Travel Insurance

[CaptainAustrali]

Hi There

It's a complex area of insurance, but let me explain it as clearly as I can (with the usual disclaimers, this is just some-guy, I'm not representing a product or anything, the advice may be completely unsound, this is just a fellow who thinks he understands things but maybe doesn't giving what he thinks is an informed but informal comment)

Under normal conditions the main categories where a company wants the "WE REFUSE TO INSURE YOU" outcome are:

1) where you are travelling AGAINST medical advice

2) you have a terminal prognosis

3) you have a problem that compromises your autoimmune response (ie you're pretty much guaranteed to get sick somehow)

4) your condition is not in the above circumstances but is severe and high risk .. like folks who require constant oxygen, etc etc

What they want to avoid is people who are certainly going to lodge a claim, and where the claim will be messy and ambiguous - for example, getting sick overseas from the flu is a condition all travel insurances would normally cover .. but if the person is dying of advanced HIV or something like that, then it's not a fair ask on the insurance company.  (If they want to go overseas and are happy with the risk, self funding is the only option).

For everybody else, the intention is to fall into one of two possible buckets:

1) You have a pre-existing condition and we are happy to cover it (usually for a fee)

2) You have a pre-existing condition, and either you dont want it covered (to avoid a fee) or we refuse to cover it (because of the risk).  In this scenario ALL CLAIMS ARISING FROM THE PRE-EXISTING CONDITIONS ARE EXCLUDED.

Most cancers fall into that Bucket #2, but the Insurance companies have these online processes that they want to be as simple & easy as possible (while at the same time protecting their interests), so it's a very messy and uncertain area of insurance.  And the online processes can err on the side of caution, rejecting cover if the event was recent (like the past couple of years) but approving it once you've been stable for more than a few years.

So one approach is to take it on the chin, and self insure, or travel in a few years when the smoke has cleared.  BUT, those online processes are complex, and have to deal with lowest-common-denominator consumers.

For example:  a person can buy a policy online and make a mistake with their disclosure.  For example, I was diagnosed with Tonsillar Cancer in 2016, and right now I'm cancer free.  (Yippee), so I might easily make the assumption that I *dont* have cancer, misunderstanding what a 'pre-existing condition' is, and simply answer NO to the online question "do you have a pre-existing condition?"

See what I mean ?  I'm not a BLEEPING lawyer, am I supposed to read and understand their mumbo jumbo definitions ?
(Yes, Yes I am.  But No .. people don't, it's a known commercial reality)

In that circumstance, the Insurer is definitely on the hook for all those routine kinds of claims (luggage, slip & fall, whatnot), and generally they want to be and are happy to be.  It becomes muddled and messy if you wind up in hospital and it's somehow directly or indirectly related to the cancer.  In that circumstance the Insurer looks at a false or incomplete disclosure, and arbitrates accordingly.  So yeah, if you get sick overseas due to the cancer, that's where there are problems, but if you bought a normal policy and had a normal unrelated claim, even though you failed to disclosure (example somone nicked your iPad), the cancer doesnt even come into the conversation and your coverage is pretty much OK.

But you see how mucky it can get ?

It's not your fault.  It's not the Insurer's fault, everybody is authentically trying to muddle through and do the right thing, but between the real human medical histories, the online processes and Insurers protecting their interests, it becomes a bit ... icky.

I can't tell you what to do, but I can tell you:

YES, you do absolutely have a thing called a Duty of Disclosure.
YES, an Insurer does absolutely have the right to refuse insurance.  It's data-based from actuarial/clinical outcomes so it's not unfair or discriminatory, it's about making insurance accessible and affordable by having a line in the sand about who can & can't be covered

NO, Insurer's dont stop you from quick-buying online, and they also don't require YOU to purchase the policy, family members can buy your insurance for you, so incomplete and misunderstood disclosures are a commercial reality

The regulators across the world widely recognise that consumers do not properly read or understand all of these jargonistic T&C documents (Product Disclosure Statements), so when there are disputes the litmus test is actually normally "what is fair and reasonable"

Most folks who have not had cancer would think it's "fair and reasonable" to assume that insurance doesn't cover cancer, so at any point saying "I thought my cancer was COVERED" even in the highest court of the land, you'll probably wind up unsuccessful

But most folks would assume that the cancer is not covered, but the other normal stuff is
(And those assumptions typically inform how claims & disputes are handled)

So yeah, sorry for the long winded reply, and again disclaimer "I'M JUST SOME GUY RAMBLING AND ACCEPT ABSOLUTELY NO LEGAL RESPONSIBILITY FOR THIS ADVICE IN ANY CONTEXT, ITS JUST RANDOM INTERNET MUMBLING.  IT DOES NOT REPRESENT A PRODUCT, AN INDUSTRY, OR AN INFORMED VIEWPOINT IN ANY WAY.  I AM AN IDIOT.  A COMPLETE IDIOT"

