Joanne Parr, 67, of North Bay, Ontario had her travel medical expenses claim denied by an insurance policy based on their infamous ‘one strike’ policy.
"I would have sworn on my life that I filled everything out correctly. With my sight, I check everything I do three or four times,” said Parr, who is legally blind and used a magnifying glass to fill out her form. “It makes no sense to answer something incorrectly. Why even pay the premium? You are just throwing money out the window,” she said.
The insurance company found the discrepancy later, after having accepted all the premiums, by digging through the claimant's Canadian medical records, after the bills were submitted.
In Parr’s case, she misunderstood a date requirement when she filled out the form for insurance with Royal and SunAlliance, sold online as Southbound Travel Insurance. She was asked if she’d been treated for heart problems in the 12 months prior to applying for insurance in August 2011. She answered no, even though she’d been to hospital with chest pains the previous October.
Parr and her husband Chuck weren’t leaving for Florida until December 2011. She said she thought the question applied to the 12 months prior to that date, because that is the benchmark she’s accustomed to from other insurance policies. “My mind was thinking departure date, because that is when I was paying my premium from,” said Parr.
Parr was treated in Florida for kidney failure, which she’s never had before and was not remotely related to any past medical issues. “The insurance company went back seven or eight years [scanning medical records] trying to find something wrong with my kidneys but they had no luck,” she said. So instead they used the chest pains as their excuse.
Royal and Sun Alliance refused to comment on Parr’s claim and appeal, although she was willing to give permission for the company to speak about her case. Parr's bill is approximately $128,000.
“The deck is stacked in the insurance company’s favour,” said Ottawa independent insurance broker Bruce Cappon, who said he’s seen several claims by seniors denied because of what he calls the "one strike you are out" clause. "Coupled with the complicated medical questionnaire, it seems like the snowbird is often having a stick of dynamite in one hand and a lit match in the other. It’s a very volatile situation."
He suggests senior travellers be wary of policies with the one strike you are out clause, and the “open barn door” clause, where unreported changes in health status between application and departure can result in cancellation of a policy. He also warned about policies that don’t cover pre-existing conditions.
We have another kind of suggestion but won’t express it here.
