Date of publication: 10 October 2019
Mykola Burtovyi, Attorney at Law, Insolvency Receiver
Source: Yurist&Zakon
Each time traveling abroad the tourists conclude an insurance contract. What types of travel insurance exist, what expenses are covered by insurance, and what do you need to pay attention to when entering into an insurance contract in order to avoid refusal in insurance indemnity?
What does the term “travel insurance” mean?
The majority of us immediately think of medical expense insurance in the case of an unexpected illness or injury occurring during a trip abroad. However, in fact, the travel insurance is a much broader and more complex product than it seems to be at first glance.
As a rule, the travel insurance program includes:
Medical services:
• accident & emergency services;
• emergency inpatient care;
• emergency outpatient care.
Transportation services, including:
• transporting to the medical facility;
• repatriation (medical evacuation) from abroad;
• repatriation of body from abroad.
Telecommunication services:
• expenses for reporting an insured event.
Related services:
• car evacuation to the nearest repair shop;
• delivery of necessary spare parts;
• document loss or theft;
• baggage loss or delay;
• flight cancellation or delay.
In order for all this to work out properly, a tourist must observe certain conditions.
How to properly insure the trip?
Firstly, before entering into a travel insurance contract, we recommend that you carefully read the insurance program, insurance rules, the list of insured events, and select the terms and conditions that best meet the purpose of your trip.
For example, if you plan to spend your whole vacation relaxing on soft Turkish sunbeds, then, of course, you do not require the winter sports insurance or insurance for professional athletes. In this case, the cost of insurance policy will be minimal, measured up against the level of insurance risk.
And vice versa, if you plan to conquer the Austrian ski slopes, and this is not included into your insurance policy, then most likely you will be denied the provision of medical services.
Nota bene: when choosing an insurance package for the coastal and maritime tourism (Turkey, Egypt, etc.), it should be borne in mind that the usual terms and conditions of the standard “coastal and maritime” insurance do not cover such activities as rafting, water skiing, surfing, sailing, parachuting, hang gliding, auto and motor sports. Therefore, if you plan to ride an ATV in Egypt in the desert, choose the Adventure (Active) Holidays package.
Secondly, you need to carefully check the correctness of filling in the personal data in the policy (first and last name, passport series and number) of all travelers. Such mistakes may sometimes serve the basis for refusal in payment.
Thirdly, one of the main and most important conditions of travel insurance is the period and territorial limits of the contract. And while the issues pertaining to the beginning of the contract are more or less clear (it should start at 00:00 am of the first day of the trip), the issue of its termination may have certain nuances.
Example from practical experience
The tourist was returning from a vacation spent in Tenerife. The flight involved a transfer. At the time of his stay at the Milan airport he urgently needed an ambulance and was taken to a local hospital because of the heart attack. Fortunately for the tourist everything ended well, and after a week of staying at the Italian hospital he returned to Ukraine.
Yet, as it turned out later, the insurance company refused to pay the indemnity, since the insurance policy expired immediately after the tourist boarded the plane at Tenerife airport, and it did not extend to the territory of transit countries.
Therefore, in order to protect yourself from the risk of failure, I recommend that you carefully study the terms and conditions of the contract and include therein all transit countries. At the same time, if your trip involves transfers, it is recommended to contract an insurance coverage by 1 – 2 days longer than your vacation. Yes, this will slightly increase the cost of the policy, but you will feel more secure when you have to wait at the airport due to a flight delay or other unforeseen circumstances.
Insured event action plan
In any case, which may be later recognized as insured event, it is extremely important to notify the insurer thereof as soon as possible.
Your notification will be received by the assistance company. This is an intermediary company between the insured (tourist) and the insurance company, which is responsible for the organization and financing of medical and other services in the country visited by tourist.
The aforementioned scheme of work organization is generally accepted in the field of travel insurance, and a tourist should not worry about this, since the assistance company acts on behalf and at the expense of the insurance company.
It is the assistance company that organizes and sends the tourist to the nearest hospital that will ensure the provision of necessary medical services.
Nota bene: the notification shall take place before the medical services are provided. Be prepared to inform the operator of the details of the insurance contract (date of conclusion, number and list of insured persons).
A popular stereotype exists that if I have an insurance, then I can go to the doctor myself, pay him for provision of medical care, and upon my return to Ukraine the insurance company will refund these funds. This is a wrong-headed idea of travel insurance, since the insurance contracts usually provide for the possibility of reimbursement of expenses incurred without prior consent of the assistance company in the amount not exceeding EUR 100.
Thus, in order to get a medical care you must first contact the insurance (assistance) company, and then follow all their recommendations. If for any reason it is impossible to provide due assistance in a particular case, and only by agreement with the assistance company, the tourist may have the right to independently seek medical or other help and/or pay for such services.
In this case it is important to ensure that after receiving the relevant treatment you have the originals of the following documents:
– extracts (or certificates) from the outpatient’s/inpatient’s card;
– prescriptions with the names of the prescribed drugs;
– documents confirming the payment for the treatment received and/or medicines purchased (stamp on payment, cashier’s check, sales receipt, bank receipt with indication of the transferred amount, bills issued by the healthcare institutions, etc.).
If possible, make sure that all documents have the required details: name of the institution, date of issue, dates of seeking medical care, duration of treatment, medical history of the disease, final diagnosis, treatment given; name of the doctor, name of the insured person, names of the prescribed drugs.
Most common reasons for refusal of the insurance indemnity
The most common reasons for refusing to pay are:
– failure to notify or untimely notification of the insurance company about the occurrence of the insured event;
– lack of a full package of documents confirming the fact of medical care, its size and the fact of payment.
It should also be remembered that, just as any other insurance, the travel insurance has exceptions to the insured events, for example, getting injured in a state of alcoholic, narcotic or other intoxication. We hope that this article will be of use to you. Take care of yourself and have a good rest!