Insurer plays hardball with senior denied claim

by 30 Nov 2015
Allison Singer’s recent two-week Baltic cruise to celebrate her 80 th birthday quickly turned into a financial nightmare when she came down with pneumonia while on the ship and was forced to spend six days in a St. Petersburg hospital as a result.
 
As if the ruined celebration and hospital stay weren’t bad enough, the Toronto resident had to pay almost $16,000 out-of-pocket for the hospital bill and flight home from Russia.
 
Singer had travel insurance but unfortunately she said she mistakenly overlooked one question on the application. TIC Travel Insurance Coordinators denied the claim as a result, although it had accepted the coverage request.
 
“Upon reviewing Ms. Singer’s file, we can confirm her claim was denied due to non-disclosure of pre-existing medical conditions the initial application process,” Dan Keon, director of marketing for SelectCare Worldwide said in a statement. “[Prospective customers should] speak to their insurance provider or physician for assistance.”
 
Singer’s failure in this situation was neglecting to answer one question on the application form that dealt with atrial fibrillation, more commonly known as an irregular heartbeat, for which she takes blood pressure medication.
 
“They denied the claim because of atrial fibrillation even though it had nothing to do with pneumonia,” Singer told Global News. “I know I made a mistake and I’m willing to admit that.”
 
The claim denial by TIC Travel Insurance Coordinators is just the latest example of the new norm around claim adjudication. Earlier this year LHP covered a lawsuit by an American steel company against Sun Life’s U.S. and Canadian divisions for wrongfully denying a claim involving stop-loss insurance.
 
SelectCare did refund Singer’s $187 premium.

COMMENTS

  • by Lynda Weinrib 2015-11-30 3:11:15 PM

    Was a licensed insurance agent involved? If so, why was her application not checked before it was submitted? Or is this simply an example of why to use a licensed insurance agent?

  • by Alice Kern - ABR 2015-11-30 6:41:01 PM

    A licensed broker, specializing in travel insurance, would have asked that question in several different ways to get the correct disclosure. Heart, whether medicated or not, is an automatic disclosure, and would have affected premium. There are insurers among products which we represent, that would simply have applied a higher deductible and paid the balance of the claim. By not dealing with a professional, the consumer is at risk of this kind of situation.

  • by Ray Battiston 2015-12-02 2:49:08 PM

    From the title I assumed the insured was being very poorly delt with. I too am a long time Insurance Broker, with 42 years in the business, specializing in Travel Medical Insurance.
    First off, premiums are charged by health history, age, length of trip, sometimes destination with different variables thrown in- example trip cancellation option, deductible options. Most companies require the senior insured to answer some type of health questionnaire.
    Invariably, many insureds 'forget' to answer the correct Yes or No question resulting in a lower premium. The insurer has the right to void the contract because the application was incorrectly filled out. It is highly unlikely an Insurer can void a contract due to an incorrect spelling or address of an insured since that really does not affect the premium. But health conditions certainly do affect the premiums.
    The client also has to be stable for the required time the contract demands for a pre existing condition to be covered.
    And on top of everything else, no insurance policy out there is ever designed to cover every possible claims situation. Your policy documents which you receive in the mail or via e mail normally include the copy of the application, the policy wording, the confirmation page or pages, and the ID card.
    Read the policy! Read the coverage benefits, and the exclusions, general conditions and limitations.
    Call your Broker, Agent or Company on any questions.