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By David Bertschi
Dec. 12, 2019

More than peace of mind: Travel and Medical Insurance, is an essential purchase for anyone travelling out of province.

On Dec. 2, 2019, the Toronto Star, reported that slightly more than 1/3 of Canadian travellers were “not likely” to purchase travel and medical insurance. To make matters worse, 40% of our citizens do not understand the disastrous costs they could be subjected to if they get sick or injured without appropriate out of province medical coverage. The Dec. 9 volcanic eruption in New Zealand which killed at least five vacationers, while on an offshore excursion from a cruise line highlights how one should always prepare for the worst but hope for the best.

As a trial lawyer who has practiced for over 34 years in litigating insurance cases, I cannot overstate the importance of obtaining appropriate medical and travel insurance when Canadians travel for business or pleasure regardless of their mode of transportation.

Annually, thousands of Canadians have their trips interrupted by accidents or illnesses which require them to seek medical intervention and/or hospitalization. Without appropriate travel and medical insurance their lives and savings became fraught with anxiety over mounting and medical legal bills in the hundreds of thousands of dollars.

While a few recent articles have touched upon the Ontario government’s recent decision, to cancel OHIP’s small subsidy to Ontario’s taxpayers requiring emergency medical services outside of Canada, the current available subsidy is really a drop in the bucket.

Part of the problem is that the majority of Canadians are too busy or not interested in obtaining Travel and Medical insurance. For those who do obtain insurance, the majority ignore the contents of their policy once it is issued by the insurer. The consequences of not taking one’s time to secure the appropriate policy for their needs or to ensure that the terms of the policy will cover them notwithstanding their past medical history, could expose them to significant financial liability and expenses putting them a stone’s throw away, in many cases, from bankruptcy.

Suffice it to say, such cases inevitably lead to costly litigation.

Canadian jurisprudence is replete with cases in which people in good faith, completed their application for travel and medical insurance, but they either misunderstood the coverage they were purchasing or what was excluded from coverage or they didn’t realize that they had to update the insurer on their health status if it changed before they actually embarked on their trip. Either way, the consequences of being faced with a lawsuit from a US medical service provider on the one hand, and on the other, a lawsuit against the broker and an insurer will prove costly, time-consuming and extremely stressful for the traveller and/or their family.

To avoid putting a family’s financial health at risk, I will briefly highlight some of the key issues that the travelling public should carefully review in their issued policies of insurance. I will then outline in this article how they can avoid common pitfalls.

Unlike the standard automobile insurance policy in Ontario [OPCF 1] medical and health insurance policies are not standardized. In fact, Medical and Travel Insurance policies are constantly evolving as insurance underwriters attempt to plug perceived loopholes in their policies as they are decided by the judiciary.

The following must be carefully examined by the purchaser of insurance:

1. Travel and Medical policies provide coverage up to a specified amount for the traveller, if they develop an illness or medical condition which occurs while they are travelling that is sudden or unexpected.

2. The treatment must be reasonable and medically necessary.

3. The policy must start on the day of departure and end on the return date in the traveller’s province.

4. Like most insurance policies, there are a myriad of exclusions of coverage which should be carefully reviewed by the traveller. Such exclusions include but are not limited to:

a. If the traveller had a pre-existing medical condition or illness which was not stable in the 90 or 120 days before departure;

b. Medication for a health condition or illness increased, decreased, changed or intensified in the requisite time period;

c. Treatment for the condition had been received in the requisite timeframe before departure;

d. Treatment had been recommended but not undertaken within the requisite timeframe;

e. Travellers have an obligation after receiving their policies to notify the insurer of any change in their health condition including but not limited to medication, hospitalization and certain services;

f. The service claimed is not emergent;

g. The pregnant traveller’s due date is nine weeks or less before her delivery date;

h. The pregnant traveller is travelling after her delivery date;

i. Various sports exclusions are routinely included such as parachuting, skydiving, bungee jumping, rodeo, Heli skiing etc.;

j. the traveller and/or members of their family are advised not to travel by a physician;

k. A government of Canada travel advisory or formal notice is issued before the travellers’ departure time or, if one is issued after their departure there coverage is limited to the following 10 days.

Unfortunately, there are too many exceptions and coverage subtleties to discuss in detail in this article. In light of the above, employers and travellers should always shop around for a policy which best suits their needs and risk profile, given the travellers’ age, and financial wherewithal.

As the case in any insurance policy, travellers must answer all questions asked of them whether verbal or in an application, in an honest and forthright manner.

Once the travel insurance policy is issued and the requisite premium is paid in full, the traveller should always look at the policy to make sure that they understand what they received and whether the information which they previously gave to their insurance company is still accurate. A duty to ensure information remains accurate is owing right up to their date of departure.

As is the case with insurance matters, “An ounce of prevention is worth a pound of cure”.

The purpose of this article is to highlight areas of concern which Canadians should consider when travelling out of province whether for business or pleasure.

This article is not meant to provide legal advice. If you have questions regarding coverage you are encouraged to seek legal advice relating to your specific policy and circumstances.

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