The Travel Troubleshooter: Is a ‘natural cause’ a pre-existing condition?

Question: I need your help with a travel insurance problem. We booked a trip to Cancun through Orbitz last year, and when we got to the last screen of the reservation, it offered us a travel insurance policy through Access America. We thought it would be a good idea to have insurance, so we bought it.

Afterwards, we received a document with the specifics of our policy. I didn’t read it because I didn’t anticipate having to make a claim. But I was wrong.

Shortly before our trip, my mother died unexpectedly. I called Orbitz, which referred me to the insurance company. An Access America representative told me to cancel the trip and suggested that I reschedule it. They promised they would “take care” of the claim.

A few weeks later, Access America denied my claim for $951, because my mother suffered from high blood pressure. The death certificate listed the cause of death as being from “natural causes.” I didn’t know a natural cause was a pre-existing medical condition. — Cheryl Ellis, Lee’s Summit, Mo.

Answer: My condolences on the loss of your mother. I agree with you that a “natural cause” isn’t a pre-existing condition, and I think Access America should have honored your claim.

But this misunderstanding might have been avoided. When you bought your insurance policy, you didn’t read the terms before buying it and made the decision to insure your vacation as an afterthought. There’s nothing wrong with buying travel insurance from your agent, but I always recommend doing a little research before purchasing any policy.

It’s as simple as clicking on a site like InsureMyTrip.com or SquareMouth and reviewing the terms and costs. Typically, travel insurance is a good idea for big-ticket purchases over $10,000, but in your case, a $951 vacation was definitely was worth insuring.

At the very least, you should have reviewed the terms of your insurance policy carefully before buying it. You might have seen some of the limits about pre-existing medical conditions and had second thoughts, and taken an opportunity to shop around before buying the Access America policy.

Then again, no one expects a sudden death in the family, so you couldn’t have known what was about to happen and it’s unlikely you would have done anything differently. That’s the thing about travel insurance: You don’t know what kind of coverage you’ll need until you need it.

I contacted Access America on your behalf and asked it to take another look at your claim. “Due to the extenuating circumstances, we have made a consideration in this case and have paid the Ellis’ claim in full,” a representative said.

(Photo: Stacy Ba um/Flickr Creative Commons)

  • Roger

    Now this is the kind of post I miss on this website. No ranting, no polls, just helping people.

    - Roger

  • Walt Blackadar

    “Due to the extenuating circumstances, we have made a consideration in this case and have paid the Ellis’ claim in full”…wow, they can’t even admit they screwed up. Unbelievable.

    This is why the hue and cry of “you should have had travel insurance” on this website needs to stop. Even when you buy it, you’re likely to get stiffed.

  • Mike Z

    Agreed roger. Good on the ins company to make good on the claim. The death cert listed natural causes, and unless the company wants to spend thousands defending a $1k claim, they should have paid at the beginning.

  • Raven

    Extenuating circumstances here is obviously Access America not wanting to look like the thieves they are in public.
    Let’s hope this serves as a warning for anyone wanting to do business with this scam-a-thon company.

  • Brooklyn

    What Walt Blackadar said! We need to change the law so the airlines are required to refund fares in situations like this, not buy travel insurance from companies that are even more dishonest than the airlines and the car rental companies!

  • Lynn

    There is quite a difference from the insurance you buy from the online agencies like Orbitz, etc than what you get from a travel agent or insurance company. I learned that the hard way a few years back. Think: if it’s cheap, it doesn’t cover much. My clients always get Travelguard

  • cjr

    I feel like some information is missing here. Was the mother supposed to go on the trip? Not that it really matters in the end, because a travel insurance company shouldn’t be acting like a medical insurance company in the first place. And it certainly shouldn’t be acting like this at all when it involves the death of a traveler’s close family member.

    The notion of refusing a claim based on the “pre-existing condition” is one of the most infuriating things about medical insurance (no, I don’t want to start a discussion about the recent health care bill).

