Learn from this one

[Must...Fly!]

This whole thread is quite worrying, when many of us do expect that our insurance will cover us. The alcohol thing is a worry. If people drink heavily and injure themselves due to it by doing stupid things, I can understand, but what if a couple go out to celebrate their anniversary and share a couple of bottles of bubbles, and being smart people decide to walk home instead of driving. On the way, they are mugged by thugs and one suffers a broken hip whilst being dragged by the handbag straps? In hospital blood samples reveal said person was 0.09 BAC. Does this mean they are not covered for the medical costs? That was a hypothetical but could happen in many areas, even the most safest of destinations

Good question.

Another scenario - what if said drinking/dinner and BAC is still constant, but instead of walking, said couple decides to grab a Taxi or Uber back to their hotel? On the way, an accident where the driver is at fault occurs.

I would presume the fact it was an accident trumps anything else? How do we know the answer? This is a deep hole...

 

[RB]

Good question.

Another scenario - what if said drinking/dinner and BAC is still constant, but instead of walking, said couple decides to grab a Taxi or Uber back to their hotel? On the way, an accident where the driver is at fault occurs.

I would presume the fact it was an accident trumps anything else? How do we know the answer? This is a deep hole...

My post 35 of this thread didn't post as I thought it would (text got tangled up in the reply quote somehow) but it quoted a company Southern Cross who issue 250,000 policies a year yet only invoke the alcohol policy 4 times a year. I don't think it is a deep hole in realty & people are inclined to jump at shadows sometimes

 

[UP4014]

It's a case of buyer beware, insurance is a promise to pay not a guarantee to pay.

Every insurance policy I've read has a get out clause, for the underwriter!

 

[Must...Fly!]

My post 35 of this thread didn't post as I thought it would (text got tangled up in the reply quote somehow) but it quoted a company Southern Cross who issue 250,000 policies a year yet only invoke the alcohol policy 4 times a year. I don't think it is a deep hole in realty & people are inclined to jump at shadows sometimes

Interesting.

But in what circumstances were the four, and why were they refused cover? What if it was excessive alcohol consumption leading to an accident - e.g. driving a moped while so pissed you couldn't talk.

But instead, what if it was excessive alcohol consumption to the point you could barely walk - but then got hit by a tram as you stumbled across the road and lost a leg? Is that also considered unreasonable for cover?

I'm not saying one either is or is not suitable behaviour in a foreign country, or a good/dumb idea, but just curious as I think this discussion is really interesting, and I'm not so sure it's been covered before.

 

[QF WP]

In Australia, the Insurance Contracts Act has a section which means that insurers can only refuse a claim on the basis that you've failed to disclose something, if that something is actually relevant to the claim you want to make. Eg a broken wrist 20 years ago would be completely irrelevant to a claim for appendicitis. But a broken wrist 20 years ago might be relevant if the claim was something to do with the same wrist.

The law for UK insurers is very probably different.

Are you sure it's that narrow? I was under the impression that they can also refuse a claim (or void your policy) if you failed to disclose something that would have increased your premium. For example with your home insurance - if you fail to disclose that you have been burgled 5 times in the past 5 years, you would get a premium that is much lower than it should be. If you then claim and this failure to disclose comes to light, my understanding is that they can refuse the new claim, even if the new claim relates to something completely different (e.g. if the house burnt down).

It's also very hard to be black and white about what medical history is relevant. Ok, breaking your wrist 20 years ago is not likely to be relevant to sudden death at the age of 37. However, serious infections can lead to long term organ damage, which in turn can increase your risk of all sorts of things. As it happens, my wife was hospitalised with a severe infection 2 years ago, and we recently discovered that a number of life insurance companies won't even provide a quote for cover because of that (even though she has thankfully fully recovered). I believe this is especially the case with the mass-market low cost insurers, as the way they keep their costs down is by only covering very low risk people.