If I were at my wits end after trying to buy insurance and feeling confused, and if I in good conscience knew my health were sound for the trip, but for some reason I keep screwing up the application forms, what I'd do is get my spouse to buy the insurance for me, let them try and work out all that pre-existing condition mumbo jumbo, probably they'd just answer NO with a quick "huh ? no, we dont want that, we know its not covered"

Anyway, I get that the above isn't really clear & comforting, if you're adamant about dotting all your Is and crossing all your Ts, what I'd suggest is:
- pick up the phone and call the candidate insurer

- ask to speak to a team leader, say you have some complex questions about pre-existing conditions

- explain your history to the team leader and say you just want general cover without the pre-existing condition, and that you're not travelling against medical advice, all clear, etc etc .. (they may ask you to send in a "clear to travel" statement from your doctor).
(the call centre phone jockeys, for the most part, can only give scripted advice, and if you ask them questions touching on scary stuff like cancer, they'll go all scooby-doo on you - so yeah, this last bit is making sure you get some clear and certain advice from an appropriate person ... the initial phone answerer generally is OK for 96% of Insurance inquiries, but you're the 4%, so ask for next-step-up helper)

Sorry if this is too rambling, vague and uncertain, just wanted to throw it all out there.

Again, disclaimer, I'm an idiot, the above is a story-telling narrative and not specific functional advice regarding any industry or product 🙂

[DavidCoyle]

My wife Jenny aged 76 was active,  fit and enjoyed excellent health when she was diagnosed with bowel cancer late last year.  She is now 14 weeks into a 30 weeks weekly chemotherapy course (fluouracil) and she is bearing up bravely and quite well it seems to the unpleasantness involved in the treatment.  We were booked to go to Africa in January 2019 but were forced to cancel that.   We are also booked to go on the "Three Queens" cruises (New York to London, London and return to Norway and vicinity and then London to various Mediterranean ports and return, then a week in Spain and fly home to Sydney.  Jenny will complete her chemo on 28 May 2019 and we are to  fly out to New York almost 12 weeks later, on August  16,  and return to Sydney on October 03. 

Jenny expects that she will be well recovered from the effects of the chemo by then.  However, travel insurers are saying otherwise, claimiing her immune system will still be compromised and are declining her travel insurance.  

we would appreciate help and advice on this ASAP.

regards David

[CaptainAustrali]

Hey Mate

When booking the cruises, did you know about the cancer ?  And did you buy travel insurance at the time ?

If so, my advice (personal and off the record, not representing any specific company) is simple:  claim.

The cancer was not a pre-existing medical condition at the time, because you didn't know about it.

Now ?  It's a "volatile" medical condition.  Insofar as any condition that's hospitalised you in the past 12 months is automatically off the table for cover in most insurances.  And yep, if you make a full disclosure when buying insurance, the companies are regrettably too conservative and will likely say "sorry, we cant"

So, that leaves only a couple of options:

- go anyway, uninsured (you personally carry the risk of stuff that might go wrong)

- a person who didn't understand the disclosure questions and all that PDS stuff could buy a travel insurance online - if a claim were not medically related at all, it would likely just be paid out, if it were medical but no relationship whatsoever to cancer (eg, car accident), likely same - the cancer issue would probably go undetected.  But if it were something like food poisoning or whatnot and her medical history came out, the insurer could potentially fold their arms and say "you didn't disclose, this is your problem, we are not financially liable!"

I can't advocate sneaking around the complex and tricky terms & conditions surrounding insurance - but the reality is these companies all sell online, and they allow others to buy the insurance on your behalf, so disclosure mistakes happen all the time.  If they say to your face "no we wont cover you", that is clearly their intent .. but in a large majority of insurance purchases, it's a quick 2 minute online transaction, and the policy is in place, with the insurer on the hook.

But in any scenario, if there were a claim that clearly related to the cancer, there's a high likelihood that it would be challenged, and you'd have to plead ignorance on the duty of disclosure stuff built into these policies.

It's a tricky area of insurance, I think the prevailing view is - dealing with cancer ?  Put your holiday on hold and rest.

BUT ... there's a bucket list aspect to this disease, and personally, if I had spent a massive amount of money for some lovely cruises, I'd find ways that enabled me to take my trip.  (It's a shame if you didnt arrange insurance when slapping down your deposit on the cruises - in which case I'd probably claim and travel in a year or two when things are settled).

