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If you’ve travelled outside of Canada, you may have purchased out of country medical insurance to protect your finances in the event of a medical emergency. 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 out of country medical 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.
Having an out of country medical 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.
How we can support you
After being denied your out of country medical insurance benefits, you might not know where to turn next. You may feel hopeless in this moment, but rest assured you are not alone. When you call Share Lawyers, you will speak with someone who knows what you are going through and can offer you the best possible advice at no cost to you.
Why you should contact us:
- It’s free to talk to us
- There are no fees unless you win
- We specialize in out of country medical insurance claims and can go through your options
- We make arrangements for a free consultation with one of our out of country medical insurance lawyers to see how we can help you get your out of country medical insurance benefits
- We're there to answer all of your questions
Our lawyers can help with out of country medical insurance claim denials
Out of country medical insurance is relatively easy to purchase by those who plan to travel outside of Canada. The insurance exists to support travellers financially if they become sick (or have an accident) and need medical attention.
These claims can be denied based on the medical questionnaire that you fill out upon purchase. Problems arise if there are any questions or suspicions around whether or not any pre-existing conditions are stable upon travel.
Why was my out of country medical insurance claim denied?
The main reason out of country medical insurance claims are denied is related to how the insurance was purchased in the first place. If you purchase an individual or family policy through a broker or directly from the insurance company, the medical questions that you must answer to get the 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.
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 insurance company refused to pay any of the amounts owing which exceeded $600,000 USD.
The insurance company 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 insurance company was inaccurate.
With the discrepancies between her answers 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.
By taking legal action, her family was able to recover funds from the insurance company 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.
It is important to read the fine print carefully so you understand what coverage you have in the event of a medical emergency.
These cases are focused both on the policy wording and the specific facts of each case, but an initial denial by the insurance company 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.
How much time do I have?
There are time limits to all disability claims and any delay in proceeding may be subject to a deadline so you should not delay in proceeding with your disability claim or obtaining legal advice to clarify these deadlines. We understand how important these timelines are and will respond to any call or email as soon as we can.
Disability Lawyers in Toronto, proudly serving clients in Ontario and across Canada
Are you looking for a disability lawyer to fight for your rights? Our law firm have unmatched experience in disability law and we don't let provincial borders stop us from helping you in your time of need. Your insurance company has a presence throughout Canada and it makes sense to hire a disability law firm that has a true expertise in disability law and has a national presence too. Your insurance company knows who we are and knows that we won’t back down.
Regardless of whether you have just applied for your insurance benefits or have been denied your benefits by your insurance company and need support, we will talk you through all of your options — free of charge. It’s important to be informed about the insurance claim process and to know your rights.
No fees unless you win your case
We understand your situation and that paying for an insurance lawyer can feel out of reach. We are here to help you no matter where you are in the process. That is why we offer a free consultation, why there are no upfront costs to you, and why there are no fees unless you win your case. You’re not alone. We believe in your case, which is why we only get paid when you do.
When you work with us, you get guidance and tools to help you along the way. You will become a member of a privileged group of clients that have access to our hub, called Life reBUILDER™, exclusively from Share Lawyers. It offers six unique services to help rebuild your life and get you back on track, beginning with the expertise of a full legal team all working for you.