# Warning about travel health insurance



## james4beach (Nov 15, 2012)

I haven't fully understood this story:
http://www.cbc.ca/news/business/buy...ess-coverage-a-couple-s-hard-lesson-1.3495864

The warning seems to be that RBC travel health insurance is a first payer/excess insurance policy. In situations where someone has an existing health coverage provider, it seems they may be better off purchasing the extra travel insurance through them.

Buying the RBC coverage actually hurt them significantly in this case. Can anyone shed more light on the lesson here?


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## kcowan (Jul 1, 2010)

I think this is a case of the need to be an intelligent buyer. Why was the insurance premium less? Is there a Santa Claus? You never get something for nothing!

I believe it would be pretty clear when an insurer was relying on your other plans. If not, get the conditions in writing. We always use a broker and they get the best coverage each year. No surprises and no special deals. We have been doing this for 20 years. We now have pre-existing conditions and they shop around every year.


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## james4beach (Nov 15, 2012)

Going through your broker, how are you clear on this matter of how it would play out with a massive claim (like 500K)?

After reading that article I still don't really understand this issue. Why are you sure that you're selecting the right coverage?


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## andrewf (Mar 1, 2010)

kcowan said:


> I think this is a case of the need to be an intelligent buyer. Why was the insurance premium less? Is there a Santa Claus? You never get something for nothing!
> 
> I believe it would be pretty clear when an insurer was relying on your other plans. If not, get the conditions in writing. We always use a broker and they get the best coverage each year. No surprises and no special deals. We have been doing this for 20 years. We now have pre-existing conditions and they shop around every year.


I think the problem is not that people expect something for nothing, but rather than frequently when it comes to financial products you can be misled into paying something for nothing.


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## Islenska (May 4, 2011)

Travel insurance, best to get a law degree before heading into this pit of no return!

Seems the traveller will always get screwed, maybe just hope for safe holidays and have some basic coverage for peace of mind.


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## gibor365 (Apr 1, 2011)

> Seems the traveller will always get screwed, maybe just hope for safe holidays and have some basic coverage for peace of mind.


 Very true! Even with insurance from work! So much troubles .... I had some minor issue in Jamaica last year (actually I just needed any simple antibiotic) , called Manulife and explained the issue, they wanted to talk to local nurse , nurse didn't understand what they want from here, called their main office and so on ... after 2-3 hours of "negotiations" , I just left ...


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## peterk (May 16, 2010)

I pay for emergency vacation travel insurance through a work plan, with Blue Cross. It is remarkably, and suspiciously, cheap... only 32c / pay, $8.32/year. Here's hoping I never have to find out whether it's any good or not...


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## sags (May 15, 2010)

The issue in the article is the couple had private health insurance with a lifetime cap, and when the insurer repaid the funds to the RBC travel insurance it reduced their lifetime cap.

But that isn't really the issue. It is the symptom of a poorly regulated travel insurance industry. Those who believe there is too much government regulation should take note.


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## carverman (Nov 8, 2010)

This subrogation clause is nothing new. My daughter (who had a scar tissue incident while on vacation (from Canada to Puerto Rico0, came down with a severe infection and had to be medivac'ed back to Sick Kids in Toronto. 

Even though she had taken out trip insurance, the trip insurance carrier sent me the bill to give to my Nortel insurance provider (Sun Life at the time), to get them to share/ pay some of the medivac cost (over $10,000.

So it's not unusual for these kinds of "medical expense sharing" to be done when one insurer knows there is another involved.

In my case, my daughter was under 25, still in school and covered by my work health plan.


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## james4beach (Nov 15, 2012)

Thanks for these notes. Sorry to hear about that situation with your daughter, carverman. Is there anything you would have done in hindsight? Any difference in what you would have done before the trip, insurance-wise?


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## ThinkingCapital (Feb 16, 2016)

The part of the story about "reading the fine print" is important. Many insurance agreements are complicated and it's crucial to read through them. A lot of them are difficult to understand.


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## coptzr (Jan 18, 2013)

I find some of the issue is fed by management when using employers policy. In my experience they don't want you to buy anything extra(more cost to the budget) such as car rental insurance, travel insurance, etc... Normally told "we have our own 'company' coverage".


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## balexis (Apr 4, 2009)

In the same type of crazy story (from http://ici.radio-canada.ca/tele/la-...e-voyage-complementaire-touriste-sud-snowbird - sorry, in French only):
A couple goes for a 6 months vacation abroad. Their credit card travel insurance covers only up to 30 days. So they purchase another policy for the last 11 months of their trip.

During the first 30 days, the women brakes her wrist. The cost is properly covered by insurer #1. She needs to go back to the hospital 6 weeks later for a check up and the removal of her cast. She calls insurer #2, who refuses to pay, invoking pre-existing condition.

In this case it was only 150$, but can you imagine if she had a major surgery in the first month, that required an expensive followup, or even additional surgery, 6 weeks later?

The bottom line: get only one insurance provider for your whole trip.


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## Numbersman61 (Jan 26, 2015)

balexis said:


> In the same type of crazy story (from http://ici.radio-canada.ca/tele/la-...e-voyage-complementaire-touriste-sud-snowbird - sorry, in French only):
> A couple goes for a 6 months vacation abroad. Their credit card travel insurance covers only up to 30 days. So they purchase another policy for the last 11 months of their trip.
> 
> During the first 30 days, the women brakes her wrist. The cost is properly covered by insurer #1. She needs to go back to the hospital 6 weeks later for a check up and the removal of her cast. She calls insurer #2, who refuses to pay, invoking pre-existing condition.
> ...


Even though you have coverage with the same insurer, you may be denied coverage for the rest of your trip. As soon as you file the claim, make sure that your coverage is still in force.


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## kcowan (Jul 1, 2010)

The key thing to advise is that you had a condition change before your second policy took effect. This is all pretty standard. But the insureco will try to use anything to void your claim. It is nothing personal.


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## coptzr (Jan 18, 2013)

Reminds of when my old auto insurance provider said it was wrong to be insured by 2 companies. I told them I've been screwed before by a quote and immediate payment only to find the terms were different. As well to find discounts no longer valid, having to cancel the policy and go back to original company. They should be glad they both got paid full premium and in the case of a claim, they should only have to pay 50% each. I know companies operate differently and don't work together but hopefully you see my point. I simply don't trust one person to do 100% for me.


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## james4beach (Nov 15, 2012)

Beware, everyone! I was just reading over RBC's travel medical insurance policy document. I spotted one very broad exclusion. The insurance does not cover any claim caused directly or indirectly by:



> (source) 11. Accidental bodily injury arising from, or in any way related to, *your chronic use of alcohol or drugs whether prior to or during your trip*.


This is a very broad exclusion. I believe habits that many of us consider normal (e.g. a few drinks a week) can be considered "chronic use of alcohol". And virtually every medical condition can relate to alcohol, as alcohol is universally bad and can be a factor.

