Travel insurance policy claim denied for vaccine cancellation

Richard Effress though he had a perfectly legitimate reason for canceling part of his trip to Africa with his mother: a new requirement that travelers entering South Africa needed a yellow fever vaccine. He was certain his travel insurance policy would cover the change.

Maybe he shouldn’t have been so certain.

Today’s “case dismissed” file is a sad lesson in making assumptions about a travel insurance policy that you shouldn’t. It is also a reminder to compare travel insurance. The fine print in your contract, it turns out, can cost you lots of money.

Let me hand the mike over to Effress to tell his travel insurance tale.

This past summer, my family went to Africa for a safari to celebrate my mother’s 70th birthday. The trip was quite expensive for the six of us and we purchased a comprehensive travel insurance policy called the Worldwide Trip Protector Plan from Travel Insured International.

The policy totaled $6,142 for all of us, and included pre-existing medical conditions as well as trip cancellation, delay and interruption.

On June 16, 2011, five days prior to our June 22 departure, we received notice from our travel agent that the yellow fever vaccine was now required of passengers entering South Africa who previously visited Zambia. As our trip included a stop in Livingstone, Zambia (near Victoria Falls), our travel agent advised us we needed the vaccine and related immunization certificate or risked not being allowed entry into South Africa.

We initially flew from the U.S. to South Africa, but then planned to travel on to Zambia and Botswana before re-entering the country for our final stop in Cape Town.

Due to my mother’s prior experience with shingles, her primary care physician, specialist and her travel doctor all informed her that she could not have certain immunizations prior to the trip, including live viruses such as yellow fever, due to the risks that with her weakened immune system she could actually catch the disease.

As such, we re-routed the trip for two of the six people in our party (my mother Jane Effress as well as her companion Harvey) to Zimbabwe for the two days we would otherwise be in Zambia. This allowed them to see Victoria Falls, albeit not with the rest of our group.

That made perfect sense. You don’t want Mom to succumb to yellow fever, a painful viral infection that could kill her.

Effress’ travel agent made the rebooking at a cost of $1,332, which included airfare, hotel and ground charges. Then Effress submitted a claim to Travel Insured International.

I would have imagined that such a necessary change would be covered under a gold-plated travel insurance policy that cost $6,142. Not so.

Effress reports,

Travel Insured denied the claim on the basis that Jane’s doctor “did not certify your illness at the point when you cancelled/interrupted your trip.

Proof of medical is required for cancellation at the point of interruption. A Physician did not advise cancellation nor certify the illness at the time of loss that prevented you from continuing your trip. Unfortunately, no benefits are payable.

Here’s the chapter and verse in her policy they invoked in a subsequent rejection letter. The World Wide Trip Protector Plan Description of Coverage under Part A says,

Trip Interruption: A) Sickness, Accidental Injury, or death of You, Your Traveling Companion, etc which results in medically imposed restrictions as certified by a Physician at the time of loss, preventing your continued participation in the Trip. A physician must advise cancellation/interruption of the trip.

Trip Insured notes,

It is my understanding that you had to re-route your trip due to not having the Yellow Fever vaccination prior to traveling. Based on the information in your file, your doctor indicates on the Attending Physician Statement form that he did not certify your illness at the point when you cancelled/interrupted your trip. Proof of medical is required for cancellations at the point of interruption. A Physician did not advise cancellation nor certify the illness at the time of loss that prevented you from continuing your trip.

Effress tried to get a doctor to help with the claim, but was turned down.

“I think the insurance company’s position is nonsense,” he says.

I’m inclined to agree, so I contacted Travel Insured on his behalf. This time I heard back from the company’s general counsel.

It is unfortunate that Ms. Effress and Mr. Lambert were precluded from visiting Zambia because she did not receive a yellow fever vaccination.

It is our understanding that all guests entering or transiting through Zambia were required to have a yellow fever vaccination prior to travel and Ms. Effress’s physician stated that the vaccination was not administered, as it was medically contraindicated for personal health reasons.

Their Worldwide Trip Protector plan provides coverage for trips that are cancelled or interrupted due to events specified in the plan. Non compliance with a vaccination requirement is not a covered event.

I understand Effress frustration with his travel insurance policy. The family paid more than six grand for insurance that didn’t cover then.

But the blame for this failure doesn’t just fall to Travel Insured for failing to see the big pictures. Always compare travel insurance offerings before you make a buying decision. Effress should have read his travel insurance policy carefully. And his travel agent should have given the policy a second read prior to making his claim.

I hate having the tell readers that they’re out of options, but I’ve taken this as far as I can. An appeal to a state insurance commissioner and a trip to small claims court would almost certainly not be worth Effress’ time. And besides, a contract is a contract.

It just doesn’t seem fair to him.

(Photo of Cape Town, South Africa by Gurney 5/Flickr)

  • Michael K

    No, that’s not so clear.  In fact, the insurer’s general counsel suggests otherwise:

    Ms. Effress’s physician stated that the vaccination was not administered, as it was medically contraindicated for personal health reasons.