  • Cosmos Human

    It seems like if this person did not contact you, the claim would never have been paid. “Natural causes” is not a pre-existing condition at all. The insurance compaines are out to make a quick buck, that is all and will find anyway to deny a claim. “Deny, delay, and defend” should be their motto, IMHO.

    Thank you Chris for assisting this daughter with the claim.

  • http://www.elliott.org Christopher Elliott

    @Walt, you raise an important issue. This post isn’t part of the series on travel insurance. It is my syndicated column, and it was queued up to go months before Access America decided to sponsor the week-long series on travel insurance.

    To underscore what is already clearly disclosed: When a company sponsors a column, it means they get to determine the subject matter — in this case, travel insurance — but they exercise no control over the content.

    By way of full disclosure, I have two more Access America columns queued up for next week: one about a dispute that was mediated to a customer’s satisfaction, the other one about a denial.

  • SirWired

    I don’t see this as an unreasonable denial on its face. “Natural Causes” merely excludes Accident, Homicide, and Suicide. It doesn’t mean the pre-existing condition of high blood pressure had nothing to do with the death.

    To make a reasoned decision, we’d need more information… stroke? heart attack? pneumonia? sepsis?

  • Clare

    Ditto what Raven said! Remind me NOT to buy insurance from these people. Chris, I’m awfully glad you were able to help this lady, who obviously has already got enough to deal with in her life right now.

  • Dan

    Roger —

    A week or so ago, my browser stopped displaying the polls. Can’t say I miss them.

    Chris originally put the polls in place because we thought he was mediating too many marginal cases. So he put them in as a mechanism to keep us happy. But he went overboard… seems like 3/5 days a poll is running. It takes away from the user experience, if you ask me.

    The “Should I mediate” polls are good — there’s an action taken (or not taken) as a result. But the “is this enough compensation?” poll, well, Chris doesn’t say if he’ll go to bat if we say no. (And quite frankly, businesses are allowed to give minimal compensation, knowing that they may lose a customer. That shouldn’t be mediated.) Same for “what should they do?” poll — usually, the options aren’t detailed enough, and there’s no indication of follow-up.

  • http://www.elliott.org Christopher Elliott

    @Dan, you can block the polls easily by blocking javascript. I added polls for “Is this enough compensation?” and other features because readers responded favorably to them. They want to be asked their opinion, even if the polls aren’t always perfectly worded.

    The folks reading this blog have become more involved in the stories, which for me is a good thing. I love hearing your opinions. It makes me a better consumer advocate.

  • sparks1093

    I was always under the impression that “pre-existing conditions” applied to the travellers, not to people who weren’t travelling. Learn something new everyday, I guess.

  • Louise

    Is being alive a pre-existing condition?

  • http://nmdfreelance.com Nancy

    “Due to the extenuating circumstances, we have made a consideration in this case and have paid the Ellis’ claim in full,” a representative said.

    Translation: Since this incident has now made it to a nationally and well-read column, we’ve decided to pay the OP their $951. This doesn’t mean we won’t put the shaft to future insured parties, we just decided to take the path of least resistance in this case. *BIG WAVE* and a hug and a kiss. Love ya!

    GAWD… Insurance companies will be the death of this country before it’s all over.

  • Roger

    Chris,

    I get that your trying to be more interactive with your readers by using polls, that’s a good thing. But I think 95% of the posts for a week being some sort of poll is a bit excessive.

    “Is this ridiculous or not?” is pushing it, in my opinion.

    Maybe just tone it down a bit. It seems like ages since there has been a story like this on your site. It was refreshing to see it.

    - Roger

  • Kathleen

    Although the claim has worked out favorably, I don’t feel like I got enough information on Access America’s re-think. What are the “extenuating circumstances” in this case that caused A.America to reconsider? Their explanation Sounds good, but what are they actually saying? I don’t feel like I garnered any educational benefit from the problem or explanation. Although, again, I’m happy the claim was paid.