So I would be cautious about this RBC insurance based on their alcohol clause. If you regularly drink -- to any degree -- they might deny a claim, even if you drank before your trip.



sags said:


> But that isn't really the issue. It is the symptom of a poorly regulated travel insurance industry. Those who believe there is too much government regulation should take note.


Absolutely agree, sags. This is a good illustration of how government regulation can protect us, by enforcing uniformity, and stop these practices. Clearly, none of us are lawyers. We can't possibly read and interpret these things. The exclusion clauses in these things is ridiculous. I've now read ones from PC Financial, TD, and RBC, and they all exclude different combination of things, using some very blanket statements. There is really no hope of navigating this properly.

The structure of this travel medical insurance is abusive towards the customer. It's set up much like American medical insurance, to give the insurer ways to deny all kinds of claims, with a severe asymmetry in knowledge and power between insurer & customer.

I would love to see the government enforce a completely standard insurance contract for the core of the coverage. Insurers could still compete with each other based on bells & whistles such as returning your pet home, stuff that doesn't really matter to cover medical coverage. And with a standard contract, we can get experts to really tell us what it covers, instead of everyone having to guess at it.


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## newfoundlander61 (Feb 6, 2011)

I have the Public Service Health Care plan with Sunlife that is part of my pension benefits so we never need to buy any medical insurance when travelling. Very happy to have this in place after leaving the army.


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## Beaver101 (Nov 14, 2011)

^ NFLDr61 ... buying (in good faith) is not the problem ... claiming (for your loss) is, just when you legitimately "need" it (questionable faith).


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## Beaver101 (Nov 14, 2011)

james4beach said:


> Beware, everyone! I was just reading over RBC's travel medical insurance policy document. I spotted one very broad exclusion. The insurance does not cover any claim caused directly or indirectly by:
> 
> 
> 
> ...


 ...I wonder how "chronic" is defined here. Not for alcohol but "drugs" namely now that MaryJoints are legalized. Especially where some life policies (read somewhere sometime ago) allow you a couple of recreational joints a week even. Talk about a two-faced industry.



> Absolutely agree, sags. This is a good illustration of how government regulation can protect us, by enforcing uniformity, and stop these practices. Clearly, none of us are lawyers. We can't possibly read and interpret these things. The exclusion clauses in these things is ridiculous. *I've now read ones from PC Financial, TD, and RBC, and they all exclude different combination of things, using some very blanket statements. There is really no hope of navigating this properly.*


 ... that's why I don't try even.



> The structure of this travel medical insurance is abusive towards the customer. *It's set up much like American medical insurance, to give the insurer ways to deny all kinds of claims, with a severe asymmetry in knowledge and power between insurer & customer*.


 ... doesn't surprise me. And the industry can move to being more litigious too.



> I would love to see the government enforce a completely standard insurance contract for the core of the coverage.


 ... do you think the regulators are in any hurry? 



> Insurers could still compete with each other based on bells & whistles such as returning your pet home, stuff that doesn't really matter to cover medical coverage. And with a standard contract, we can get experts to really tell us what it covers, instead of everyone having to guess at it.


 ... in that case, I would rather have the "major" coverage(s) are fixed (ie covered as intended) rather than skirted. Those bells and whistles can wait ... much later.


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## Longtimeago (Aug 8, 2018)

If you enter into a contract with a company for a service, it is YOUR responsibility to understand the terms of that contract. In travel forums, I keep saying you have to READ and UNDERSTAND a travel insurance policy OR accept the consequences of not doing so. The linked story is simply an example of just that. The clause that they ran afoul of is indeed a very common clause and one that the traveller should be aware of if it is likely to affect them. I for example do not have any group insurance as the couple in the article have. The clause would not have affected me at all. I can ignore it, they obviously should not have. But I can ONLY ignore it after having read the clause, understood it and determined that it did not affect me.

It is all about responsibility, your responsibilities and the insurer's responsibilities. An insurer's responsibility is to provide you with a written Policy that sets out the terms and conditions of the coverage you are contracting with them to supply. It's no different than buying any other product. If you buy an electric drill, would you then complain when it does not provide the capabilities of a 'hammer drill' for drilling masonary? The seller did not make you buy a regular drill because it is cheaper, you made that decision.

Your responsibility as the buyer is to make sure you buy the right product for the right job. IF you are not sure if it is the right product, it is YOUR responsibility to find out. One way to do that is to ASK questions of the supplier when you don't understand something. An insurance company has a responsibility to answer your questions as best they can until you say, 'OK, got it, now I understand.' But it's YOUR responsibility to ask. Most people who buy travel medical insurance do just one thing. They shop for a price. Then most do no reading of the policy before or even after having bought coverage. That's on them, not on the insurer.

Take the example james4beach gives of an exclusion re alcohol. What does it mean? It's quite simple really. If alcohol played a part in what you are claiming for, the claim may be denied. In today's Google world, it isn't hard to find an explanation and determine if it is likely to apply to you in your travels. https://www.insuremytrip.com/travel...-H1wZYmQQDsuHbhwp748ivGrabC2CYlxoCCjIQAvD_BwE

I used to live in a popular tourist area. I'd say that a fairly high percentage of all travel medical claims involved alcohol. For example, someone goes out drinking all evening and then gets on a rented scooter to go back to their hotel. They have an accident, oops. They should have taken a taxi. See the difference, if an accident occurs? On the scooter, the alcohol is quite likely to have played a part in the accident either through your causing the accident yourself or being too impaired to react quickly enough to avoid the accident. If you were in a taxi and an accident occurred, regardless of how intoxicated you were, no cause and affect can be attributed to you being drunk. The first claim is likely to be denied, the second paid. So all that clause is saying is, 'if you are going to drink alcohol, then be prepared to accept the consequences if you do so. You did not buy DRUNK insurance. It isn't saying, you can't drink, that's your choice. It's saying that we won't cover you if you fall down a flight of stairs when you are drunk.

It isn't a 'broad exclusion' james4beach, it is a specific exclusion. If alcohol is a factor in terms of cause and affect, you will not be covered. If you drink a few drinks a week as you say, that will not be a factor unless you consume ALL of those 'few' drinks at one time and something happens as a result of you having done so. I doubt you can find any travel medical insurance policy that covers you while you are drunk AND the alcohol can be linked in a cause and affect manner to your claim. Remember if you are in a taxi and drunk, you will be covered if the taxi is involved in an accident, because there is no link of cause and affect between the accident and you being drunk. So the exclusion is specific james4beach, the alcohol MUST be linked through cause and affect.

Do you think your auto insurance is any different? Do you think if you drink and drive home and get into an accident, that your auto insurance will cover you for anything? It will not. Go ahead and read your auto policy. Here is an example. https://www.rogersinsurance.ca/blog/auto/how-does-drunk-driving-affect-auto-insurance/ And by the way, that applies to government supplied insurance that some provinces provide as per that link. Why wouldn't it? So comments like, _"I would love to see the government enforce a completely standard insurance contract for the core of the coverage."_ can be shown to have the same clauses requiring you to read and understand the policy obviously. In other words, what I am saying is if the government set down a standard for travel insurance the same clause would still be in there regarding alcohol and you would still need to read and understand that government mandated policy.