    When they write:

    A Physician did not advise cancellation nor certify the illness at the time of loss

    It’s not at all clear whether the objection is in regards to the timing of the physician’s actions relative to the itinerary changes, or in regards to the timing of the illness onset (a pre-existing condition issue?) or in regards to the physician’s actions alone (and if so, precisely how did the physician’s actions fall short of their requirements?).

  • pizo

    I booked through BaseCamp and we could not have been more pleased with how things went.  It was beyond anything we could have hoped for.  Our guide was named Sos and our cook Zulu.  I wrote a long “how our trip went” on the Tanzania forum on TripAdvisor and on LonelyPlanet.com. 

  • pizo

    Even with backpacking and whatnot $50 per person per day is awfully cheap, incredibly cheap when you consider the price of gas and the entry fees into national parks.  in Tanzania it’s $50 a day per person just to be in a national park. 

  • pizo

    Having an immune system that can be compromised by a live virus jab does NOT equal weak and elderly.  My mom didn’t get the Yellow Fever jab either due to health issues although thankfully they didn’t check when we got to Zanzibar (where it is required).  My mom is currently on a week long ocean kayaking trip, she’s hardly “weak”. 

  • Anonymous

    That was not the case at all, see post below from Mr. Effress below.  The fact that many misinterpreted what happened here again is an indication of a vaguely worded insurance policy which really can not be interpreted by a layman. 

    As for asking someone to clarify what the policy says, try to get that “clarfication” in writing.  Won’t happen in our lifetimes.  Insurance companies do not clarify in writing what they have carefully and “artfully” worded in the policy.  Generally they say they are not allowed to by their counsel.  Insurance agents and other bystanders have no authority to clarify anything on behalf of an insurance company.  Only an company officer can do that when it is put in writing.

  • Judith

    I was recently in Zambia and returned to South Africa to fly home, but prior to leaving home I knew of the vaccination requirement.  My HMO, along with the CDC, recommends that individuals over 60 not get the yellow fever vaccination because of the high risk of side effects, which can include organ damage.  I emailed the South African Consulate in Los Angeles and they replied that if I had a doctor’s letter advising against the vaccination I could enter South Africa without it.  I obtained the letter and carried it and a copy of the Consulate’s email and provided both, when asked about my vaccination, to the airline checking me in at Livingstone.  The clerk made a photo copy of both, and checked me in and everything went fine.  US residents should be aware of this.  I’m hoping it will also work when I go to Brazil next year!   

  • Sadie Cee

    Good for you Joelw!!! 

    I clicked “Like” but would have clicked “Love” if there were such an option.  :-)

  • Tony A.

    The irony is the WHO ITH removed Zambia from the Annex 1 list (Countries with risk of yellow fever transmission and 
    countries requiring yellow fever vaccination) for 2011. Zambia is now a low risk country. However South Africa does not agree and told the WHO that they would require Vaccination certificates from travelers.

    South Africa – Revised requirements for Yellow Fever vaccination21 SEPTEMBER 2011 - The National Department of Health from the Republic of South Africa informed WHO that it considered that travellers from countries with low risk of yellow fever transmission still pose a risk of yellow fever importation into the country and that proof of yellow fever vaccination will be required from all travellers (unless in possession of a valid waiver certificate) coming from yellow fever risk countries – including Sao Tome and Principe, Somalia, the United Republic of Tanzania and Zambia. Also, all travellers transiting airports in these countries will have to show proof of yellow fever vaccination at entry in the Republic of South Africa.The South African yellow fever vaccination policy for travellers can be consulted on the National Department of Health website.http://www.doh.gov.za/docs/policy/2011/draft_yellowfever.pdf
    According to RSA Health Department the requirement only started OCTOBER 1, 2011. Check link above.If this information is correct then when the Effresses started their trip on 22JUN, they still didn’t need an ICVP certificate. Again I will push back to the travel agent. Did they get accurate information?

  • Master Bator

    Well it comes down to what is ‘preexisting’ – honestly I don’t blame the doctor for not writing a not if he isn’t sure, given the amount of scrutiny that such letters get.

  • sdir

    Well, he’s a lousy doctor only if he did indeed tell the family prior to their cancellation.  If they cancelled the trip, and only then contacted the doctor, then they did things in the wrong order.  Sucky situation for the family regardless, but that’s how I read it.

  • flutiefan

    why not? it’s a description, not an insult. i’d call a 3 year old “young”, i’d call a 13 year old “young”, and i’d probably call a 23 year old “young”. would that be insulting?

  • http://pulse.yahoo.com/_SYR4YYOAPY4X3UUYLPCADARF3Q emanon256

    I don’t know anything other than what I stated.  She offered it to us, and said it was a policy where would could make any change at any time with no catch.  We didn’t have to file any claims; we could just make any and all changes to anything. I was not through any sort of insurance provider, but through her as our agent.

  • http://profiles.google.com/saucywench S E Tammela

    “Being unable” is not “non-compliance”.