Ah yes, there are a number of section in the ICA 1984 that are relevant here:

INSURANCE CONTRACTS ACT 1984

1. Section 13 - utmost good faith
2. Division 1 (Sections 21 to 22) - Insured Duty of Disclosure
3. Division 2 (Sections 23 to 27) - Misrepresentations by Insured
4. Division 3 (Sections 27A to 33) - Remedies for non-disclosure and misrepresentation by Insured
5. Section 46 - Pre-existing defect or imperfection
6. Section 47 - Pre-existing sickness or disability

However Section 54 of the ICA (1984) discloses where an insurer cannot avoid a contract.

There are specific remedies available to the insurer in the event of fraudulent non-disclosure (which is different to innocent non-disclosure), in Section 56. Finally, there are remedies (Sections 58 to 63) for cancellation of contracts.

Some light bedtime reading - it's been a couple of years since I have read them in total.

 

[QF WP]

My post 35 of this thread didn't post as I thought it would (text got tangled up in the reply quote somehow) but it quoted a company Southern Cross who issue 250,000 policies a year yet only invoke the alcohol policy 4 times a year. I don't think it is a deep hole in realty & people are inclined to jump at shadows sometimes

Fixed post #35 for you.

 

[Jack_OC]

My post 35 of this thread didn't post as I thought it would (text got tangled up in the reply quote somehow) but it quoted a company Southern Cross who issue 250,000 policies a year yet only invoke the alcohol policy 4 times a year. I don't think it is a deep hole in realty & people are inclined to jump at shadows sometimes

It's not 4 out 250,000 claims though. The vast majority of people with travel insurance will never claim, so the 4 out of 250,000 statistic is a bit misleading. Also, a lot of travel insurance claims are for things like delays/cancellations, lost baggage, theft from hotel rooms etc. Most of those events have nothing to do with the policy holder, so whether or not they have consumed alcohol is unlikely to be relevant.

It is comforting that only 4 per year are rejected due to alcohol consumption, but I'd be interested to know the following: how many claims do they receive for medical cover, how many do they reject in total, and of those, how many are rejected due to alcohol consumption? If we knew all of that, we'd have a better idea of how much of an issue this is.

 

[Mogul]

Also good to keep in mind that the Australian Government has reciprical rights for emergency care of Aussies abroad in certain countries.

Reciprocal Health Care Agreements - Australian Government Department of Human Services

 

[Jack_OC]

Here are a few interesting articles on this subject. The first two are from the UK, while the third is from Aus. All of them create the impression that this is indeed something that we should be concerned about. However, it seems that if a claim is denied for this reason (or indeed any reason that you don't agree with), it is very much worth fighting your corner, as apparently the Financial Ombudsman Service in both the UK and Australia has upheld complaints against insurers in relation to this issue.

Travel insurers won't pay if claimants are drunk, warns watchdog: exactly how much CAN you drink on holiday?

issue 120, case studies: alcohol exclusions

Travel insurance alcohol exclusions - Travel - CHOICE

 

[Jack_OC]

Also good to keep in mind that the Australian Government has reciprical rights for emergency care of Aussies abroad in certain countries.

Reciprocal Health Care Agreements - Australian Government Department of Human Services

That's a great point - although sadly it's a very limited list of countries.

On a related note, anyone entitled to a passport from an EU member state should get one (and a lot of Aussies are). The reason is, EU countries must treat citizens of other EU member states in the same way as they treat their own citizens. So, for example, because I have an Irish passport, I'm covered like a local throughout all 28 EU member states, and even some non-members like Norway. This doesn't necessarily mean healthcare is free, but most treatments will cost very little - kind of like being covered by Medicare in Australia.

However, here's another factor to worry about: even if your holiday is to a country where you have access to low cost healthcare (e.g. Europe), you will probably have to stop somewhere along the way where that is not the case. Furthermore, if you become seriously ill while on a flight, the captain might decide to land at the nearest suitable airport to get you treatment. That could mean you end up in hospital in a country that you had never intended to set foot in! Not very likely, I know, but it does happen.