Now let's consider the example given by balexis of someone who switched insurers during their trip. This again is a common example of where people get THEMSELVES into trouble with travel insurance. Insurer one provided cover for 30 days. No problem. Insurer two provided cover from the start of their policy effective date and their policy included a 'pre-existing condition' clause which is pretty universal. What is there to not understand?

It was the responsibility of that couple to consider what the implications of the second policy were when they chose to use their 'free' policy for the first 30 days. Suppose you were them and you read the second policy and came to this 'pre-existing condition' clause. Would you not ask yourself, 'well if this policy doesn't come into affect until day 31 of our trip and something happens during the first 30 days while we are covered under our 'free' policy, would that become a 'pre-existing condition'? The simple fact that they even attempted to make a claim on the second policy tells me that they did not read and understand it would not be covered and they obviously did not phone the insurer or do anything else to determine beforehand if they would be covered. That's on them.

In almost every case you will find in a travel forum or sensationalist headline media story of an insurance claim being denied, you will find the same story. The traveller did not read and understand their policy. But people don't want to accept responsibility for their own mistakes, they want to blame others. In this case the insurance company. 

Travel insurance works perfectly fine in terms of being able to claim for what you are insured against, the same as any other kind of insurance you buy. The problem is when someone THINKS they are insured for something and in fact they are not. That's on the person, not the insurer.


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## Beaver101 (Nov 14, 2011)

^ WOW, what a lecture of being responsible for a freebie (or supposedly free feature) from a credit card.


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## james4beach (Nov 15, 2012)

I still think the alcohol point is a broad exclusion that gives the insurer tons of freedom to deny claims. They have repeatedly done this in the past using other exclusion clauses; it makes the media sometimes.

Imagine that someone has a heart attack on vacation. They didn't drink any alcohol while on vacation. However, they did have a few drinks each week before starting their trip. The way that exclusion is worded could give the insurer grounds to not pay for the treatment of the heart attack.

Alcohol is a significant contributor to the risk of heart attacks, especially for someone who already has cardiovascular problems. Alcohol is a powerful drug, and what society considers normal (such as occasional drinks each week) can be quite dangerous to one's health: https://www.heart.org/en/healthy-li...art/nutrition-basics/alcohol-and-heart-health



> The incidence of heart disease in those who drink moderate amounts of alcohol (no more than two drinks per day for men or one drink per day for women) is lower than in nondrinkers. However, with increased intake of alcohol, there are increased health dangers including high blood pressure, obesity, stroke.


Therefore, I believe the insurer could say: this man drank relatively frequently prior to the trip. Alcohol is a significant contributor of risk to heart attacks, so his alcohol use was in fact "in any way related to" the heart attack.


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## OnlyMyOpinion (Sep 1, 2013)

This article may be of interest.
And the followup article.


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## cainvest (May 1, 2013)

james4beach said:


> I still think the alcohol point is a broad exclusion that gives the insurer tons of freedom to deny claims. They have repeatedly done this in the past using other exclusion clauses; it makes the media sometimes.
> 
> Imagine that someone has a heart attack on vacation. They didn't drink any alcohol while on vacation. However, they did have a few drinks each week before starting their trip. The way that exclusion is worded could give the insurer grounds to not pay for the treatment of the heart attack.


One thing I see is you worry to much james4beach! 

So how would they even know you had drinks before your trip?

Honestly all insurance has "loophole-ish" wording so either don't buy any insurance and take your chances or buy some with the thought they may deny your claim if they have grounds to do so.


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## Plugging Along (Jan 3, 2011)

Longtimeago said:


> Take the example james4beach gives of an exclusion re alcohol. What does it mean? It's quite simple really. If alcohol played a part in what you are claiming for, the claim may be denied. In today's Google world, it isn't hard to find an explanation and determine if it is likely to apply to you in your travels. https://www.insuremytrip.com/travel...-H1wZYmQQDsuHbhwp748ivGrabC2CYlxoCCjIQAvD_BwE
> 
> I used to live in a popular tourist area. I'd say that a fairly high percentage of all travel medical claims involved alcohol. For example, someone goes out drinking all evening and then gets on a rented scooter to go back to their hotel. They have an accident, oops. They should have taken a taxi. See the difference, if an accident occurs? On the scooter, the alcohol is quite likely to have played a part in the accident either through your causing the accident yourself or being too impaired to react quickly enough to avoid the accident. If you were in a taxi and an accident occurred, regardless of how intoxicated you were, no cause and affect can be attributed to you being drunk. The first claim is likely to be denied, the second paid. So all that clause is saying is, 'if you are going to drink alcohol, then be prepared to accept the consequences if you do so. You did not buy DRUNK insurance. It isn't saying, you can't drink, that's your choice. It's saying that we won't cover you if you fall down a flight of stairs when you are drunk.
> 
> ...


I have travelled a lot. I have also unfortunately had to use insurance more often than I would like (NONE have been my fault). I read the fine print, but it isn't as cut and dry as you say. It's also not as dire as James perceives.

In your example of alcohol, it needs does NOT need to be a direct link for the insurance to try and get out of it. When my spouse was working in NY, he had a couple of beers (2 in a 3+ hour period) with colleagues after work. He was walking back to his apartment, and when crossing the street on the "walk' signal, a taxi turning right didn't stop and hit him. He wasn't seriously hurt, but the travel insurance said that the taxi should pay, the taxi insurance said that because he came out of a pub, there was alcohol involved. It took the police report (officer was at the other corner) and statements from the coworkers, the receipt from the bar to prove though my spouse had alcohol, it no way contributed to him being hit. He had to prove, not even slightly intoxicated, walked on the right light, AND the taxi driver had turned on a RED light. 

It was quite ridiculous. So thinks not as clear as you say.


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## Plugging Along (Jan 3, 2011)

james4beach said:


> I still think the alcohol point is a broad exclusion that gives the insurer tons of freedom to deny claims. They have repeatedly done this in the past using other exclusion clauses; it makes the media sometimes.
> 
> Imagine that someone has a heart attack on vacation. They didn't drink any alcohol while on vacation. However, they did have a few drinks each week before starting their trip. The way that exclusion is worded could give the insurer grounds to not pay for the treatment of the heart attack.
> 
> ...


This would be worrying too much. If you weren't diagnoised as a risk for heart attack in the 6 (might be 12 months) before you bought your insurance, it wouldn't matter how much you drank. If you were hospitalized for alcohol poisoning, then no, but a heart attack that wasn't there before and you drink, won't be denied.


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## Longtimeago (Aug 8, 2018)

OnlyMyOpinion said:


> This article may be of interest.
> And the followup article.