    For the amount of money involved, I’d seek legal advice.

  • Anonymous

    It is a telling that this is the only example provided. This isn’t an example of a travel insurance company going above what is expected, but of a travel agent who took it upon herself to provide something of real value.  That is a sad commentary on the state of the travel insurance industry.  I had hoped to see someone write a story that would cause me to change my mind.  Instead, crickets….

  • Clare

    Okay, so if the OP’s mother had gotten the vaccination against her doctor’s instructions, and got seriously ill while on the vacation, would the insurance company have covered hospital and medivac costs, etc.? 

    And would they have covered them for the whole family, or only covered them for the patient, and expected the rest of the family to continue to enjoy themselves on vacation while Mom was flown back to a US hospital all alone? 

    And if Mom ended up dying of the disease, and it was established that she had caught it from the vaccination, which she had to get if she was to take the trip as originally planned, then the insurance company obviously would have concluded that it was none of THEIR business, right? 

    What’s the name of this insurance company again?  Let’s all write it down, shall we? 

  • Tony A.

    You forgot one more – if she was actually QUARANTINED, it would be an INTERRUPTION that most travel insurance would pay for.

    While most of what you are saying may be true, it is important to understand how travel insurance works. What will it pay for?
    These are things one cannot just assume. They must read the policy to make informed decisions. (If you cannot understand the policy then WHY BUY INSURANCE?)

    The same is true for South Africa’s travel health policies. The OP said he received an email from their tour agency sometime in June, 5 days before they departed the USA. Well, did they bother to check the official circular that the Republic of South Africa’s Health Department put out? Or did they take the agent’s word as fact?

    I posted the announcement from the World Health Organization’s (WHO) International Travel and Health Dept (ITH). This is the agency that coordinates vaccination requirements of international countries. They (ITH) posted the letter coming from RSA’s Health Dept. saying the effective 1OCT 2011, RSA would require Vaccination Certificates from travelers coming from Zambia. Isn’t this evidence a hell of a lot clearer than an email from a travel agency/tour operator? What is the agency’s source of information? Validate it.

    And then there is the doctor who said OP’s mom is not healthy enough to get the YF vaccine. So why didn’t he download the vaccination waiver form from the US CDC and sign it. She could have avoided the perceived problems in the first place. RSA clearly states that they will accept health waivers.

    Here’s what I cannot understand – so many travelers can go online search fares, tours, things to do, restaurants, and whatever. But when it comes to reading travel insurance policies online, the US CDC information online, or googling “South Africa Health Department”, they seem to get brain freeze.

    You really cannot replace KNOWLEDGE by buying INSURANCE.  When people buy expensive or exotic trips, they need to plan a lot better. A complaint to Elliott wont help either. Sorry but taking a trip to the wild side ain’t a trip to the park.

    PS. I’ve actually had one of this Yellow Fever Vaccinations for a trip to South America. First, you just can’t schlep to your Primary Care Physician and get one. He doesn’t stock it on in his fridge. You’ll need to located a Travel Vaccination Clinic. Sanofi Pasteur is the maker of this vaccine (YF-VAX®) and they have a website that helps you locate their outlets: http://www.travelersvaccines.com/en/Clinics/Clinic_Locator.cfm
    The CDC also has a clinic locator:
    http://wwwnc.cdc.gov/travel/yellow-fever-vaccination-clinics/search.htm
    Note: the challenge is finding the center that has it in stock. Usually you need to make an appointment and make sure they have the vaccine and the all important CARD (the certificate itself that you need to show when you enter the country). BTW, it ain’t cheap. Budget $100++ (some will charge a consultation fee extra).

    Second, the vaccine is suppose to protect YOU from getting sick if you get bit by an infected mosquito. It takes at least 10 days for your body to create enough antibodies (as a reaction to this live but attenuated antigen). So you must get the injection at least 10 days before you enter the foreign country requiring the immunization.

  • http://pulse.yahoo.com/_HMW3OTJSBDWWRKIEKEKWWM7BEA bc

    Thanks! I will check it out!

  • Joelw

    Was there any kind of documentation or was this just a verbal promise?

  • Joelw

    If it’s a description then it’s an inaccurate one and yes, some people aged 70 would take it as an insult.

  • Caitlin

    I had to claim on insurance when I was hit by a car in Germany as a high school exchange student. It covered the ambulance and assiciated bills ( I was fine), the driver’s expenses (it was my fault), and replacement of the destroyed bicycle I was riding. There was not a problem.

    My father dropped his video camera in a canal in Venice. His travel insurance company replaced it. There was not a problem.

    I guess most Americans who can afford to travel have health insurance that covers them for most travel. For those of us who live in countries with proper public healthcare, travel insurance is essential because we are not covered for medical expenses away from our home countries.

  • Anonymous

    I am really interested – could you let me know what company it was that treated you so well, and if you have any connection with the travel industry?Many thanks!

  • http://twitter.com/xrae Rae A

    Remember, we don’t hear the stories of all the trip insurance claims that benefit the traveler. It’s not news.