  • Megan

    How did access america know the customer’s fm had high blood pressure if the death certificate had natural causes listed? Did this customer indicate the high blood pressure in the regular claim forms?

  • Linda Snow

    Megan’s question is a good one. To add a couple of points: I have heard that insurance companies tend to deny ALL claims when they’re first submitted, then will back down on appeal most of the time. Also, they will use almost ANY condition (headaches, for example) as a “preexisting condition”. It’s possible if the OP fought the denial herself she might not have had to involve Chris.

  • MVFlyer

    To the OP: my condolences on your loss.

    As for being alive being a pre-existing condition:

    My father-in-law used to say that “life is sexually transmitted and ALWAYS fatal”.

  • Dan

    @Chris,

    Fair enough for allowing users to express their opinion. But can you do a bit better on some of your wording? Sometimes, especially for the “it’s ridiculous” polls, the poll question is so terribly leading that’s it’s not even worth asking. (Reference the “should customers have to pay extra for their airline to be nice to them?”) The best poll questions are ones where you can realistically expect the voters to vote something close to 50/50. A good poll question is going to get an extra page view from me when I check to see what the masses did. A lame one won’t.

    So I think what your users want to see are fewer, but really good polls, and a bit more consumer advocacy — that has been missing as of late.

  • http://www.elliott.org Christopher Elliott

    @Dan, I’m a little confused by your comment.

    Today’s post on travel insurance — advocated for customer, case resolved.

    Day before yesterday’s post on fuel surcharges — which had a poll — resolved, too.

    Previous day on bug bites. I worked with the customer in real-time to get it resolved.

    And Monday’s post on the honeymoon in Fiji. Fixed.

    How is that not consumer advocacy?

    As I read the comments, here’s what I think some folks are saying — and please correct me if I’m wrong:

    The “troubleshooter” scenarios are more traditional, old-media columns. They’re lectures.

    The polls are more new-media. They’re debates.

    Are you saying you like more lecture and less debate?

    I prefer the debate to the lecture, even if I can’t always frame the debate perfectly. I learn more from the comments than pontificating as a know-it-all — which I assure you, I’m not.

  • dennis kavanagh

    In dealing with insurance company denials of your claim always in writing assert “bad faith” by the company on the denial. In Calif. the Insurance Code has a statute on “good faith claim handling”. Most other states have similiar laws. Also, complain to the state Insurance Commissioner. Retired insurance attorney.

  • Jennifer

    This is a really strange story. When Cheryl Ellis says “we” were going on a trip to Cancun, who is “we?” If Cheryl’s mom was actually going on the trip, then preexisting conditions are a well-known exclusion many trip insurance policies unless the customer buys the insurance within x number of days of the first payment, or jumps through whatever hoops the insurer can think of.

    I have never seen a trip policy exclude death of an immediate family member (who is not traveling) for whatever reason as a reason for cancellation. This is a strange one. I’m glad Cheryl got her refund.

    As for all of the complainers, Chris, write your own column. There will always be someone who complains. They’re free not to read the site and/or start their own and include only articles they are interested in. Or how about they ask you for a refund? Oops, reading your columns doesn’t cost anything.

  • Michael K

    If someone dies of any cause other than a random accident, I suppose one can always discover a “pre-existing condition” with the benefit of hindsight, even if it takes an autopsy to find it.

    If Access America could deny this claim (and apparently not even concede that they made a mistake), it makes me wonder if they ever pay out any claims except under pressure of embarassment or a lawsuit.

  • bodega

    I tell clients that the last thing insurance companies want to do is pay out. I haven’t had any claims denied, but other agents have and often these been paid on a second submission.

    I went over to Orbitz to check out the Access Insurance. The initial screen that comes up provides very little information. You have to actually go outside of that link to Access’ website to get additional details, which then takes more clicks around the site to find what you need to read.