What the articles outline is the low percentage of denied claims, the most common reasons for most of the denials and in the follow up, how it is up to the individual to make sure they get it right. That all makes total sense to me.


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## Longtimeago (Aug 8, 2018)

Plugging Along said:


> I have travelled a lot. I have also unfortunately had to use insurance more often than I would like (NONE have been my fault). I read the fine print, but it isn't as cut and dry as you say. It's also not as dire as James perceives.
> 
> In your example of alcohol, it needs does NOT need to be a direct link for the insurance to try and get out of it. When my spouse was working in NY, he had a couple of beers (2 in a 3+ hour period) with colleagues after work. He was walking back to his apartment, and when crossing the street on the "walk' signal, a taxi turning right didn't stop and hit him. He wasn't seriously hurt, but the travel insurance said that the taxi should pay, the taxi insurance said that because he came out of a pub, there was alcohol involved. It took the police report (officer was at the other corner) and statements from the coworkers, the receipt from the bar to prove though my spouse had alcohol, it no way contributed to him being hit. He had to prove, not even slightly intoxicated, walked on the right light, AND the taxi driver had turned on a RED light.
> 
> It was quite ridiculous. So thinks not as clear as you say.


Your anecdotal evidence of the incident involving your husband simply shows how important it is to have coverage (the bills were paid after all) and that in some circumstances you may find yourself between two entities arguing over who should pay. His insurer had a perfect right to expect the taxi company to pay did they not? His travel insurer did not raise the question of alcohol, the taxi insurer did. It had nothing to do with his travel insurer not paying when there was a third party involved.

If your husband had come out of the bar, tripped on the sidewalk and broke his leg, then had his travel insurer question the claim because of alcohol, THEN you would have a story of some relevance. But even then, the insurer has the right to question how many drinks he had if they are somehow made aware of his having had a drink immediately before the accident. They didn't jump on that possible 'out' just from thin air.

You write as if the taxi insurer had no RIGHT to question how much he had to drink. But in fact they DO have that right if they are made aware he had been drinking just before the accident. Insurance isn't one sided, the insured doesn't just have the right to get paid, the insurer has the right to determine if the policy conditions were adhered to.


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## Longtimeago (Aug 8, 2018)

james4beach said:


> I still think the alcohol point is a broad exclusion that gives the insurer tons of freedom to deny claims. They have repeatedly done this in the past using other exclusion clauses; it makes the media sometimes.
> 
> Imagine that someone has a heart attack on vacation. They didn't drink any alcohol while on vacation. However, they did have a few drinks each week before starting their trip. The way that exclusion is worded could give the insurer grounds to not pay for the treatment of the heart attack.
> 
> ...


James4beach, find a link that shows such a scenario having happened to someone. The insurer would not get to just say, 'this man drank relatively frequently prior to the trip' and deny a claim. They would have to PROVE a link between that man's drinking habits and their being 'in any way related' to the heart attack.

You write, 'They have repeatedly done this in the past using other exclusion clauses; it makes the media sometimes.' So go ahead and find some links that prove that point.

People often make statements about a belief of some kind but there is no actual evidence to substantiate that statement. Your statement is such a belief.


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## Mukhang pera (Feb 26, 2016)

james4beach said:


> I still think the alcohol point is a broad exclusion that gives the insurer tons of freedom to deny claims. They have repeatedly done this in the past using other exclusion clauses; it makes the media sometimes.
> 
> Imagine that someone has a heart attack on vacation. They didn't drink any alcohol while on vacation. However, they did have a few drinks each week before starting their trip. The way that exclusion is worded could give the insurer grounds to not pay for the treatment of the heart attack.
> 
> ...


Actually james4, I do not see the source you cite as wholly supporting your demonization of alcohol. In fact, it suggests quite the opposite, i.e., that moderate consumption can be of benefit to heart health. That being the case, where an insurer seeks to avoid coverage on discovery of the “few drinks each week before starting the trip” you have mentioned, the insured can come back with the defence that it was no more than a therapeutic dose. 

For an interesting B.C. case involving this issue, see:

_Ouimet (Estate)_ v. _Co-operators Life Insurance Co_., 2006, BCSC 841

INSURANCE — Travel insurance — Conditions precedent • Exclusions — Insured buying travel insurance, travelling to U.S. a few days later, undergoing hospitalization almost immediately and dying of sepsis soon afterward — Insurer denying liability on ground that insured misrepresented her health status when buying the insurance, contrary to condition precedent in policy, or that she was "affected by" alcohol at relevant time, contrary to exclusion clause — Court rejecting insurer's position on both grounds — Judgment for insured's estate.

In that case, the trial judge held, in part (not an exact quote):

_As for the exclusion clause, the reasonable interpretation of the words "affected by" was one that would entitle the insured to coverage unless the use of alcohol affected his capacity in a manner that related to the coverage. Presumably coverage is suspended when an insured is so affected, because the insurer is not willing to insure against risk when the insured voluntarily reduces his physical or mental capacity to appreciate and respond to risk. However, so long as the insured has the capacity, there is no reason to suspend coverage. Therefore an insured is "affected by" alcohol when, because of its use, he lacks the capacity to appreciate and respond to risk that is reasonably consistent with his normal capacity.
_
The full text judgment (21 pp.) is here:

https://www.bccourts.ca/Jdb-txt/SC/06/08/2006BCSC0841.htm

Our Court of Appeal took a different view.

_Ouimet (Estate)_ v. _Co-operators Life Insurance Co._, 2007 B CCA 163

INSURANCE — Travel insurance — Misrepresentation • Insured obtaining travel insurance based on declaration, "I am in good health and know of no reason to seek medical attention" — Appeal court finding the opposite to be true and thus upholding insurer's denial of subsequent claim.

As I read the appeal judgment, that court did not specifically disagree with the trial judge’s interpretation of the “affected by” alcohol provision, but, its focus was on the insured’s declaration that:

I am in good health and know of no reason to seek medical attention. I am aware that if I have any condition affecting my health, that claims relating to this condition may be excluded under this policy.

Of that declaration, the court said, in part:

_She had, however, within the previous 24 hours, been in a state of respiratory distress that rendered her unconscious because of her problem with alcohol, and been told she should be admitted to hospital. Further investigation was indicated. I do not see on what basis she could possibly have properly said she was in good health and knew of no reason to seek medical attention. She had sought medical attention immediately before making the declaration and had misled her doctor by understating her consumption of alcohol.
_
https://www.bccourts.ca/Jdb-txt/CA/07/01/2007BCCA0163.htm

An unrelated, but still interesting, case would be:

_Kulak_ v. _Reliable Life Insurance Co_., 2012 BCSC 1738

INSURANCE — Travel insurance — Misrepresentation • On application for travel insurance, plaintiff erroneously giving himself "health score" of 0, instead of a score of 3 required of an applicant with a heart condition — Plaintiff thus obtaining insurance for a premium of $903 instead of $2,260 — Motor vehicle accident on plaintiff’s trip to Arizona resulting in hospital costs of $167,140 — Defendant denying coverage on learning plaintiff did in fact have a known heart condition — In plaintiff’s suit for coverage, court finding the application forms were not so confusing that the court should excuse the plaintiffs’ error, and that plaintiff made a misrepresentation that was material to the underwriting risk — Action dismissed.

https://www.bccourts.ca/jdb-txt/SC/12/17/2012BCSC1738.htm


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## sags (May 15, 2010)

Alcohol is a well documented trigger for Atrial Fibrillation, which can cause blood clots leading to a heart attack or stroke.