Final note:  if you don't get insurance and decide to still go, note that most of these insurance companies will resolve major emergency incidents on contract - basically they're monolithic insurers with big bucks and relationships, and you can ring their emergency assistance arms and say "I'm an aussie stuck in denmark, I don't have insurance but I need to organise an air ambulance and repatriation to australia as cheaply as possible" and they will do that on your behalf (you're on the hook for costs, but those costs can be tremendously mitigated given the networks & experience at play).

Sorry, I can't give you a clear-cut black & white advice, just the ramblings of someone who knows a little about the industry and products.

You need to weigh it all up and form a strategy on this.  In your shoes, I'd find a way to go and take as much joy in the trip as I can (unless her cancer made it non-viable).  Seriously, cancer treatment does give you horrible waves of fatigue.  I'm more than 2 years out and I still get awful depleting waves of fatigue that can shut me down out of nowhere.

[Ridgy]

I have huge issues with this too since being diagnosed with an incurable but treatable cancer two years ago that has caused me no end of subsequent chronic conditions, most recent heart damage added to the mix, so I use my credit card's automatic travel insurance. I can't afford ANY cover (and like you get refused cover) because of my health issues so I decided all I need are my bags and flight delays covered, which is automatic when you buy a flight via a credit card, or your bank has this as an add-on FREE service. I'm with CBA. All I do is click on the link online saying where I'm travelling to and when, and my bags, my flight, even issues unrelated to my health are covered. Sometimes the carrier you fly with will do this to. I guess what I'm saying is I don't disclose current health condition(s).

[Liz728]

Hi David,

In the end the only travel insurance I could get was for non related conditions - so if I fell down stairs and broke my leg, got food poisoning, lost a camera, lost luggage, I'd be covered but if I got any cold or flu etc that could be related to lung cancer the insurers would get out of it by connecting it to an existing condition. It is so difficult and totally unfair.

You actually have to speak to a person, not try and get insurance online as it immediately declines when it is under a year of treatment etc.

After emailing an ombudsmen, I was told to phone the company and explain I wanted travel insurance , that I had existing co ditions and knew I couldn't get cover for them but I wanted basic cover. There are so many loop holes they can and will use to get out of paying too.

Perhaps a letter from the oncologist to say that 3 months after ceasing chemo her immune system will be ok and that she is not travelling against doctors advice.

I'm 10 years post breast cancer and they still won't cover anything to do with that let alone recent lung cancer , thyroid cancer, sepsis, pneumonia , hypothyroidism etc.

apparently, according to the ombudsmen, if you are medically cleared to,travel they cannot deny you insurance for conditions not relating to bowel cancer- ie loss of camera, broken leg etc.

Please keep me updated. I went through Medibank Private in the end.

I wish you luck and send special thoughts to your wife tell her to hang in there and to be kind to herself.

Good luck

Liz

[CaptainAustrali]

"I guess what I'm saying is I don't disclose current health condition(s)"

I want to be careful not to advocate any specific course of action, but note this advice about using credit card cover.  Those credit card insurances are typically not .. great .. as far as terms and limitations go, and .. by not disclosing health conditions, you're technically in breach of your Duty of Disclosure.

BUT .. they provide this 'set and forget' insurance, and it's easy for them to do, and from a business sense part of the cost of that is having to untangle 'tricky' claims where there has been a false / failed / incomplete disclosure.

Anything unrelated to the cancer ?  You claim is most likely going to be completely fine.

Anything that may directly or indirectly be attributed to the cancer ?  You may have some uncomfortable discussions with the insurance company regarding your improper disclosure, and where and how their liability ends.  (And note that even if they outright refuse to be on the hook for the costs of claims, they are still experts in travel/medical emergencies, and can help you limit your costs).

Every day, when people buy insurance, they answer "NO" to that question "Do you have a Pre-Existing Condition ?", and they get their insurance, unaware of the breach in their Duty of Disclosure.  

If you fell into that bucket, you'd have a policy, but if you had a cancer related problem, it would get messy.

So .. don't travel against medical advice, and have enough money in the bank or equity in your mortgage that if something went cataclysmically wrong and it's cancer-related, you can deal with the emergency.  Otherwise, the insurance actually wants you as a customer and wants to cover all those non-cancer claims, it's just a very murky and tricky area for all parties.

[Nickim]

Hi Captain Australia and others - any help would be appreciated please.

My 85 year old mother (in NZ) has been diagnosed with secondary bone cancer (6 weeks ago). No primary yet identified and no proposed treatment plan yet from the oncologist, however she's been told she has months to live, rather than years.  She's stable at the moment and hasn't been hospitalised for this condition at all yet

I'm planning a 2 week trip to Thailand in early June, and there's a small chance I (and my travelling partner) might have to cancel if my mother's condition deterioriates quickly.  

