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The Trip from Hell and the Trip Up That Has to Be Avoided
At this time of year nearly every Snowbird in Western Canada is preparing to get to warmer climates to avoid those months of rain, snow and colder weather.
Some brokers are very active in writing Travel Medical Insurance and have developed an office flow that accommodates the rather detailed questionnaire or narrative that is required to get that wallet card and assurance to Mr. & Mrs. Snowbird that they are good to go and enjoy the warmer climates and different surroundings.
But wait; if you are filling out a vehicle insurance application or a property application, the answers are generally black or white, yes or no.
For Travel Medical you are dealing with a confidential medical record including time lines and drug prescriptions that have confusing names and of which patients generally don't know even what they prevent or enhance. Failing memories often don't mention why they went to the doctor a few months ago.
Travel Medical Insurers have a reputation of denying claims for "non-disclosure". Their underwriting practices are meant to ferret out the information relating to those prior conditions that may cause problems in the warm sun, over stressed travel days and in situations where language and strange surroundings may trigger that fainting, collapse or sharp pain from tension, long waking hours or bad food.
Some examples are a lady named Turpin from Victoria went to Southern California. She had had some abdominal paid which she went to the doctor about in Victoria. Drugs were prescribed and she was advised to be mindful of continuing paid which subsided. A few weeks after, she went to her local Insurance broker's office who quickly completed her Travel Medical application and glossed over the prior conditions issues. She signed the app and walked out, happy that she and her husband were fully covered for their trip. A few days in the sun and she got the abdominal pain back so went to the California clinic close by where she was treated after detailed examination and prescribed medication. The bill sent to Manu Life was for $27,000.
Upon return to Victoria and another bout of same, yielded an appendectomy. ManuLife Travel denied the claim in California because of prior undisclosed condition. Poor Mr. & Mrs. Turpin sued ManuLife because they said the policy wording was ambiguous, however, they admitted they hadn't read it in any event, as their broker had suggested.
The Supreme Court of BC trial judge ruled that the wording was ambiguous for the ordinary insured and gave judgement to the Turpins against ManuLife. It was appealed as it was deemed a major issue for the traveling public. But the Appeal court said no, the wording was clear.
If you have a prior illness or condition and you do not declare it, you are out of luck if you have a re-occurrence of that when you are out of the country the claim will probably be denied. That insurance broker who glossed over the prior history questions without explaining the pitfalls is a professional and she/he should have known better even though the insured signed and said she would read and understand the policy.
The case of Turpin vs ManuLife is attached. The E&O claim against the broker is not reported here.
Recently we have seen two very similar cases, one in Burnaby and one in the Interior. Another on the Sunshine Coast a few years ago gained some notoriety because it involved an adjuster who believed he had disclosed all the medical history but the Travel Medical Insurer challenged his every argument and he lost.
Here is the bottom line:
As an insurance professional, you are expected to have the knowledge to overcome these types of pitfalls for your clients who come to you for advice and the proper coverage. Your challenge is that you are dealing with very sensitive medical histories that in some cases clients or prospects simply do not want to reveal or have forgotten the severity of, after living well for a number of years. The Insurer however underwrites on that condition not being present, even if history shows that travelers of certain ages on average, have these afflictions, and so the dilemma.
The solution:
Two of our major E&O clients have recently made the decision that writing travel medical is simply too challenging in todays confidential and information guarded medical world. They also have little confidence in their ability to negotiate with the Travel Medical Insurers in the grey areas. Accordingly, they have instructed their staffs to simply refer to the Travel Med company web sites or expert travel medical brokers who do nothing other than Travel Med. Those experts will take the time, know the pitfalls and danger signals, to avoid Errors and Omissions claims from this line of business.
The conflict here is that you walk away from an opportunity to make commission on this business; however, history has shown that for the overall commissions gleaned from these business vs the deductibles on your E&O that you may have to pay, it is simply not a paying proposition.
Your E&O coverage is designed to help you enjoy doing business not worrying about what you might have missed asking Ms. Snowbird sun tanning in San Diego.
Call us we can help..........
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