Many people are careful and buy travel insurance before they leave Canada to protect themselves in case they have a medical emergency while traveling. After all, some countries, like the United States, have expensive medical systems that can cost travelers tens of thousands for even the simplest treatments. Smart travelers seek to avoid this risk through travel insurance; however, few of these travelers actually read the densely worded insurance policies that apply to this type of insurance. If they did, they might be shocked to learn how many exclusion clauses these policies contain.
Exclusion clauses are terms in the insurance policy that specifically exclude coverage for certain things. These clauses give the insurance company an opportunity to deny your insurance claim. You might go on vacation and end up fighting for your life in the face of a medical emergency, only to make it back to Canada and end up in another battle, this time with the insurance company. If the insurance company denies your claim and you disagree with their decision, you can try to change their mind, but ultimately you may have to take them to court and sue them for coverage under your insurance policy.
In a recently reported court decision, our firm successfully challenged an insurance company’s decision to deny a claim. Our client was faced with a cripplingly large medical bill for a quadruple bypass surgery in the United States. The insurance company refused to cover our client’s expenses, saying that our client had left on vacation while having a reasonable expectation that he could require medical treatment while traveling.
After a hard fought trial in British Columbia Supreme Court, the Court agreed with our argument that our client had taken reasonable steps in the circumstances, and did not have a reasonable expectation of needing medical care while on vacation. The Court ordered that the insurance company indemnify our client for his medical expenses, and pay legal costs.
This case is not unique, because many travel insurance claims are denied based on exclusion clauses. The exact structure of these exclusions varies from policy to policy depending on the wording, but the general result is that if you travel with a pre-existing medical condition, or take a trip knowing that you might require treatment, you can end up in a dispute with the insurance company if your condition deteriorates and you need medical treatment while abroad.
A cautious traveller, and in particular anyone with known health challenges, would be wise to take the following steps prior to travelling:
- Read your insurance policy and make note of exclusion clauses. What are they for? Do they seem like something that would apply to you?
- If in doubt, ask your insurance broker, or the insurer directly whether you are covered in your specific circumstances. Make notes of the conversation, who you spoke to, and the information they gave in case a dispute develops later.
- Talk to your doctor if you have specific health problems or concerns that might arise while traveling.
- If in doubt, consider postponing your vacation until your health improves. This is a frustrating last resort, but inevitably less frustrating than becoming involved in a costly legal battle if you need medical treatment while traveling and your claim is denied.
No one sets out on a trip expecting to have a medical emergency. The careful traveller buys travel insurance in case the worst happens and a trip is ruined by just such an emergency, but coverage is never absolute and if your claim is denied the financial consequences can be devastating. Being careful, reading the policy, and seeking more information if necessary, can help you avoid a situation where the insurance company denies your claim for medical expenses incurred while traveling.
If you take all these steps and the insurance company still denies your claim, then you may need to take the insurance company to court to get coverage for your expenses. Velletta & Company is experienced in dealing with insurance companies through both negotiation and, if necessary, litigation. We regularly deal with insurance companies including on cases involving motor vehicle accidents, life insurance, home insurance, and travel insurance. If you are facing a dispute with an insurance company, we would be happy to meet with you and discuss your unique needs.
Cadeyrn Christie is a civil litigation lawyer and business lawyer with Velletta & Company. A former tradesperson, business owner, and high performance athlete, Cadeyrn focuses his practice on providing dynamic representation to individuals and businesses.