Travel Insurance Lawsuit Highlights Issue Of Pre-Existing Conditions

As travel agents become more engaged in helping their clients purchase travel insurance, it's especially important that they remind clients with pre-existing conditions to seek their physicians' approval to travel and obtain waivers if that's prudent.

This summer, a Vancouver man finally resolved a six-year dispute over $180,000 in medical expenses that resulted from an emergency surgery in the United States as he was headed home from a Mexico vacation.

British Columbia Supreme Court Justice Jacqueline Dorgan found that before departure, Paul Fletcher had "prudently" consulted his doctors about his health; they determined that his condition was "stable" and believed his trip "would not pose any increased risks to his health," thus meeting his travel insurance company's policy requirements.

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Fletcher traveled from his home in Victoria, BC, to Mexico in March 2011. He was being treated for issues related to his heart and had consulted with his doctors about his condition prior to the trip. His doctors approved the trip, and he purchased travel insurance through Royal & Sun Alliance Insurance Company.

Three days into his trip, Fletcher began to experience chest pains that weren't going away, even with the nitroglycerine tablets he had brought, so he cut his trip short. His symptoms worsened on the flight home, and at a scheduled stop in Seattle, he was taken by ambulance to a Seattle hospital. There he was diagnosed with severe coronary artery disease and transferred to the intensive care unit at Seattle's Swedish Medical Center for emergency bypass surgery. 

Royal & Sun Alliance denied payment based on an exclusionary clause in Fletcher's policy that allowed the insurer to claim Fletcher suffered from an unstable pre-existing condition, and that there was a reasonable expectation he would need treatment or hospitalization during the trip.

Travel insurance companies have the right to look back into a traveler's medical history up to the defined period of time stated in their policy to determine whether an incident is related to a pre-existing condition. Most consider a pre-existing condition to be a diagnosed illness or medical concern that has not been "stable" within a defined period (typically 60-180 days) prior to the consumer purchasing insurance.

Generally, "stable" means the condition has not changed or worsened in any way; no new diagnoses, treatments, medications were prescribed; and no pending or initiated treatments, scans or test results were planned, says an InsureMyTrip web-based primer for U.S. travelers.

Royal & Sun Alliance attempted to introduce an opinion from its own medical expert as evidence, but the judge rejected it on the grounds that he was not the treating physician.

InsureMyTrip tries to advise travelers in advance of how to protect themselves from situations like the one Fletcher faced. On a page offering guidance for U.S.-based travelers, the company says: "To make sure that you've done everything you can to protect yourself and your trip, do your research; be up-front with your insurance company about any conditions you think might apply; purchase your travel insurance policy as soon after paying your initial trip deposit as possible; and familiarize yourself with all the details of your policy before you depart."

Most companies stipulate that you must buy your travel insurance policy within 10-14 days of making your initial deposit on your trip in order to be eligible for the pre-existing conditions waiver, so benefits will be paid without looking into the traveler's medical background if a claim is made. In some cases, waivers require no additional paperwork and no additional fees, but in others a fee will apply.