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Thread: Will I be covered?!

  1. #1
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    Default Will I be covered?!

    Got my self into a slight pickle here guys.

    Crashed my car and fractured my skull on the 28th of February this year, nothing too serious, I was discharged after 48hrs. But this "near death experience" inspired me to do something worthwhile with my life. So I've got myself booked onto a 3 months conservation program in west america.

    All planned OK but its come to sorting the insurance out....which leads me to my problem. The insurance company that I was wanting to go with says that it wont cover me for anything related to any medical issues I've had the previous 12 months. I don't ship out until the 10th February. Does this mean for example, if I were to bang my head in america after the 28th February I'd be covered? and that I've just got to watch my self those first 18 days that I'm there?

    Thanks in advance, any advice is appreciated.

    Sam



  2. #2
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    Quote Originally Posted by Sam_N View Post
    Got my self into a slight pickle here guys.

    Crashed my car and fractured my skull on the 28th of February this year, nothing too serious, I was discharged after 48hrs. But this "near death experience" inspired me to do something worthwhile with my life. So I've got myself booked onto a 3 months conservation program in west america.

    All planned OK but its come to sorting the insurance out....which leads me to my problem. The insurance company that I was wanting to go with says that it wont cover me for anything related to any medical issues I've had the previous 12 months. I don't ship out until the 10th February. Does this mean for example, if I were to bang my head in america after the 28th February I'd be covered? and that I've just got to watch my self those first 18 days that I'm there?

    Thanks in advance, any advice is appreciated.

    Sam
    If you've already recovered, then a new injury is normally covered. If it's something pertaining to your injury in February which causes further damage (loss of vision, hearing, memory, motor skills, etc.) and it can be shown that it is at least in part due to that accident, then you won't be covered for your loss no matter how far in the future you get into your policy. If you hit your head again and it causes new damage, then chances are you will be covered. What the insurer is trying to protect itself against are pre-existing conditions and injuries which occurred before the policy/coverage was in force. Essentially, they don't want to give you coverage for something that has already happened to you, otherwise everyone would get insurance after they needed it and never before they needed it. This would defeat the purpose of insurance, which is to help you finance unforeseeable and unfortuitous events, not events that have already happened.

    All of this being said, you should always ask these types of questions directly to your agent/broker as they are specialists in the wordings of the companies they deal with. The plans I sell usually mean this when it's pertaining to pre-existing conditions.

    If I'm understanding you correctly, this is what the company means. You should also ask what the stability period of the insurance is. The stability period is the amount of time the insurer waits before they will cover you for a certain condition, and it is based on how long the condition goes without "acting up" or without changing. So for instance, if a new prescription is filled out by your doctor (change in dose), the stability period starts over for that condition and it will not be covered until the stability period is satisfied. Once the stability period is satisfied, they include this in your coverage. This is only in some conditions.

    This is why you should talk to your broker. There are too many factors that are different with every different insurer.

    NOTE: A pre-existing condition also includes illnesses you've already contracted.
    Last edited by bsd058; 11-07-2011 at 02:12 PM.
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  3. #3
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    Thanks for the reply!

    The insurance policy states:


    "At the time of taking out this policy:
    Any medical condition you or anyone insured on this policy have or have had for which:
    symptoms or diagnosis has occurred within the last 12 months or
    there has been a change in treatment (including medication, dosage, surgery, tests, investigations or diet) in the last 12 months."


    I dont think I made it clear, I've been discharged and given the all clear for about 7 months now. I'm on no medication and it doesn't effect me in the slightest.

    Either way, I guess I'll shop around to be on the safe side.

    Thanks again!
    Sam

  4. #4
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    It appears you have a stability period of 1 year prior to the inception of the policy. So they will not cover you for the conditions you've had which are unstable (have changed in the past 12 months, by their definition). If you've been recovered for the past 7 months, then you'll have about 5 more months to go before they could cover you for that. Sometimes, if you ask your agent/broker to ask the insurer, they will allow you to satisfy the stability period within the policy period. From the wordings you've posted, it appears that the insurer will not cover the condition of your previous injury from 7 months ago since it has not been 12 months yet.

    Thing is, the condition doesn't exist anymore so there really isn't anything to fear. If you get injured again, it will be considered a new condition. However, it's when you suffer from the same injury that the insurer will decline to pay.

    For instance, if you get into a car accident and injure your head again, and you need treatment, the new head injuiry will most likely be considered a new condition (and will probably be covered) because your previous head injury did not cause the new medical expenses.

    On the other hand, if you are not newly injured but you experience new effects from your injury from 7 months ago, that will probably not be covered.

    Maybe someone else can offer their opinion on this. I sell health insurance in Canada to new comers during the waiting period between their arrival and their government issued health insurance inception date; I know that the rules and laws can sometimes be different. Usually insurance is insurance in North American, but sometimes there are differences that others can comment on.
    Last edited by bsd058; 11-08-2011 at 06:59 AM.
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  5. #5
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    It will be covered if your previous injury is cured, and for better knowing the fact that most of the company will provide cover before another hit your way.

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