Should people like this be helped?

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#2087996 12-Sep-2018 09:02

sbiddle:

rb99:

First of all I freely admit I haven't read all ten pages of this sad and alarming thread, but one question - what about an unknown condition ?

An unknown condition isn't preexisting per se.

To quote my 1Cover PDS -

The key word here is investigation, what does that mean? It hasn't been diagnosed, or advised upon, so what would investigation mean in this context?

kryptonjohn

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#2088013 12-Sep-2018 09:08

rb99:

kryptonjohn:

dejadeadnz:

Fred99, for example, has highlighted a potential quandary. The head of the Insurance and Financial Services Ombudsman's office has recently come out advocating reforms around issues of non-disclosure by insured and the perceived harshness of insurers being able to avoid policies on the ground of non-disclosures that many ordinary people would overlook. On one of the travel insurance policies cited, claims can be denied if it involves a condition that is "under investigation". I can tell you that a colleague is currently acting pro bono in a case and she is actively in discussions with two QCs over arguments as to what "investigation" means between an insured, a broker, and an insurance company in the context of a life insurance claim. But it's all very simple according to you -- then again, you seem to be an expert on everything.

As I've discussed, I don't have particularly strong views either way on this issue. But a thread full of moral exhibitionists bleeting on repeatedly about issues of moral hazard that are well-known and well-explored in addition to making laughably self-aggrandising claims like fully understanding all the terms of insurance and their implications (a claim that many specialist insurance lawyers wouldn't even make - there is a reason why there's so much insurance litigation), against the background of a tragic case where dignified and respectful silence would be more befitting, tells one plenty.

So there was no gleeful hand rubbing then? Glad we cleared that up.

As to respectful silence... Silence would be the absolute worst response. If one good thing has come out of this sad case it is that people will now be more aware that they should never omit a known condition from a policy application.

First of all I freely admit I haven't read all ten pages of this sad and alarming thread, but one question - what about an unknown condition ?

Indeed - it comes down to wording. In the policy I cited, "pre-existing conditions" are not covered, but the definitions section of the document it says:

Pre-existing medical condition means any physical defect, infirmity existing
or recurring illness, sickness, injury, disability
or condition:
(a) which you are aware of, or ought to have
been aware of; or
(b) for which advice, care, treatment,
medication or medical attention has been
sought, given or recommended; or
(c) which has been diagnosed as a medical
condition, or an illness or is indicative of
an illness; or
(d) which is of such a nature to require, or
which potentially may require medical
attention; or
(e) which is of such a nature as would have
caused a prudent, reasonable person to
seek medical attention;
prior to commencing travel.

a) "aware of or ought to be aware of" says it's ok if it unknown unless it ought to be known.

b) c) and d) are obvious.

d) is concerningly ambiguous. Does that mean an un-diagnosed, previously symptom-free issue that flares up overseas is not covered? To me, cases like that are half the point of travel insurance.

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#2088017 12-Sep-2018 09:11

tdgeek:

sbiddle:

rb99:

First of all I freely admit I haven't read all ten pages of this sad and alarming thread, but one question - what about an unknown condition ?

An unknown condition isn't preexisting per se.

To quote my 1Cover PDS -

The key word here is investigation, what does that mean? It hasn't been diagnosed, or advised upon, so what would investigation mean in this context?

I would say that if you had been to the doctor about stomach pains but the cause was still unknown, you go overseas and find you have stomach cancer that was causing the pains, they'll say it's not covered under f)

tdgeek

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#2088030 12-Sep-2018 09:27

kryptonjohn:

tdgeek:

sbiddle:

rb99:

First of all I freely admit I haven't read all ten pages of this sad and alarming thread, but one question - what about an unknown condition ?

An unknown condition isn't preexisting per se.

To quote my 1Cover PDS -

The key word here is investigation, what does that mean? It hasn't been diagnosed, or advised upon, so what would investigation mean in this context?

I would say that if you had been to the doctor about stomach pains but the cause was still unknown, you go overseas and find you have stomach cancer that was causing the pains, they'll say it's not covered under f)

That would be covered under advice a) Hence why I can't see what investigation means as by virtue of a) advice, it doesnt mean advice, it means something else.

And is it the insurance company's investigation or the client's??

rb99

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#2088032 12-Sep-2018 09:28

Sounds like an awful lot of get out clauses to me, like the stomach pains mentioned above. Or as was mentioned - key word = investigation. Stomach pains, trip to doctor, doctor has a prod, takes notes, says don't worry about it, six months later...

Maybe we just should nationalise all this stuff, you pay the government instead of a private company, whats so bad about that...

“The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness.” -John Kenneth Galbraith

rb99

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#2088041 12-Sep-2018 09:37

rb99:

Sounds like an awful lot of get out clauses to me, like the stomach pains mentioned above. Or as was mentioned - key word = investigation. Stomach pains, trip to doctor, doctor has a prod, takes notes, says don't worry about it, six months later...

Maybe we just should nationalise all this stuff, you pay the government instead of a private company, whats so bad about that...

That would be taken as a socialist act I suspect. By taking over businesses from the private sector.

