TRAVEL INSURANCE CLAIM DENIALS: HOW TORONTO COPESUpdated on Aug 11, 2014
Of all Toronto’s travel-insurance policyholders, insurers annually deny only an average 2 per cent who file claims. That’s an impressive rate of coverage, but that same 2 per cent is then often left to deal with tremendous expense, often while subject to healthcare systems outside Canada’s own.
Typically, insurers deny travel insurance claims based on one of three factors or some combination of them: an inaccurate or incomplete initial medical questionnaire, a risky pre-existing condition, or claims for ineligible expenses as defined under the policy. Incorrectly answer the questionnaire, and there’s still a “best-case” scenario of being hit with a deductible instead of outright claim denial.
If you do find yourself among the 2 per cent whose claims fall through, it need not be the end of the world. There’s a right way to go about disputing the insurer’s decision. It doesn’t involve righteous rage or bitterness, but it does involve hearing the insurer out and making your own case to an independent party who will back you.
THE LAWYER-FREE OPTION
Going about disputing a travel insurance claim denial without qualified counsel can be a gamble. Remember, the insurer definitely has lawyers on retainer who are paid well to provide quality advice that avoids costly payouts.
That said, you’ll still be expected to proceed through defined channels first. Specifically, address the insurance marketer first, followed by the insurer and its underwriters through a process outlined by the internal dispute-resolution system. Should that either fall through or proceed without a reply to you in 90 days or less, it’s then time to consider appealing to a group such as OmbudService for Life and Health Insurance (OLHI) to receive an additional opinion.
Bringing OLHI into your dispute won’t forfeit your right to pursue a civil action or small-claims court case seeking damages from the insurer later, regardless of the OLHI case’s outcome. Be advised, OLHI representatives or their gathered information will not be admitted into evidence in court, per OLHI non-disclosure agreements.
GOING TO COURT
If you do decide to go to court, it’s neither an inherently futile gesture nor an assured success. It depends from one case to the next, but be warned that courts historically do not look kindly upon blatantly disingenuous medical questionnaires. In some cases, judges have forgiven simple misunderstandings some measure of mercy.
Either way, you’re simply safer being forthright from the start. That, and shopping for your policy with professional insistence from a Blue Umbrella Financial Services representative. Our business is your security. Every Toronto representative and broker that services our thousands of satisfied clients applies knowledgeable expertise that guarantees a policy agreement rooted in well-placed trust between insurers and the applicants with whom we pair them.