Emergency doctors say they see patients with afib on a regular basis on Mondays after a weekend of boozing.

It isn't beyond the realm of possibility that an insurance company would try to avoid payment because of alcohol consumption in the case of heart attack or stroke.


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## Longtimeago (Aug 8, 2018)

sags said:


> Alcohol is a well documented trigger for Atrial Fibrillation, which can cause blood clots leading to a heart attack or stroke.
> 
> Emergency doctors say they see patients with afib on a regular basis on Mondays after a weekend of boozing.
> 
> It isn't beyond the realm of possibility that an insurance company would try to avoid payment because of alcohol consumption in the case of heart attack or stroke.


No, it isn't beyond the realm of possibility, but you can be sure the insurance companies know what their percentage chance of winning that argument is under a given set of circumstances. Insurance companies are not in the habit of going to court over a claim and then an appeal court as per Mukhang pera's example, on a whim. They have to believe they can win their case.

When I lived in a popular tourist destination, as I have said, I saw tourists all the time who were out all night drinking and then got on a scooter to ride back to their hotel or took a taxi to their hotel and the next morning while still hungover and under the influence, went out on a scooter to ride around the island etc. Any of the scooter rental companies of which there were literally hundreds, could tell you how often they got a scooter back from rental that was banged up. Tourists fall of them regularly and there are 2 primary reasons. First, unfamiliarity with riding them, they don't have one at home. Second, under the influence of alcohol. The rental companies have insurance that covers the scooter but it is the traveller's own medical insurance that is going to have to cover any medical bills. If you owned a travel medical insurance company under those circumstances, would you check to see if they had been drinking before getting on that scoooter? I sure would and they do. Many of those claims get denied as they SHOULD.

What kind of medical problems are involved, is irrelevant. The question is was alcohol clearly linked to the accident? In most cases where claims are denied, the link is going to be quite clear indeed. It isn't any kind of a 'not beyond the realm of possibility' to link it, it is easy to link it.

If on the other hand the tourist had been out drinking the night before and then the next afternoon suddenly had a heart attack while walking from the poolside lounger to the hotel restaurant, proving a link to alcohol would be an entirely different matter. Saying something 'isn't beyond the realm of possibility' doesn't mean it is going to happen all the time or that a claim is going to be successfully denied as a result of it.

The alcohol clause in travel insurance is quite simple and sensible in intent. The intent is not to use it as an 'out', it is to deny claims where alcohol was CLEARLY a factor and easily proven. James4beach's concern that it could be used as a general out is unfounded.


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## Longtimeago (Aug 8, 2018)

When I was living on that Greek island, all tourists got free emergency medical care provided by the Greek government. I don't know if that is still the case today but it was then. This was provided as part of encouraging tourism and makes some sense. 

So if a tourist walked in to a hospital emergency department with 'road rash' and told the doctor they had fallen off a scooter, the doctor would clean them up, etc. and send them on their way, no charge. But IF the doctor determined that in the doctor's opinion, they were under the influence of alcohol, they had to pay for the treatment. NO ONE is going to pay for the treatment of someone who was drinking and driving in other words. Why would anyone expect anything different?

Now you can be sure that if a tourist had to be brought in by ambulance and had a broken leg, the doctor who saw them paid more attention to whether it looked like they were under the influence, than they did with the tourist who just had some road rash. Why, because the cost of treatment is going to be significantly more in the second case. But if everything looked reasonable to the doctor, that treatment would also be free of charge. If the tourist had serious injuries and had to be air ambulanced to Athens and a major hospital for major treatment, you can be very sure they paid even more attention. That should make simple sense to anyone. 

Insurance companies are going to do the same thing. Because it makes sense to do so. Some people seem to write as if they don't think the insurance companies have a right to question a claim at all. That's just ridiculous.


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## Beaver101 (Nov 14, 2011)

Here's a recent example of gimmicky marketing by the insurance industry.

https://www.cbc.ca/news/canada/new-brunswick/blue-cross-travel-insurance-sandra-white-medical-bills-1.5292126 



> ...
> 
> *Buyer beware*
> Michèle Pelletier, New Brunswick's consumer advocate for insurance, *didn't think the province-of-residence issue is made clear to buyers.*
> ...


 ... I think insurance companies should not be selling insurance online, period. Better yet, rule that as illegal marketing there.


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## Topo (Aug 31, 2019)

There needs to be some sort of standardization, where the consumer doesn't need to have a law degree to know their rights and responsibilities viz a viz the insurer and the pathways to insurance misuse are closed.


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## sags (May 15, 2010)

I wonder how many insurance companies ever called a policyholder and said "you have a pre-existing condition and don't qualify, so we are returning your money".

I am guessing...........nobody, before the policyholder made a claim.


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## sags (May 15, 2010)

As to alcohol restrictions, a friend of my son went to a outdoor concert and got drunk. He was fine until he started getting sick.

He spent the night in the bathroom and the next day was curled up in pain. They called an ambulance and took him to the hospital.

The verdict was "dehydration due to alcohol consumption". I bet an insurance company would pounce on that if it happened at a resort where people tend to drink a lot.

My sister and brother in law only travel to resorts that are all you can drink. That is all they care about and all they do is drink. They are blitzed for a week.

I could see them getting alcohol poisoning some day and having to go a hospital.


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## Longtimeago (Aug 8, 2018)

Beaver101 said:


> Here's a recent example of gimmicky marketing by the insurance industry.
> 
> https://www.cbc.ca/news/canada/new-brunswick/blue-cross-travel-insurance-sandra-white-medical-bills-1.5292126
> 
> ... I think insurance companies should not be selling insurance online, period. Better yet, rule that as illegal marketing there.


Where is the 'gimmicky marketing'? There is no marketing involved here, online an application for coverage was involved. The application asked for 'province of residence' which was New Brunswick. I am sure it asks for your intended departure date from your province of residence and your intended return date to your province of residence. The son admits he believes he put in Ontario as the province of residence which was of course false. That it was the province of departure is not what the question asked. How is it an insurance company's fault if he did not answer the question correctly? What should they have done differently?

There is a limit to just how much hand holding one party can be expected to do when entering into a contract with another party. Here is the limit:

"*The Blue Cross online form does ask for your departure date from your province of residence — not from your province of departure.

