Why doesn’t travel insurance cover dad’s illness?

When Jessica Kamzik’s father was diagnosed with stomach cancer last summer, there was no question about what she had to do. Dad’s prognosis was “grave” — the doctors said he probably wouldn’t make it to the holidays — and, “as any loving daughter would do, I immediately cancelled our vacation to stay closer to him,” she says.

Good thing she had travel insurance through Access America, she thought. At least she wouldn’t have to worry about losing the cost of her trip.

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But she thought wrong.

Kamzik make a claim on her policy, confident that it would help her recover the $1,400 she’d spent on her vacation. After all, her travel insurance covered the “illness of a family member” and specifically one that “is considered life threatening or requiring hospitalization” — which is what her father’s illness was.

But Access America didn’t see it that way.

She explains,

They refused to pay based on what they say is a “pre-existing” condition. They made this claim based on a doctor’s note that was first sent in, which stated that my father had symptoms two months prior to when he was diagnosed.

Their insurance policy says that if the client had symptoms 120 days prior to when the policy was bought (July 19th 2011), the refund was void.

Now, I understood this, so asked for verification from his doctor. His doctor sent in all the notes, explicitly stating that my father was very healthy prior to his cancer, and that any symptoms he had were not necessarily related to cancer.

Yet, the travel insurance company still refuses to refund our money.

As I reviewed her case and examined the fine print in her contract, I thought Access America was taking a very narrow view of what constituted a “pre-existing” condition. Had her father been diagnosed with cancer, or had his doctor’s suspected he had cancer and were in the process of testing him for it when she bought the policy, then they’d have a valid reason for denying her claim.

But stomach pain? I get that whenever I eat grandma’s spaghetti (but it’s a good kind of pain). Is my travel insurance going to deny a claim because I had a little heartburn? I thought this was worth bringing to Access America’s attention. Maybe one of its adjusters had failed to see the big picture.

Access America reviewed its decision. Here’s what it had to say:

We are very sorry that Ms. Kamzik’s father is ill and we wish him and his family the best. We had our claims department investigate the status of Ms. Kamzik’s claim.

The travel insurance policy that Ms. Kamzik purchased excludes claims for existing medical conditions. Existing medical conditions are defined as any illness occurring to a family member during the 120 days prior to and including the effective date of the purchased insurance for which: a) medical diagnosis or treatment by a Physician has been sought or advised or for which symptoms exist, which would cause a prudent person to seek diagnosis, care or treatment.

A review of Ms. Kamzik’s father’s physician’s notes from July 28 indicate that he had constant stomach pain for the past one and a half months. As these symptoms of illness occurred within 120 days of Ms. Kamzik’s purchase of her travel insurance policy, any subsequent claim based on a stomach illness or condition would be excluded from coverage.

I’m very sorry that we could not cover Ms. Kamzik in this situation, but we do wish her the best in her future travels.

That’s really too bad. I asked Kamzik for her reaction.

That’s disappointing. I will continue to fight this, however, because I believe that Access America will do everything they can to scam buyers out of their money.

They already gave me this answer (multiple times), so I went back to each of my father’s doctors and had them confirm that my father’s symptoms were not related to his current condition (a terminal illness). Even with both doctors backing me up, Access America refuses to do the right thing.

I’m moving Kamzik’s case into my “dismissed” file, but I’m not happy, either. Too many travelers are getting snagged by what seems to be a strict interpretation of the pre-existing conditions clause. It’s definitely something to be aware of the next time you buy travel insurance.

(Photo: Free and happy/Flickr)