Out Of Country Medical Insurance

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If you’ve travelled outside of Canada, you may have purchased out of country medical insurance or travel insurance to protect your finances in the event of a medical emergency on your trip. No one wants to think about needing to use this insurance, but unfortunately, medical emergencies do happen, and you want to be able to rely on the insurance you bought so you can get the services you need.

If you have travel insurance, health care providers in other countries will usually provide services to you on the basis that you have such coverage available, but in some cases, insurance companies deny the claims after large medical bills have already been incurred after an accident or injury. This can be true for out of country medical insurance claims, medical coverage, or other types of insurance claims being denied.

Having a travel insurance claim denied for you or a loved one causes great anxiety and can lead to receiving collection notices from the hospital, labs, doctors and any other health care providers that may have become involved in providing medical coverage after an accident or injury.

The main reason out of country medical insurance claims are denied is related to how the insurance was purchased in the first place (with importance placed on pre existing medical conditions). If you purchase an individual or family travel insurance policies through a broker or directly from the insurance company, the medical questions that you must answer to get out of country medical insurance coverage will be heavily scrutinized if a claim is made. Any inaccuracies in the answers given will be used to deny the claim on the basis that no insurance would have been offered if the insurance company had all of the information about any pre existing medical condition. For example, questions regarding whether your condition is stable or whether there has been a recent change in medication can result in a claim being denied if inaccurate information is provided. These denials can be challenged as the decisions may be a question of interpretation. It may be possible to still recover all or part of the funds owed and reach a resolution with the health care providers so that you are not out-of-pocket. We recommend contacting our team of out of country medical insurance lawyers to see how we can help.

When buying out of country medical insurance make sure you provide accurate answers to any questions about your prior health to try to ensure that you won’t experience a claim denial when a claim has to be made.

An Example

A 75-year-old Ontario woman took out out of country medical insurance for her winter trip to Florida prior to leaving in October. She travelled to Florida and in February of the following year, she became ill requiring urgent medical attention. Unfortunately, as a result of her illness she passed away a few weeks later in Florida. She incurred extensive medical expenses and the insurer refused to pay any of the amounts owing which exceeded $600,000 USD.

The insurer alleged that she misrepresented her health when applying for the insurance. They said she should have disclosed that she had a heart condition and was being treated for hypertension prior to her application and that she has also been treated for shortness of breath and had been prescribed a number of medications.

She had provided answers based on her understanding and knowledge of her health and had never been told by any doctors that she had a heart condition. The prescription information mentioned by the insurer was inaccurate.

With the discrepancies between her answers about her medical history on the original application and the information that was in her medical records, the question of the validity of her claim was open to interpretation and this gave rise to the possibility of pursuing the claim so that her medical bills could be settled at no cost to the family. Her family submitted the claim in a timely manner and looked into the denial as quickly as well.

By taking legal action decisively and without delay, her family was able to recover funds from the insurer that were used to settle the outstanding accounts with the medical providers on a compromised basis. No further bills were left owing, the settlement covered this as well as the legal expense of pursuing action. The family all knew the outcome and made sure to get all the disability insurance, out of country medical insurance and travel insurance for themselves in the future.

It is important to read the fine print carefully so you understand what coverage you have in the event of a medical emergency and treatment.

These cases are focused both on the policy wording and the specific facts of each case, but an initial denial by insurance companies should not be taken at face value, without being further reviewed, as decisions to pay the claim are based on the proper interpretation of the coverage, insurers err on the side of denying the claim rather than admitting the claim.

We Can Help

Before accepting a refusal by an insurance company to pay out on your out of country medical insurance claim, we encourage you to consult further with one of our out of country medical insurance lawyers to determine whether we can assist you in recovering all or part of what rightly belongs to you or your family.