 

[Anna]

However Section 54 of the ICA (1984) discloses where an insurer cannot avoid a contract.

Section 54 is about when an insurer can refuse to pay a claim. That's why its heading is "Insurer may not refuse to pay claims in certain circumstances"

In this thread there is general confusion about 3 entirely separate concepts -

1. the insurer's decision whether or not to accept a risk and issue an insurance contract for that risk
2. an insurer trying to avoid an insurance contract (avoid = annul in legal speak, it does not mean evade/dodge/refuse a claim)
3. an insurer trying to refuse to pay a claim.

 

[Junes]

Perhaps this article is a bit more factual-
Egyptian hospital denies turning off life-support for UK tourist after £7,000 medical bill - Egypt Independent

Ah. That makes some sense, thanks RB. Daily Mail report - let’s all stop reading now.

 

[k_sheep]

... The end of the story being I was notified to the Heath Department as Diphtheria is a notifiable infectious disease, however I did not contract it (I had been vaccinated for it). So does that mean I now have to notify a travel insurer that I've had Diphtheria?

Off topic, but the good news is you haven't had diptheria .... diptheria means you had a toxigenic strain of a bacterium called Corynebacterium diphtheriae which can affect the skin, but the dangerous one is when it is in the upper airways. If you were vaccinated even once the chance of you getting a toxigenic infection are basically nil (unless immunosuppressed).

What we are now finding is that the majority of the population have Corynebacterium diphtheriae living on the skin, not causing any problem (like countless other bacteria that make up our normal flora). It's just the identification methods are advanced now, such that it can be detected much easier. We're still trying to figure out how much we should actually report it when we detect it, or if we lump it into the category of "normal skin flora".

Today's mini-microbiology lesson ....

 

[Deleted member 29185]

We're still trying to figure out how much we should actually report it when we detect it, or if we lump it into the category of "normal skin flora".

Today's mini-microbiology lesson ....

Many thanks. That's a far better explanation than my Doc gave me. So I haven't had it and therefore no need to notify a future insurer of it. As an adjunct, +1 also got the same thing. Positive on a swab of a mozzie bite infection, but didn't progress. I don't think she has ever been vaccinated for it as she became very sick as a baby following vaccinations and both her mother and now her are totally against any vaccinations (except the ones she must have for her work).

 

[k_sheep]

Many thanks. That's a far better explanation than my Doc gave me. .

Your average doctor won't know much about it - the newest technology to identify specific bacteria (MALDI-TOF) has only been around in diagnostic work for a couple of years, and still only in the bigger labs! So it'll take a while to filter through to all the medical specialties.

Made me think I really should read about what is considered a pre-existing condition on my insurance! I've broken rather a lot of bones etc, would never occur to me any of that would be a problem.

 

[Pushka]

Your average doctor won't know much about it - the newest technology to identify specific bacteria (MALDI-TOF) has only been around in diagnostic work for a couple of years, and still only in the bigger labs! So it'll take a while to filter through to all the medical specialties.

Made me think I really should read about what is considered a pre-existing condition on my insurance! I've broken rather a lot of bones etc, would never occur to me any of that would be a problem.

I agree. But even being prudent I’m not sure you can think of everything.

 

[Rnwillia]

There's more to this than meets the eye and pre-existing conditions may have been a big factor - in any case it is scary that a hospital would just turn off life support equipment without notice. I think I would have rung the Australian Embassy urgently if I was involved in such a situation.

 

[Rnwillia]

How dreadful. I’m just wondering why the Insurance company felt that alcohol was the contributing factor and if a blood test was taken, at what level he was for them to decide that. Given they were biking it just doesn’t sound right.

There's more to this than meets the eye and pre-existing conditions may have been a big factor - in any case it is scary that a hospital would just turn off life support equipment without notice. I think I would have rung the Australian Embassy urgently if I was involved in such a situation.