Insurance Coverage

by Samfiru Tumarkin

Friday, January 30th, 2015 at 7:52 pm

Every day in our office we see people who thought they had valid insurance, but have had their claim for travel, medical or life insurance denied. Often these people thought they were insured, having answered questions honestly when they applied for the insurance. What they did not know, and what agents and brokers often fail to tell them, is the long list of exclusions to coverage that a person may fall under. How can you protect yourself against being left holding the bag for exorbitant medical or other costs?

  1. Read the policy. This cannot be stressed enough. The best way to avoid being stuck with a policy that gives coverage that is too narrow so to read it yourself. Not reading the policy if given he chance is not likely going to be a valid excuse if you end up in an dispute with your insurer.

  3. Tell. Tell your broker about exactly the kind of coverage that you and your family need. The more information a broker has, the better able they are to recommend a policy that is right for you.

  5. Ask. Ask your broker about the policies they recommend to ensure it meets your needs and will provide sufficient coverage.

  7. Be Honest Answering questions fully and truthfully is paramount in obtaining insurance coverage. If you are not truthful or forthcoming about important aspects of your health or circumstances, an insurer can void your coverage.


What if it’s too late?

You may not be out of luck, especially if you were communicative, honest and forthright when applying for insurance. If you explained your needs to your broker and what you require coverage for, the broker should provide you a policy that fits those needs. If you are provided with a policy that does not give the coverage you request, the broker could be liable for misrepresentation.

As an example, what if you are 6 months pregnant and want to travel, but need insurance for your peace of mind? If you tell your broker you need coverage for any pregnancy-related issues that could come up on your trip, and the policy they provide fails to extend that coverage, your broker could be liable.

This is what happened with one of our clients recently, for whom we are now fighting both the insurer and broker over sizable medical costs.

If there are exclusions in your insurance policy that are poorly worded, or vague, those exclusions will be interpreted narrowly by a court. An insurer has the responsibility to craft the policy in a way that is clear in its meaning.

If you have been denied coverage for your insurance claim, it may not be too late to consult a lawyer. Insurance companies sometimes have very weak reasons for denying coverage in the hopes that you do not fight back. Do not take their denial letter as the last word, because often that is only the beginning.

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