    Access covers preexisitng conditions if the coverage is taken out within a certain time period, which this traveler does not state when he took it out. However, since Access paid the claim after Chris got involved, I am assuming the purchase was made within the time period required. Death of a family member is listed as reason for payment and no particulars are listed. So if she had high blood pressure the preexisting condition would be covered it the coverage was taken out during the necessary time period. Yet, the listed cause of death is natural causes, so no preexisting condition is listed(although I loved Louise’s comment!), therefore the coverage should have been paid.

    Sadly this is the game of many insurance companies and this was one submission to Chris that warranted his involvement.

  • Dan

    @Chris,

    I don’t think any of us are auditing exact content over a specific week. I think perception is reality, and the perception is that there have been a lot more polls (new media) than troubleshooting (old media) in recent past. When you added a stream of articles about the TSA — I think that irritated a lot of people. Don’t get me wrong — I side with you on the TSA — but it seemed like you lost balance in your posts during that time. So, when we think back to elliott.org in recent history, we think TSA-bashing and polls. We don’t think old-school consumer advocacy.

    Now that said, and don’t get me wrong here… I like a good debate. I like polls that are written such that there is no obvious “correct” answer. I like polls that draw me back to check the results. I don’t like one-sided polls where only an industry rep (or one who would be accused of being such) would take the opposite opinion.

    Maybe to spawn better debate, you can rework the “is this enough compensation” polls to be multiple choice. For instance, one of the last ones was a woman who took a Gulf beach vacation that had the beach full of cleaning equipment. She got $300 back. She wanted a free vacation. She didn’t get enough compensation, but she shouldn’t get the whole thing for free. Since you get a lot more pollsters than commenters (you’ll get polls with more than 600 voters, but less than 10% comment), maybe better polls will tell a better story and perhaps engage your readers more. For instance, with the Gulf vacation, I might list what she was given, what she wanted, and some middle ground — like an additional $400 cash back or X% off another vacation and ask the readers to choose.

    With the AA 5-star service thing, the entire example was about AA. But the poll was “should airlines charge their best customers extra to be nice?” Who is going to say no to that? AA was offering an additional service. You could simply have asked, “Would you purchase this service for yourself or someone you know? (like elderly parents)” and gotten much better responses. You caught a lot of heat in the comments for that one, and defended yourself by saying, “I was just using that as an example to illustrate the poll.” But it didn’t read that way, and we let you know.

    With more thoughtful polls, you *will* keep your readers more engaged and inspired to comment on the topic, and less apt to knock you for a poorly designed poll. Using new media correctly isn’t a slam dunk — it does require a bit of thought.

  • Jennifer

    @Roger I agree with your post. I like to see people in need get help…answering surveys, not so much!

  • http://www.santafecheapskate.wordpress.com ChelseaGirl

    It wouldn’t have done any good to read it once it was purchased, unless you are allowed to cancel it within a certain time frame…but buying a policy without first finding out what it excludes is just dumb. Nonetheless, most policies do cover deaths in the family so Access America was most likely in the wrong.

  • http://www.elliott.org Christopher Elliott

    Sigh.

    OK, the entire reason I started with the polls was because readers were second-guessing my decision to media cases that apparently weren’t worth mediating.

    I figured — why not ask you?

    And now you don’t want to be asked anymore?

    For the record, I love the debate, even if it’s wrapped around a silly poll. The poll is just a question. No one has to answer it.

    I’m extremely confused.

  • Roger

    Chris,

    I think what we are saying is the poles are great, just balance them out with your traditional content, and poll good quality questions.

    - Roger

  • Jeanne in NE

    @Chris,

    When you originally asked us, the readers, whether we should vote or not, I said NO, because this is your column, this is your passion and I’m “not the boss of you”, as my 8-y.o. granddaughter would say it.

    Now that you have the polls, I find myself checking your site first thing in the morning – and voting. (I know, shame on me for being a hypocrite.)

