What Counts as a ‘Pre-Existing’ Medical Condition
for travel insurance
It’s a tale of a minor medical miracle. 44-year-old mum Lisa Robinson, from Consett in County Durham, was told she was on death’s door after she was diagnosed with a deadly brain tumor – while in Turkey.
Lisa had travelled to Turkey to get dental work done – an increasingly popular option among Brits, given the huge waiting lists for dentistry on the NHS and the sky-high costs of private care. Even after paying for a flight and a hotel, it often works out much cheaper to go all the way to the eastern Mediterranean country.
But during a consultation appointment ahead of getting dental implants, staff at the Happy Smile clinic in Antalya became concerned about Lisa’s state of health. She was struggling to keep her balance, making staff initially think she’d been drinking.
When Lisa told them that wasn’t the case, she was taken to a nearby hospital, where doctors soon diagnosed not only the brain tumor but a bleed on the brain. With no time to lose, she was rushed into emergency surgery. The procedure to remove the tumor and stop the bleeding took 13 hours.
Lisa was moved into intensive care. But even after the surgery, doctors didn’t rate her chances of survival highly. Her family flew out to be at her bedside having been told to expect the worst.
To everyone’s amazement, Lisa pulled through. Five days after her life-saving operation she was out of intensive care. Three weeks later, she was able to fly home.
No pay-out
Yet there’s a twist in this heart-warming story of tragedy avoided. Facing a £50,000 bill for the life-saving treatment she received in Turkey – standard for anyone receiving medical care in a country they are not a citizen of or resident in – Lisa put in a claim against her travel insurance.
But her provider turned down the claim on the grounds that she had ‘known’ about her medical condition before she travelled. Lisa had no idea she had a life-threatening brain tumor. She had been experiencing headaches for around two weeks before she flew. She had gone to her doctor, who diagnosed cluster headaches. Lisa assumed it was down to the stress of starting a new job.
According to Lisa’s insurance provider, knowledge of that ‘condition’ should have been passed on to them. They would have given her an alternative (probably more expensive) policy designed for people with medical conditions.
Stories like this don’t, of course, do the travel insurance sector any favors. It seems all Lisa did wrong was go to her doctor because of her headaches – if she had arrived in Turkey and had the brain tumor diagnosed out of the blue, her insurance company may well have had no grounds to turn down her claim in that case.
But it does raise an important question. What counts as a ‘pre-existing medical condition’ for insurance purposes? Is going to your doctors because you are getting headaches something you really have to tell your insurance provider about? In most cases, it shouldn’t be. But it also underlines how some insurers are less equipped to handle medical claims than others.
What do I have to declare?
Medical travel insurance exists to cater to the needs of people who want to travel with existing medical conditions. There are two things here. First, from the insurer’s perspective, the medical part of a standard travel policy is intended to cover unforeseen medical emergencies and accidents. If you have an existing medical condition, falling ill with that would not count as an ‘unforeseen’ event. There’s more risk of you making a claim, so insurers say you need a special kind of policy.
But from the customer’s point of view, you’re also getting better protection with medical travel insurance. Especially with cheaper policies, the medical cover may look like it will pay out plenty of money (typically £1m to cover the most catastrophic cases). But the terms of what it pays out for will be narrowly defined and won’t include any treatment connected to specific conditions.
With a medical policy, you get dedicated cover for the treatments you need, should you need them.
As Lisa Robinson’s case highlights, insurers do require customers to declare any medical conditions and reserve the right to void their cover if they do not. This includes declaring any medical complaints that are ‘under investigation’. It seems likely that Lisa’s insurance company based its refusal to pay out on this latter point, arguing that her trip to see a doctor for her headaches constituted them being ‘under investigation’.
This sounds like a harsh interpretation. But it exposes the fact that, when it comes to medical travel insurance, many providers are reluctant players. They prefer to keep their definitions of what they will cover in terms of medical costs as narrow as possible, and use strict interpretations of the rules to avoid going beyond them.
Two things come out of this story. If you do find yourself needing to visit your doctor before you travel and have already bought travel insurance, it’s best to play it safe and contact your provider to see if it’s anything they need to know about.
Second, if you do have a known medical condition, stick to providers who specialize in medical travel insurance.
They will be more straight with you about what you do and do not have to declare (usually only anything that has a material impact on your health), they will offer you a better deal and they will provide you with a more robust level of protection. It’s a win-win all round.
