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Insurer plays hardball with senior denied claim

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Life Health Professional | 30 Nov 2015, 08:15 AM Agree 0
A Toronto woman is paying the ultimate price for failing to correctly fill out an insurance application reminding insurance advisors why you come in handy
  • Lynda Weinrib | 30 Nov 2015, 03:11 PM Agree 0
    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?
  • Alice Kern - ABR | 30 Nov 2015, 06:41 PM Agree 0
    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.
  • Ray Battiston | 02 Dec 2015, 02:49 PM Agree 0
    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.

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