Case dismissed: “The insurance will not cover our tickets”

Beware of the pre-existing medical conditions clause in your travel insurance policy!

Oh alright, maybe that’s a little dramatic. But could you at least pay attention to it?

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I mention this because of Ingrid Murray, whose claim against Access America recently crossed my desk and then made its way into the “dismissed” file.

She’d planned a trip to Italy this fall with a companion, who fell ill just before they were about to leave. Good thing she’s taken out a travel insurance policy.

She explains,

At the end of June, [my companion] went to a specialist for her hip. The doctor said she needed surgery and to cancel this trip.

I submitted my claim, but Access is stating due to some pain she had been having in her hip prior to the trip that this is considered a pre-existing condition and the insurance will not cover our tickets.

She appealed the decision to an Access America executive, but was denied again.

Next, she appealed to Orbitz, which had sold her the policy. It said she could get flight credit, as long as she paid a $250 change fee (standard answer). She asked her airline, Air Canada, for help, and it referred her back to Orbitz.

So she asked me to investigate.

I would like to know if you think there is another way to come at this. I don’t know how Access can say it is a pre-existing condition, this is a BIG loophole in their insurance which gives them an ‘out’ in almost any situation.

I agree, the pre-existing medical conditions clause is troublesome. And there’s a way to avoid it by purchasing a more expensive “cancel for any reason” policy — but that’s beside the point.

As always, the devil is in the details. If Murray’s companion developed a medical condition after purchasing insurance, then I thought Access America should reconsider its decision. So I contacted the company on her behalf.

Here’s what it said:

We are very sorry that Ms. Murray felt that she needed to cancel her trip due to the illness of a traveling companion. We understand how frustrating it can be to have to cancel a trip you’ve been looking forward to and we sympathize with Ms. Murray’s situation.

According to Ms. Murray’s traveling companion’s orthopedic surgeon, her traveling companion had been in pain for the last two years and had “gotten progressively worse over the last six months.”

The doctor indicated that symptoms began approximately 2/1/11. As Ms. Murray’s travel insurance policy was purchased on 5/11/11, the onset of her traveling companion’s symptoms fall within the exclusionary period of 120 days prior to and including the date the insurance was purchased.

The medical records show that the condition would be considered an existing medical condition and any claim related to that condition would be excluded from coverage.

In Ms. Murray’s travel insurance policy, an existing medical condition is defined as an illness or injury that you, a traveling companion or family member were seeking or receiving treatment for or had symptoms of, on the day you purchased your plan, or at any time in the 120 days before you purchased it.

We’re very sorry that we were unable to cover Ms. Murray in this circumstance, but we wish her well in her future travels.

That’s too bad.

I’ve written about pre-existing medical conditions on numerous occasions, and while I agree with Murray that they can be used as a blanket excuse for denying a claim, her particular case had gone through numerous levels of appeal. There’s nothing more that could be done.

Could Orbitz, the online agency that sold her the policy, have done a better job of explaining the limits of her policy? Maybe.

But this trip, unfortunately, won’t be covered by her travel insurance.