I've looked at a few travel insurance policies, and while there is cover for 'pre-existing conditions' the catch seems to be whether or not hospitalisation/death can be 'foreseen'.  Do you have any advice to offer on this and/or are you aware of any insurers who may not view this eventualaity as as being forseeable?

Thanks very much

Nicki

[CaptainAustrali]

Hey Nicki

If you entered into the insurance BEFORE learning about the cancer, then there may be scope to claim, depending on your policy, but note that most of them have exclusions not just for pre-existing medical conditions, but also for age.

If you enter into insurance now, I can confidently say that every policy in the marketplace will have some kind of clause to avoid the claim scenario you're describing.

Why ?  It's not because insurers are scumbags, they just have to cover the UNFORSEEN.  That's the important word.  Stuff that can't be anticipated.

When you have a loved one who is given months to live, the stance on most of these insurances will be very simple:  don't plan a holiday.  And if you do:  it's at your own risk if you have ro cancel or rush home.  You were planning at an imprudent time, and the event was foreseeable.

The insurances are there to cover unexpected calamity.  Bolt from clear blue sky kind of stuff.  Relatives getting sick or hurt or whatnot is definitely in those scenarios.  But relatives of an advanced age with an aggressive, terminal disease ?  The policy basically apologises, sympathises, but says:  that's something you have to factor into your holiday planning, and be accountable for your choices.

Sorry, it's really black & white on this, mate, I can't give specific advice about any particular insurance, but I can pretty confidently say that ALL of them will be unreceptive to the kind of claims scenario you've described.

[Ridgy]

Hey @CaptainAustrali liked your cancer  shoutout initiative :-). Meantime just wondering whether you can point me in the direction of info to access Super early under TPD claim? Is this easy for cancer patients with unknown prognosis to get their hands on their own money? Is there someone you know that can advise? It takes 6 months to process a claim and you need 2x specialists to sign off on this but most doctors won’t as it negates hope. I expect to be around to get my super but while I feel OK I would like to make use if it. Seems while you are unwell they make it difficult to process. Should be automatic in my humble opinion.

[CaptainAustrali]

Hullo Mate

Travel Insurance and Super are completely different beasts, but I can give a bit of loose advice (as a general citizen who is "just bulls***ttin'", so don't hold me legally liable in any way, etc etc etc

Travel Insurance (like my outfit: www.simplytravelinsurance.com.au, minor plug, heh) basically works heavily (like most insurances) around a concept called "Pre-Existing Medical Conditions.  If you had cancer BEFORE you entered into the insurance, the policy stance is pretty much, "hold on buddy, you knew about that, you dont INSURE against it (like the unknown) you PLAN AROUND IT (and take responsibility yourself)"

(That's how it works in a nutshell)

Super is a different creature, because it's basically Little Johnny Howard forcing everybody to save up and pay for their own retirement, so that this government can navigate away from pensions, social security and become a bit more Americanised.  So yeah, it's YOUR MONEY already.  Principle is, if you're in distress, or your life is shortened, you should be able to access it (the balance point being that someone has to decide how bad the situation is, how much distress you are in, and how likely you are to kick the bucket, so that Little Johnny Howard can still force you to save for your grey years).

My best tip here is to get a lawyer, ideally a free one, do a search for lawyers that help people in distress access their superannuation, make a phone call, check their success rates, and whether they deduct any fees, take an afternoon to really inform yourself and shop around.  I know that might seem kooky, but I'm confident it would dramatically improve your chances of accessing funds, and also segway me into the next point.

The next point being:  MOST SUPER HAS LIFE INSURANCE wound into it.  I think it depends on super provider, your income, not really sure, but I know my super has a life insurance policy that I've been paying on for the past 15 years or so (before I got cancer).  If my cancer fight goes south, I should honourably and lawfully be able to access it to help my family, and one thing I need to do if a doctor ever looks at me soberly and says "Simon, I'm sorry but ...." .. one thing I need to do pretty soon after is have a chat with a lawyer, just like suggested above.

So yeah - in support of the advice, I have a friend who had a stroke a couple of years back which rendered him unable to work, and he just accessed one or both of the above, and was able to pay off his mortgage, releasing a massive amount of financial distress.  It may have been a claim under a benefit that guarantees income, and a lump settlement, it may have been his super, it may have been a permanent disability claim .. getting a lawyer to help wade through that stuff is probably worthwhile.

So yeah, it's about looking at their specialty, past work, and pricing - I'm sure there's free assistance out there, just make sure you're happy with the arrangement before you write your name down on anything ?

(Or ignore my suggestion above and do your own thing.  I'm not afraid to give advice, I just want to make sure that anyone receiving it knows that I'm just an idiot and they really need to kick the tyres themselves and form their own opinions and strategies!)  😉