Matthew White said he believes he put in Ontario, not New Brunswick, because that is where they were starting their trip into the United States. To him, it only made sense.*"

The question was CLEAR, how he interpreted it otherwise is what should be in question here. The insurance company cannot be responsible for how he fails to understand what 'province of residence' means.

I always remember I guy I knew who bought a new VW Beetle many years ago. He drove it for a long period of time and one day the engine seized up on him. He had it towed to the dealer. They determined that it had been run out of oil. Not a leak, just burned up. They asked him when he had last had the oil changed and he told them he had never had the oil changed. They asked when he last checked the oil level and I suppose seeing where the conversation was leading, his reply was that 'NO ONE had TOLD him he had to check or change the oil. He insisted it was THEIR fault and their responsibility to tell him when he bought the car.

That information is of course included in every car owner's manual. When to do oil changes, when to check oil levels, brake lights, turn signals, headlights are working, etc. All in the manual. The responsibility for READING the manual is on the car buyer, not the car seller. The same applies to insurance. The insurer has to provide the information to you in the policy and YOU have to read and understand it before entering into a contract with them.

As with most complaints about insurance, this example is just another case of a buyer who did not read their contract and then want to complain when THEY having failed to meet THEIR side of the agreement have a claim rightfully denied. At what point is the buyer supposed to accept responsibility for their own actions? Never?


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## Longtimeago (Aug 8, 2018)

sags said:


> As to alcohol restrictions, a friend of my son went to a outdoor concert and got drunk. He was fine until he started getting sick.
> 
> He spent the night in the bathroom and the next day was curled up in pain. They called an ambulance and took him to the hospital.
> 
> ...


Yes if the insurer became aware of the reason for the claim they would deny it. They have the right to do so. There is nothing WRONG with them doing so in that case. 

As for your relatives, how they choose to live their lives is their business but they also have to take responsibility for their own actions. If their drinking results in them having a claim denied, that's on THEM. Do you really think that if as you say, "I could see them getting alcohol poisoning some day and having to go to a hospital', that an insurance company should pay for their hospital care? 

You know, if you want 'drunk' insurance, it is possible to get it. Women who have sex have insured against getting pregnant for example. But you have to PAY for that kind of thing and you will pay a lot more than for ordinary travel insurance believe me. One of the most famous cases of insurance was the actress Betty Grable who apparently had her legs insured. http://content.time.com/time/specials/packages/article/0,28804,2015171_2015172_2014872,00.html

If people are STUPID enough to get drunk and then expect to claim for medical care that is needed as a result of their being drunk, then that's all they are, just STUPID.


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## Beaver101 (Nov 14, 2011)

Longtimeago said:


> Where is the 'gimmicky marketing'? There is no marketing involved here, online an application for coverage was involved.


 ... so an online application isn't marketing? Did the insurance company not accepted the premiums, thereby the application?



> The application asked for 'province of residence' which was New Brunswick. I am sure it asks for your intended departure date from your province of residence and your intended return date to your province of residence. The son admits he believes he put in Ontario as the province of residence which was of course false. That it was the province of departure is not what the question asked. How is it an insurance company's fault if he did not answer the question correctly? What should they have done differently?
> 
> There is a limit to just how much hand holding one party can be expected to do when entering into a contract with another party. Here is the limit:
> 
> ...


 ... so the insurance company is denying a $50K claim on a minor questionable technicality. Would it make a difference on the claim (amount, type, etc.) if she lived in NB or ON? The lack of common sense is astounding.




> As with most complaints about insurance, this example is just another case of a buyer who did not read their contract and then want to complain when THEY having failed to meet THEIR side of the agreement have a claim rightfully denied. At what point is the buyer supposed to accept responsibility for their own actions? Never?


 ... when she retains a lawyer I guess.


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## Longtimeago (Aug 8, 2018)

Beaver101 said:


> ... so an online application isn't marketing? Did the insurance company not accepted the premiums, thereby the application?
> 
> ... so the insurance company is denying a $50K claim on a minor questionable technicality. Would it make a difference on the claim (amount, type, etc.) if she lived in NB or ON? The lack of common sense is astounding.
> 
> ...


Umm, how is it that you forgot to explain the 'gimmicky' marketing Beaver101? That an insurer 'markets' their product online is not the same thing as saying as you did that it is 'gimmicky' marketing. But you conveniently ignore your own comment.

How did you reach the conclusion that answering a question incorrectly is a 'minor questionable technicality'? First, it isn't minor. Travel medical insurers want to know when you leave your province of RESIDENCE for a reason. They can claim back money in some cases from your provincial healthcare provider. Second, it isn't 'questionable', there is nothing questionable about 'residence' vs. 'departure'. Third ALL contracts are about 'technical' details. Every line in a contract is 'technical', should we able to ignore them all? Your lack of common sense is what is astounding Beaver101.

As for the insurance company accepting the premiums and thereby the application, yes they did. BASED on the answers to the questions in the application. Again, what do you suggest they do? Refuse to accept any online applications and insist that every traveller looking for insurance, visit their office and answer the questions in person to someone who will grill them as to the veracity of the answers they give?

I have used CAA for travel cover in the past as well as other providers. I mention CAA because on some occasions I have applied at one of their bricks and mortar locations rather than online. There you do get asked the questions by a person and they can ascertain if they are getting the right answers. If this guy had gone into one of their offices what do you think he would have said when the person he spoke to asked, 'what province does your Mother live in?' Would he have 'assumed' he was being asked what province they were going to DEPART from? I don't think so.

When you chose to apply online, the responsibility for getting the answers right is all on YOU. There is no one to help you make sure you get them right and YOU have made that choice.


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## Beaver101 (Nov 14, 2011)

Longtimeago said:


> Umm, how is it that you forgot to explain the 'gimmicky' marketing Beaver101? That an insurer 'markets' their product online is not the same thing as saying as you did that it is 'gimmicky' marketing. But you conveniently ignore your own comment.
> 
> How did you reach the conclusion that answering a question incorrectly is a 'minor questionable technicality'? First, it isn't minor. Travel medical insurers want to know when you leave your province of RESIDENCE for a reason. They can claim back money in some cases from your provincial healthcare provider. Second, it isn't 'questionable', there is nothing questionable about 'residence' vs. 'departure'. Third ALL contracts are about 'technical' details. Every line in a contract is 'technical', should we able to ignore them all? Your lack of common sense is what is astounding Beaver101.


 ... you seemed to have forgotten that it was her son who filled in the application and made the error (?) with her residency. In any event, I guess it was so much easier and cheaper for the insurance adjudicator (does it even exists?) to just simply "deny" her claim based on this technicality than having to do some work of retrieving any costs from her actual provincial healthcare provider. The marketing is "we're here to help", BS!



> As for the insurance company accepting the premiums and thereby the application, yes they did. BASED on the answers to the questions in the application. Again, what do you suggest they do? Refuse to accept any online applications and insist that every traveller looking for insurance, visit their office and answer the questions in person to someone who will grill them as to the veracity of the answers they give?


