. Even if the reimbursement rules are specifically listed but due to the fastidious way of insurance contracts, there may remain an afterthought on the risk of not receiving the coverage to which one would be entitled by paying the premium insurance.
This bias may come from several sources. One of the situations is that the insured person has misinterpreted the cover which he thought he had. The role of a broker or insurance representative is crucial because they are the privileged interlocutor to understand the needs of a traveler and to adequately inform the guarantees but also the restrictions and exclusions. Another situation is that the traveler is exposed to a risk of which he had forgotten that was not under his travel insurance policy. A final situation is sometimes the insured traveler did not correctly assess his condition beforehand from the conditions agreed in the travel insurance policy for emergency medical care abroad.
Complaints are perhaps not always easy to complete, but if the rules were well set out in the sale of insurance and where they were being followed by the insured, there is no reason that an insurer does not pay during a disaster.
The restrictions and common exclusions in travel insurance
Whether with travel insurance or without medical questionnaire, any contract includes provisions regarding the prior state of traveler health before his departure date or the date of entry into force. In addition, any traveler must keep in mind some general exclusions on most products. Many travelers are unaware of them and therefore this opens the door to a dispute at the presentation of a medical claim.
The travel insurance does not usually cover
- sports risks;
- the activities of paid professional sports;
- speed or endurance races;
- piloting an aircraft or a flight as a paying passenger in another public transport method;
- countries, regions or cities in which Canada’s Foreign Affairs issue a warning not to stay;
- and in some cases paid work (some insurance travel products for the Snowbirds do not cover people working against remuneration).
Exclusions that can be felt more by all travelers:
- an optional treatment (medical care that can wait for the return trip);
- a trip undertaken for the purpose of receiving medical treatment;
- concealment or deliberate misrepresentation regarding insurance or the presentation of a claim;
- drug use, abuse of drugs or alcohol that directly or indirectly leads to a claim;
- attempted suicide or self-harm;
- mental or emotional disorders, anxiety, stress or depression unless you need to be hospitalized. Here it should be noted that some travel insurance products never cover mental or psychological problems because they are not considered a medical emergency.
Of these exclusions, the one that causes problems most often is the abuse of alcohol.
If you go to the emergency room following a banal accident from a fall causing a blow to the head, a cut above one eye or a sprained ankle, and if they think you exceed the permitted alcohol limit and after a blood test result are above the legal limit, the insurance company has the right not to pay your medical expenses related.
The importance of calling the emergency phone number before any medical consultation
Failure to call the assistance center before consulting (unless a serious medical condition or admission to hospital in extreme emergency) can create unpleasant surprises for you, such as non-payment of the claim. By contacting the support center, the speakers will tell you immediately how to proceed, so you do not make a mistake. The emergency numbers to call are listed on your insurance certificate and your insurance policy detailing the exact scope of coverage purchased.
The importance of having a valid health insurance card
Whatever your province or territory of residence, you will normally have a registration for a public insurance plan. This gives you a health insurance card. It must always be in place, because during a claim when traveling abroad, the insurer verifies if you are in good standing. If unfortunately, your card is no longer valid, your medical claim is likely to be refused or the level of reimbursement of benefits may be drastically reduced.
The best way to avoid problems in medical travel claims is to read your insurance policy before departure and ask all relevant questions to your broker or your insurance representative.