    My husband will ask me what’s going on on elliott.org today – it’s a great conversation starter. We’ll debate the issue and the posts.

    I agree with Dan, though. There are a few situations where a yes/no vote doesn’t cut it. (I just don’t vote, then. I would hate to have someone’s problem not solved just because I was indecisive or not fully informed.) People post all the time asking, “when did this happen?” or “how did the OP pay for this”, ad infinitum. Depending on the circumstances, some middle ground might be more appropriate than “yes/no”. And the debate could be centered more properly on the actual facts, rather than suppositions.

  • Geoff

    There are questions to be asked here. When was the policy purchased? What Access Policy was purchased? Their “Classic” , if purchased within 14 days of the original purchase/deposit day covers pre-existing conditions. So there is much more to this situation that your article discloses.
    The Access company has always been very fair.

  • Harry

    Hey Chris,

    I think people like this type of story because it is a feel good story. a person was wronged and you came in and saved the day. It was also a full story where we found out the resolution. I enjoy these stories for those reasons.

    But I also enjoy the “Should you mediate” stories as well.
    Those are interesting to see what people think and most of them are in the grey area with relation to if compensation is deserved or not.

    I personally don’t understand how people can get upset over a poll.
    if a poll bothers you, just don’t answer it.

    Personally I am going to be reading the site no matter what you post, i think it is all interesting. Unless you go off on some sort of knitting tangent.

  • Ed

    It is exactly this kind of thing that makes me wary about travel insurance.
    @Raven said it right…Access only paid out because it was brought to the public eye…Personally, I think *ALL* insurance is run by a bunch of sheisters! And travel insurance is the worst since it doesn’t seem to be regulated or controlled…these creeps can take your money and then there is no recourse in collecting if there is a covered issue….jerks!

  • cjr

    “GAWD… Insurance companies will be the death of this country before it’s all over.”

    They’re going to have stiff competition from politicians and lawyers.

  • Sadie Cee

    My sincere condolences to the OP Cheryl on the loss of her mother.

    So far I have read only one of the articles in the travel insurance series – what to do if a claim is denied. I now see that I will have to read them all as I am under a number of misapprehensions.

    For example, I thought that coverage for trip cancellation applied in the event of a death in the family of the insured, even if the deceased was not a travelling companion. I also believed that the “pre-existing condition” referred to the insured, never to a member of the insured’s family. Also, I thought that in the case of “pre-existing conditions” if the condition was under treatment and had been stable for three or sometimes six months, a claim would not be denied on this basis.

    To those posters who are counselling reading the policy before purchasing it, I would say this. Last year I purchased additional travel insurance as I would be away for a four-month overseas trip. (My permanent travel insurance covers trips of 62 days only.) After purchase, I downloaded and printed the policy. It was 25 pages long. I made a good attempt, but gave up after reading about 10 pages. I took the printout with me but never read any more of it as it was just too tedious. Not a smart move, I suppose, but thankfully I never had to make a claim to find out that some particular area was not covered. Do the terms of travel insurance policies have to be so lengthy and involved?

  • Johannes

    It seems that many people do enjoy the polls – they generate a lot of debate and discussion. Comments are allowed in case people don’t think the simple yes/no can be clearly applied. I don’t see that 95% of the content of this blog consists of polls – let’s not get ridiculous with our statements here. Like Harry above said, if you don’t like the polls, don’t read them, there are many worthwhile stories to read.

    I buy travel insurance for all of my trips that cost over $1000. It is on the buyer of the policy to READ the terms of the insurance and to COMPARE the policies. While it’s true that we cannot anticipate the exact problem that would necessitate us to use our policy, there are pretty comprehensive ones that are usually not the cheapest. I have had policies that covered me when I needed them to, and once, a policy that did not (I understood that the problem was not covered so I did not whine about it). Reputable companies will give a buyer the policy that they selected; understand what is being bought and unless the company screws up (e.g. lumps death in with a “natural clauses” exclusion, unless death of a family member is specifically excluded) the failure is often on the buyer’s part. Insurance is one of those things that you buy hoping to not have to use, but if you do, better make sure it’s good enough to cover some of the most common things that happens. Which means that the cheapest option is not always the best.