The Ombudsman and the Government and Opposition need to legislate that these terms are simpler to understand. If insurance companies are forced to write layman english, they lose the ability to hide behind it. Then they can compete on price and not use the T+C lever to artificially and passively reduce claims. Plus people once educated are fully aware, they also then can assume full responsibility. Right now its a bit shared.

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#2088059 12-Sep-2018 09:56

I don't have any problems with socialist acts (well some of them).

But anyway, it would be interesting to know (not that we ever could until we tried it) what would happen, if overseas travel insurance was compulsory with no exclusions. Would it increase ten fold or 10%. Why not a compulsory, I dunno 10% on the ticket price (or package price) or $20 per day or something - too simple?

“The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness.” -John Kenneth Galbraith

rb99

tdgeek

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#2088066 12-Sep-2018 09:58

rb99:

I don't have any problems with socialist acts (well some of them).

But anyway, it would be interesting to know (not that we ever could until we tried it) what would happen, if overseas travel insurance was compulsory with no exclusions. Would it increase ten fold or 10%. Why not a compulsory, I dunno 10% on the ticket price (or package price) or $20 per day or something - too simple?

Compulsory is a good idea. What is the premium for pre existing at the moment? I'd imagine its 10% or 20%?

rb99

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#2088074 12-Sep-2018 10:11

tdgeek:

rb99:

I don't have any problems with socialist acts (well some of them).

But anyway, it would be interesting to know (not that we ever could until we tried it) what would happen, if overseas travel insurance was compulsory with no exclusions. Would it increase ten fold or 10%. Why not a compulsory, I dunno 10% on the ticket price (or package price) or $20 per day or something - too simple?

Compulsory is a good idea. What is the premium for pre existing at the moment? I'd imagine its 10% or 20%?

No idea, though I'm sure those who actually travel will. Overseas travel is unfortunately a foreign concept to me - went to Tauranga a few months ago though !

(The topic is still interesting).

“The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness.” -John Kenneth Galbraith

rb99

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#2088077 12-Sep-2018 10:25

rb99:

I don't have any problems with socialist acts (well some of them).

But anyway, it would be interesting to know (not that we ever could until we tried it) what would happen, if overseas travel insurance was compulsory with no exclusions. Would it increase ten fold or 10%. Why not a compulsory, I dunno 10% on the ticket price (or package price) or $20 per day or something - too simple?

I know what would happen. A monopoly has no pressure to be efficient. It will turn into a monolithic bureaucracy and will cost far more and deliver far less.

Personally I abhor compulsion and believe that market competition will deliver a better result.

Look at ACC, It's compulsory, sort of monopolistic, and just like insurance companies they try very hard to avoid paying claims.

rb99

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#2088080 12-Sep-2018 10:31

And there was me thinking this entire thread was about the free market delivering no result at all.

“The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness.” -John Kenneth Galbraith

rb99

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#2088084 12-Sep-2018 10:36

rb99:

And there was me thinking this entire thread was about the free market delivering no result at all.

Well, travel insurance is currently very very cheap and only a small percentage of claims are denied. I would say most of those are denied fairly under the policy.

Terrible exceptions such as the one we are discussing are rare. Kiwis take millions of trips per year.

I'd say the system is not perfect but works OK most of the time. I would also say when governments steam-roll in with compulsion the success rate would be a lot lower. Imagine the cost blowouts in the new IT system for a start!

Paul1977

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#2088089 12-Sep-2018 10:49

What I am reading here and seeing spouted on the news is the importance of declaring pre-existing conditions; but I feel like I am missing something.

I declare a pre-existing condition, and am told it will not be covered by my policy.

I fail to declare a pre-existing condition, if I try to claim on it my claim is denied.

So... why is it so important to declare it if it will not be covered either way?

rb99

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#2088103 12-Sep-2018 11:03

kryptonjohn:

rb99:

And there was me thinking this entire thread was about the free market delivering no result at all.

Well, travel insurance is currently very very cheap and only a small percentage of claims are denied. I would say most of those are denied fairly under the policy.

Terrible exceptions such as the one we are discussing are rare. Kiwis take millions of trips per year.

I'd say the system is not perfect but works OK most of the time. I would also say when governments steam-roll in with compulsion the success rate would be a lot lower. Imagine the cost blowouts in the new IT system for a start!

True, we only hear about stuff when it goes wrong, but I reckon there are well run, efficient government departments and badly run, inefficient government departments, ditto insurance companies and companies in general. I would tend to think a well run (hopefully) government department / section that gets x% of the trip to cover, well, not all, but significantly more of this stuff would be an improvement. Or insurance being just plain told (somehow, easy for me to say I know) to cut back on that extensive list of exclusions would also help.

“The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness.” -John Kenneth Galbraith

rb99

tdgeek

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#2088105 12-Sep-2018 11:11

Paul1977:

What I am reading here and seeing spouted on the news is the importance of declaring pre-existing conditions; but I feel like I am missing something.

I declare a pre-existing condition, and am told it will not be covered by my policy.

I fail to declare a pre-existing condition, if I try to claim on it my claim is denied.

So... why is it so important to declare it if it will not be covered either way?

Declare it, pay the extra for that cover

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