 ... it wouldn't matter anyways since the modus operandus is "collect the premiums first and underwrite the claim later or better yet, hope you don't claim" of which you do not seem to get. The marketing is just marvelous.


Anyhow, not writing a long winding post ... let's see how a judge will rule if this case goes to court.


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## Longtimeago (Aug 8, 2018)

Beaver101 said:


> ... you seemed to have forgotten that it was her son who filled in the application and made the error (?) with her residency. In any event, I guess it was so much easier and cheaper for the insurance adjudicator (does it even exists?) to just simply "deny" her claim based on this technicality than having to do some work of retrieving any costs from her actual provincial healthcare provider. The marketing is "we're here to help", BS!
> 
> ... it wouldn't matter anyways since the modus operandus is "collect the premiums first and underwrite the claim later or better yet, hope you don't claim" of which you do not seem to get. The marketing is just marvelous.
> 
> ...


Are you suggesting her son did not know which province she lives in and therefore could be excused answering incorrectly? 

As for court and a judge, I doubt she could find a lawyer to take the case unless of course the lawyer was just happy to take her money for representing her without any hope of winning the case.


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## Beaver101 (Nov 14, 2011)

^ No, I'm not suggesting that nor do I need to because it's outlined in your own post #39, second bolded sentence. 

Interesting that you can be judge, jury, et al to determine the outcome of this case. More like, WOW, AMAZING.


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## Longtimeago (Aug 8, 2018)

Beaver101 said:


> ^ No, I'm not suggesting that nor do I need to because it's outlined in your own post #39, second bolded sentence.
> 
> Interesting that you can be judge, jury, et al to determine the outcome of this case. More like, WOW, AMAZING.


You've got to be kidding. So I went back to my response 39 and the quote I bolded there. 

*"The Blue Cross online form does ask for your departure date from your province of residence — not from your province of departure.

Matthew White said he believes he put in Ontario, not New Brunswick, because that is where they were starting their trip into the United States. To him, it only made sense."*

Now are you really trying to say that her son did not know what province she lives in and that the quote shows you that? Really? What it shows you is that he put in the province they were departing from, NOT her province of residence. Do you have a reading comprehension problem? He CHOSE to put in their departure province, not her province of residence as the question asked him to.

When he writes, "To him, it only made sense.", what he is saying is that HE decided that asking him for her province of residence did NOT make sense, that HE decided what they really wanted to know was her province of departure.

He didn't call and ask them if he was right and the question was wrong, HE DECIDED. When he did that, HE screwed up and no one else.

As for being judge and jury, any 12 year old who understands common logic would be able to see the only possible outcome if he tried to take it to court.


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## Mukhang pera (Feb 26, 2016)

As I see it, there is nothing gimmicky, sneaky, underhanded or otherwise about being asked for one’s “province of residence”. How could the question be stated more plainly? And what a load of BS about, “oh, we thought we would say Ontario, because that’s were we were at the moment.” What childish nonsense. If one gives so little thought, care and attention to applying for a policy under which the insurer might be called upon to pay a claim running to tens of thousands of dollars, one deserves a denied claim. Nothing harsh, oppressive or unconscionable about that.



Longtimeago said:


> As with most complaints about insurance, this example is just another case of a buyer who did not read their contract and then want to complain when THEY having failed to meet THEIR side of the agreement have a claim rightfully denied. At what point is the buyer supposed to accept responsibility for their own actions? Never?


So I am with LTA on that score.



Beaver101 said:


> Anyhow, not writing a long winding post ... let's see how a judge will rule if this case goes to court.


We’ll probably never know if it goes to court, unless in BC, then I would know.

But it’s not much of a case for court, leaving aside the fact that it would be a case of dubious merit. In BC, it would have to be brought in Supreme Court to claim $50,000. The monetary jurisdiction of the Small Claims Court here is $35,000. Here, I would recommend to the intended plaintiff commencing the action in small claims and seeking judgment for $35,000, abandoning the excess. In small claims, you can represent yourself and no costs are recoverable. 

In Supreme Court, an award of costs can be crippling. At the same time, pursuing judgment in SC can be very expensive and even a victory with an award of costs can leave one out of pocket. Even in my early days at the bar, a $50,000 SC lawsuit was uneconomic. Today, I would say unless a claim is worth at least $150,000, it’s not worth an SC action. When I started out, it was well understood that one must be rich or crazy to start a lawsuit. Those words ring just as true today. Time has served only to enhance their meaning.


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## Beaver101 (Nov 14, 2011)

^ We shall see as I ain't no lawyer. Maybe she'll declare bankruptcy then no one else can make any $$$ further.


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## Longtimeago (Aug 8, 2018)

Beaver101 said:


> ^ We shall see as I ain't no lawyer. Maybe she'll declare bankruptcy then no one else can make any $$$ further.


No, we shall not see Beaver101.

You obviously want to believe that insurance companies are all out to rip off anyone who makes a claim. You can of course believe whatever you choose to. But the FACT remains that 98% of all travel medical insurance claims are paid out to the travellers who make a claim. That only leaves 2% who are refused. So I don't see WHY you would want to believe the unpaid claims are all because the insurance companies are trying to rip everyone off rather than considering that maybe, just maybe, people who complain about not getting a claim paid are responsible for what they themselves did that resulted in the insurance company denying their claim.

https://blog.ingleinternational.com/just-how-many-travel-insurance-claims-are-denied/

Forget about 'losing' an argument here Beaver101 and think about this as an opportunity to move yourself from a 'belief' based on hearsay to a change in belief based on facts.


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## Beaver101 (Nov 14, 2011)

Longtimeago said:


> No, we shall not see Beaver101.


 ... then don't bother. 



> You obviously want to believe that insurance companies are all out to rip off anyone who makes a claim.


 .. that's a rather broad unwarranted accusation. Moreover, you're aware that we're discussing "travel insurance" here and not just any/all "insurance companies". 



> You can of course believe whatever you choose to. But the FACT remains that 98% of all travel medical insurance claims are paid out to the travellers who make a claim. That only leaves 2% who are refused.


 ... so can you. Btw, that "FACT" from your link is almost a decade old and interestingly enough, from Ingle International. By chance, are you affiliated with the industry?



> So I don't see WHY you would want to believe the unpaid claims are all because the insurance companies are trying to rip everyone off rather than considering that maybe, just maybe, people who complain about not getting a claim paid are responsible for what they themselves did that resulted in the insurance company denying their claim.


 ... right, and you can't never, ever be in a claimant's shoes as you're so perfect.




> Forget about 'losing' an argument here Beaver101 and think about this as an opportunity to move yourself from a 'belief' based on hearsay to a change in belief based on facts.


 ... so this is what you think this is all about ... to argue in order to win? Did it ever occurred to you that poor woman's plight might be a learning lesson for anyone other than the perfectionist(s).

And as for your accusation of my "belief" based on "hearsay" instead of your version of decade-old "facts", give me a break. Your facts were nothing but a plenty bunch of verbiage. But I must admit this isn't a surprising trait amongst manipulative sales-types.


