whats a pre existing medical condition in insurance ?

bnorth

Dear All

often travel insurance request you submit you inform them of a pre existing medical condition over the previous, say, 2 years but are vague regarding what this means ?
for example does a high cholesterol reading count as a pre existing medical condition ? how high does it have to be ? obviously insurance details aren't exhaustive but I wish they were more thorough.

if cholesterol is notifiable why not weight ? if cholesterol is a risk factor why not pay more for being male ? thats also a risk factor for heart disease ??

if someone with an alleged high cholesterol has a heart attack an insurance company may say a doctor will decide if the (eg) cholesterol caused it.
How ?? How can a doctor decide this ?
Why can't a doctor say in advance whether a heart attack would be caused by that person's cholesterol if given his/her medical history ? why further info would that person actually having a heart attack provide.

and how would a doctor decide this ? Are doctors usually well versed in epidemiology ? eg odds ratios, estimation of population attributable risks etc.
or would the insurerer have a "special" doctor eg a cardiac epidemiologist (who may not in fact be a medical doctor) who would know this stuff ?

and assuming they do would the doctor base his decision on something general eg the population attributable risk (the % of heart attacks in the population caused by high cholesterol)
or something more tailored eg the persons data (cholesterol, age, BP) are fed into a risk engine (eg a Cox model) and then the person's data fed in to the risk engine again (but with cholesterol changed to normal) and the results compared to assess how much of that person's risk is attributable to cholesterol.


sorree for long series of often technical questions ...

stephenni1971

Just take a deep breath for a minute...

If you are taking a travel insurance policy only then the onus is on you to provide the insurer with the details of any pre-existing medical conditions which could make you more susceptible to illness or injury on your trip.

Unlike life insurance, where each case is looked at on an individual basis, many travel policies are sold in huge volumes and have pretty standardised terms, hence why you can buy one over the counter at Tesco or Boots for example.

It would be worth letting the insurers know about your cholesterol but I doubt it would make any serious difference to your policy, after all millions of travel policies are bought each year and averages says a large %age of these will be to people just like yourself.

bnorth

thansk Stephenni,

thanks for your reply ...
yes I realise insurers want to know about pre existing medical conditions.
I really just wanted to know what counted as a pre exisiting condition
if they mean conditions that pre dispose me to being ill should I tell them I don't exercise enough ? that I don't eat enough fruit (as it happens I do a bit of exercise and eat loads of fruit and veg) - what counts as enough ?
actually my cholesterol was high years ago but had come down a lot by my last reading (and I can't remember exactly what it was for sure, probably still a bit above "average", does that count as high - I'll get another blood test soon I think)

I can buy extra cover but do I need to ? to be honest I probably will anyway to be safe - in most respects I'm pretty healthy but anyweay can have a heart attack - whos to say if the cholesterol "caused" it.
so though I'm not sure I am at high risk and it'd be nice to know if I do need to and to know before rather than after how insurerers would deal with a heart attack.
after all I can't see why they can't tell me now if a heart attack is covered instead of this "a doctor will decide" approach.

stephenni1971

How much information is enough?

There has to be some common sense involved in this, if you had had 2 angina attacks and did not declare this that would be taken as non-disclosure.

If however you had high cholesterol years ago and that had been brought down to normal-ish levels then it could be reasonably argued that it's not a current medical problem.

Travel policies are written under what is called a 'group' basis in that while they will never be able to get full medical details & history etc for those taking out the insurance, they have to assume that some will be normal risk and some will carry a higher risk, just like the general population.

Get your policy, declare your cholesterol, and have a good holiday!

lisyloo

whos to say if the cholesterol "caused" it

The insurer might if you haven't declared it.
They might not be right but the onus would be on you to prove it, so lots of hassle grief with your claim.

In your posistion I would declare it (and the fact that it's improved).

If you don't declare it you risk a claim not being paid due to non-disclosure.
You have to remeber there are people employed to find reasons NOT to pay out.