    Speaking of which, Chris, it’d be good to have an updated list of the most common claims that insurance companies pay out for, as well as some of the most common claims that are made but are not paid out on (exclusions on policies, for example) so that we can all refresh ourselves on what level of coverage we would most likely need.

  • Jeanne in TX

    I actually like the increase in the polls. I don’t always comment, but I very much enjoy participating in the polls.

  • Frank Palmer

    @Chris

    Just run what Dan is saying through a enigma machine and it will all become clear. I think you are doing a great job and I like your polls.

    @Dan

    Are you kidding? The stories on the TSA are awesome. Who are you refering to when you say “we” only remember TSA bashing and polls?? I bet you believe that a lot of people think like you but you would be wrong. Chris should have a poll so we can settle this issue.

  • Steve Horwitz

    Let me get this straight: if I want to buy travel insurance that covers death of a family member from Access America, I need to get the medical histories of every family member and key person whose death might justify terminating or canceling a trip. I need to decide whether the condition is stable and under control and whether medications have been changed during the last four months. I have to evaluate whether any condition could lead to death. Here is the language that AA used in a contract I had with them for travel in 2009:

    EXISTING CONDITIONS
    “An illness or injury that you, a traveling companion or family
    member were seeking or receiving treatment for or had symptoms of on the day you purchased your plan, or at any time in the 120 days before you purchased it.
    You, a traveling companion or family member are considered to havean existing medical condition if you, a traveling companion orfamily member:
    · saw or were advised to see a doctor
    · had symptoms that would cause a prudent person to see a doctor
    · were taking prescribed medication for the condition or the
    symptoms, unless the condition or symptoms are effectively
    controlled by the prescription, and the prescription hasn’t changed.

    Presuming the contract language has not changed and presuming the claimant’s mom was doing OK on her medication, AA had to have ignored its own guidelines in denying compensation. At the least, AA had to have done some serious investigating with the deceased’s doctors, pharmacists and their own specialists to reach the conclusion it did. Or it just could have decided to see what happens if it just spits in the insured’s face. I’d bet on the latter.

  • Joe in Calif

    If you have a 100 claims a year for $1000 each – you have to pay out $100,000 plus the cost of administering the claims.

    If you generate $750 a year in premium to cover 100 people, you generate $75,000 in premium revenue. Now, you have lost $25,000 from those 100 claimants.

    Now, lets assume your business practice is to deny 50% of all claims just because. And none of the 50 appeal the denial – you just went from $25,000 of loss to $25,000 of income. Now, if even HALF of those 50 people you deny walk away from the denial and just complain about it but do not formally appeal – the WORST you can do is break even.

    So – there is a powerful incentive to deny claims for any pretext you can find in order to maximize revenue. It is an illegal business practice and claims practice in all 50 states, but is someone gong to seriously bring a class action over a $1000 claim for insurance and do anything other than pocket the $1000 check they get for complaining loudly?

  • Raven

    @Chris:
    I’ve read you for a long time. The first case I read was on your old site and I think it was the mother getting thrown off the plane in Orlando with the kids screaming “don’t take my Mommy!”

    Anyway, I like the site, the polls, even the comments.

    So, I say don’t change a thing.
    –Raven

  • http://flightstotours.com Ian

    The three rules for dealing with any insurance claim are; deny, deny, deny.

    These companies don’t become multi-billion dollar corporations by giving away money.

    Any time someone suggests regulation of the insurance industry, the spectre of socialism is always raised.

    Is it socialism to prevent corporate fraud?

  • Rosered

    Thank you.  I just hope I can remember this if/when I might have occasion to use it.