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## Longtimeago (Aug 8, 2018)

You need to understand that most denied claims are by idiots like the following, who don't understand how to even answer some simple questions on an application.

https://toronto.ctvnews.ca/mississa...after-travel-insurance-claim-denied-1.4617920

The guy insured with RBC. If you take a look at their application, you will find when you get to the medical question section that they initially ask only ONE question. That question is, "1. In the last 12 months, have you used or been prescribed oxygen?" It is only if you answer NO to that question that another 6 questions appear. If you answer YES to that first question, they will not cover you. So HOW did he THINK he was OK for coverage unless he answered that question with a NO, which was in fact not true. He was on home oxygen prior to travel!!!

Even if he answered NO to having been on oxygen, when he got to the 7th question, it asks if you have had any heart trouble. He had a heart operation 2 months before his trip. Did he answer NO to having had heart trouble? If he answered YES, again he would have been unable to continue on with the application.

These are always the kind of stories that make the news and that you Beaver101 seem to think mean something. What they mean is that many people are STUPID. The 'poor woman' that you refer to in regards to the son who couldn't answer, 'province of residence' correctly, has only her son to thank for the problem and NO ONE else, just as the guy in this $800K+ case has only himself to thank for the debt he now owes.

As for his attitude of 'well I don't have the money', it shows a total lack of RESPONSIBILITY for his own actions. If you watch the video in the link, he very obviously does not care at all whether he owes the US hospital this money or not. He just thinks they have no chance of collecting so they can do nothing. He doesn't care that it was his OWN fault, he doesn't even try to defend his actions. 

What do you think he would have said if the interviewer had shown him a screenshot of the first medical question the RBC application asks and then asked him, 'how did you answer this question?'


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## OptsyEagle (Nov 29, 2009)

Saw the tidbit on the guy with RBC today and wondered the same thing. Why would he even bother with insurance. He should have known that he would not be covered if he lied on the application (perhaps he didn't know that but it is the way it is). I doubt the US hospitals are done with him because he is broke, but that part I cannot say. 

I can agree, he is an idiot. To treat a hospital, that probably saved your life or at least your well being, like that publicly, makes a person embarrassed to be part of the human race. I imagine his intent is that if he publicly announces that he is broke, the hospital will just go away. I doubt that will happen. Wish it was so easy.


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## Longtimeago (Aug 8, 2018)

OptsyEagle said:


> Saw the tidbit on the guy with RBC today and wondered the same thing. Why would he even bother with insurance. He should have known that he would not be covered if he lied on the application (perhaps he didn't know that but it is the way it is). I doubt the US hospitals are done with him because he is broke, but that part I cannot say.
> 
> I can agree, he is an idiot. To treat a hospital, that probably saved your life or at least your well being, like that publicly, makes a person embarrassed to be part of the human race. I imagine his intent is that if he publicly announces that he is broke, the hospital will just go away. I doubt that will happen. Wish it was so easy.


I also read that RBC paid $50k to fly him home (I guess air ambulance). No doubt they too will be looking to collect from him. I guess they only denied his claim after he got home and they investigated his circumstances as you would expect they would with a $800k bill to pay. I think he is in for some serious hassle regardless of his wish it would just go away.

It was his attitude that got me, no concern at all or acceptance of it was his own fault.


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## Userkare (Nov 17, 2014)

Maybe if he thinks he has been terribly wronged ( he wasn't, it's his own stupid fault! ) he can get the publicity to either have the hospital write off the debt, or someone will come to his rescue with a go-fund-me campaign.


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## OptsyEagle (Nov 29, 2009)

Userkare said:


> Maybe if he thinks he has been terribly wronged ( he wasn't, it's his own stupid fault! ) he can get the publicity to either have the hospital write off the debt, or someone will come to his rescue with a go-fund-me campaign.


His mistake was that he was "smiling" when he was discussing his financial situation. That non-verbal statement is what will do him in. Had he looked a little more concerned and despondent, it might have worked.


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## Zipper (Nov 18, 2015)

With rotten teeth that obviously haven't been looked at in years and his obviously flabby fat condition at only 68 he gambled and lost in more ways than one.


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## Mukhang pera (Feb 26, 2016)

He is probably a man of straw, just as he said in his tv interview. Judgment-proof. A professional debtor.

I think I knew he was uninsurable and lied on his application, knowing that no claim would be paid. He was also smart enough to know the hospital would not treat him without first verifying that he had insurance. So he obtained insurance by misrepresentation. He knew he would receive treatment and that the insurer would eventually deny coverage. Do you think he cares?


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## Longtimeago (Aug 8, 2018)

So as it happens, we just bought some travel medical insurance yesterday for a spur of the moment trip to Switzerland to get in some late season hiking before the snow arrives.

We have been using the CAA for insurance for the last decade or so. We always go to their local office and buy the insurance in person. We do it this way to make sure we eliminate as many questions as possible.

One question on the application was about 'respiratory condition'. I happen to have chronic bronchitis. It's very mild and I am on no medication for it at all but it exists. The question asks however if I have ever 'required medical treatment' for it. I have to answer YES to that question as my family doctor keeps an eye on it when checking me out. There is no real 'treatment' being done but by answering YES, I eliminate any possible question as to whether I provided 'full disclosure' or not. Farther into the questionnaire, it asks 2 more specific questions about any respiratory condition and to those I can answer NO. Those no's basically cancel out the previous yes in that they show no prescriptions or treatment in the last 3 years. So I won't pay more but I have fully disclosed.

My wife happens at the moment to be using a prescribed topical cream to treat a small skin problem. The last day she will use the cream is the day before we leave on this little trip. She answered YES to the appropriate question and then in another area, gave the information re the end of the treatment. In both my case and my wife's case, the CAA agent we were talking with was able to go to her far more detailed manual to confirm how we should answer. For my 'respiratory condition' for example she was able to go to a long (50 or so) list of conditions that would apply including my bronchitis. 

She also made clear to us that if I had a breathing problem given my 3 year no treatment history, I would be covered. If my wife's skin condition 'flared up' while we were away and she needed to consult a doctor, get a prescription and treat the condition, that would NOT be covered. Both of those make absolute sense to us as I would think they would to anyone. 

My point is that if you take the time to do it right, you and your insurer will know just what is and is NOT covered. If someone answers 7 questions online, doesn't read their ENTIRE Policy line by line and doesn't bother to actually ASK any questions about something that might be applicable to them, then having a claim denied is their OWN fault. My wife is not going to claim if her skin condition recurs while we are away, she knows it isn't covered and she isn't going to think her travel insurer is 'ripping her off' because they won't cover it. She could if she wanted to get a 'rider' for a 'pre-existing condition' which WOULD cover it but given the fact that the treatment she has already had is most likely sufficient and a recurrence is not likely, that added expense is not really justifiable and so we will KNOWINGLY take the 'risk' on ourselves.


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