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An 89-year-old man's travel insurance mistake
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Toronto Star- Tony Smith of Kitchener had a heart attack while visiting Florida this past February. A few months late, in June, Leon van Witsen was hospitalized in Texas. He was diagnosed with congestive heart failure, treated and flown home to Toronto by air ambulance.
Both men had turned to the same company to buy insurance that would pay for any unexpected medical emergency while outside of Canada.
But that’s where the similarities ended and the heartache began for 89-year-old van Witsen’s family.
RBC Insurance paid all $98,400 of the bills for diagnosing Smith, and for installing two stents into blocked arteries a few months before he turned 76. It would pay none of van Witsen’s near $65,000 of hospital and transportation bills, however.
The insurer determined that Smith had qualified for the protection under the short-term policy he bought for a mere $71, less than he would have paid at his usual source of coverage, the Canadian Automobile Association.
But RBC determined van Witsen had not qualified for two reasons. So he was denied compensation for his bills, based on a straightforward reading of the contract he had signed.
“It’s also about fairness to other people,” says Martha Turnbull, the registered nurse who heads the automobile, travel and property claims department at RBC. Anyone who buys insurance and plays by the rules has a right to expect that those rules will be applied equally and fairly to all, she explains.
Members of van Witsen’s family quickly complained to a Toronto Star reporter, to provide other travelers with the lesson they learned. But one also argued RBC was harsh, and that it should show more compassion.
She had no grounds for saying so. The relatives acknowledged their family elder had failed to disclose his high blood pressure, and that he had seen a doctor about his heart before leaving for Florida. This was an indication the condition of his health was not stable, as required under the contract. (There is no insurer that sells policies with a compassion clause, in case you happen to withold information or are ineligible for the coverage you bought.)
“We really empathize with Mr. van Witsen and his family in the current circumstances,” says Turnbull, before providing new information about RBC’s reasoning. “We can share with you the claim was denied for two reasons: Primarily . . . he did not answer the medical questionnaire correctly. He said ‘No’ to the following question: A. Are you currently taking medication to treat or prevent high blood pressure? B. Have you been prescribed medication to treat or prevent high blood pressure and chosen not to take it?
Neither question is ambiguous.
John Wilson of M. Butler Insurance Brokers Ltd. in Niagara Falls says there would have been little difference in price of coverage if van Witsen had answered “yes” to the question about his blood pressure and was able to answer “no” to every other question: $289 versus $223 for 14 days of coverage with RBC.
Van Witsen’s daughter-in-law told a Star reporter in June the man had seen a doctor before he left Toronto. “There was concern that he could have a heart problem but he was told he was okay and could travel,” she said.
Turnbull says RBC also learned he was referred to a heart specialist. “(Even if he had) answered the questionnaire correctly, his claim wouldn’t have been covered, because of an increase in severity and frequency of symptoms of a heart condition.”
Most individual travel health policies require health conditions to be stable for three or more months. While some policies will now waive the normal stability clause, the consumer must inform the insurer so it has the opportunity to charge a higher premium to cover the additional risk.
Smith was quite familiar with the need to read insurance application forms carefully, and to answer questions truthfully. “The first thing I look at are exclusions (from coverage),” says the former broker for commercial insurance, who thought he would stay fit by starting to cut grass at a golf course after he turned 65.
He consulted RBC’s call-centre to be sure he understood the meaning of all the health questions and policy language, and stopped by a Royal Bank of Canada branch to check further. He had just had his annual physical check-up, and says there were no signs of the trouble ahead.
“After three or four days there (in Florida) I felt some indigestion after dinner, but I burped and it went away. After the third day (of feeling stomach upset, but no pain), my wife said: ‘You’re not right.’ She knows me well after 53 years of marriage, so she suggested I go to a walk-in clinic.”
A nurse there administered an electrocardiogram test, and referred him to a hospital where a doctor ordered blood work that showed enzymes in his blood, the sign of a heart attack. So he was flown by helicopter to the Holmes Heart Centre. “They found out I had two arteries 90 per cent plugged.”
“All you read in the papers (about travel medical insurance) are horror stories,” says Smith. “To me, this is a good news story. Everybody was so good, the medical people . . . the people at RBC. My wife sent them a thank you note.”
Now he has had his operation and the claim has been paid, Smith says he’s pretty sure he won’t be crossing borders, for at least a year. “[My wife] said I won’t be going at all.”
Wilson and other brokers who sell a lot of travel insurance pride themselves on knowing their regular clients, and questioning them carefully until they are confident all health conditions have been disclosed truthfully.
But no matter how well a client is known to a broker, bank teller or travel agent, these people are not the clients’ doctors. Turnbull of RBC says consumers should not expect sales agents to challenge their answers on policy applications.
“It is really beyond our scope of practice or our role to go beyond accepting what individuals are doing,” says Turnbull. “We can (only) provide advice, which is why, on the questionnaire, we provide very clear advice that it is important that you answer these questions accurately.”
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