If you do declare it, you have the opportunity to find an insurer that responds reasonably AND the the peace of mind of knowing you are covered.

I know the definition is tricky, but basically if there is something you are aware of then you should inform them.

roddydogs

Its always a "Grey" area...example i went to to doctors with headaches 10 years ago, had tests,, no problem found........but if i go on holiday and then get a Brain tumor...they could say i hadnt informed them.........who keeps a record of everytime you go to the doctor?

Quentin

If not mentioned specifically, then cholesterol is covered under any questions related to "blood disorders".

If you just take regular medication for it, and have done for some time it normally is covered without any special terms.

But what is the point of non-disclosure? If it does "catch up" with you while you are away, you may not be around to have to deal with all the problems caused by your insurers using it as a way of rejecting any asociated claim on the policy by those you leave behind to sort it out!

bnorth

thanks all for your advice

I wasn't thinking of not disclosing my cholesterol but should I take out extra insurance on top of standard to cover medical events arising from it ?

if I don't and the insurance company decided my cholesterol "caused" my heart attack then unless I pay extra I'm not covered.
but they won't say in advance if they wil judge that my cholesterol will "cause" a heart attack.
a doctor will decide after the event

how would anyone know if my slightly higher than average cholesterol "caused" a heart attack ?
cholesterol, smoking and high BP combined cause less than 50% of heart attacks so there's a plenty of other causes, including unknown ones !
can I not say "there's no proof my slightly high cholesterol caused this, it can easily be some biochemical that I have a lot of but no one knows puts you at risk of heart disease so can't be regarded as a decarable risk factor"

lisyloo

who keeps a record of everytime you go to the doctor?

Well actually I do, for precisely this reason (although I accept that's unusual).

The second answer is that you doctor has this information if you needed it.

but should I take out extra insurance on top of standard to cover medical events arising from it ?

You need to get a response from the insurer.
If they are happy to cover it on normal terms and normal prices then there is no need to purchase extra.

but they won't say in advance if they wil judge that my cholesterol will "cause" a heart attack.
a doctor will decide after the event

They WILL say in advance whether they will cover you for it.
In which case it doesn't matter whether it was a cause or not.
Your covered anyway.

how would anyone know if my slightly higher than average cholesterol "caused" a heart attack ?

As I tried to point out already.
It doesn't matter how. If they refuse your claim its' YOUR problem (or your famlies).

cholesterol, smoking and high BP combined cause less than 50% of heart attacks so there's a plenty of other causes, including unknown ones !

Yes, but do you want to leave your family to argue over that in court ??

can I not say "there's no proof my slightly high cholesterol caused this, it can easily be some biochemical that I have a lot of but no one knows puts you at risk of heart disease so can't be regarded as a decarable risk factor"

Not if your dead. No you can't.
If your alive you can chose to take on a court case after the event.
Your choice.
I would have thought it would be a LOT easier to declare it and just have it covered.
Claim paid out, no hassle.
Why would you deliberately want to cause yourself hassle if cover is easy to obtain.

bnorth

lisyloo wrote: »

I would have thought it would be a LOT easier to declare it and just have it covered.
They WILL say in advance whether they will cover you for it.

well as I say I will declare it
but even if I do the insurer won't cover any consequences unless I pay extra.
and in fact the insurer won't say in advance if they will decide that a heart attack is caused by slightly high cholesterol. a doctor will decide on an individual basis
In fact I probably will pay extra just to be on the safe side but it'd be a lot simpler if the insurance company did say in advance whether a heart attack was covered by standard insurance if slightly high cholesterol was declared.

lisyloo

but even if I do the insurer won't cover any consequences unless I pay extra

So have you asked them already?
If they want extra then your choices are:
1) pay the extra and be covered
2) Go uninsured and face a potential headache, possibly on a valid claim
3) Try a different insurer/broker

and in fact the insurer won't say in advance if they will decide that a heart attack is caused by slightly high cholesterol. a doctor will decide on an individual basis

Of course.
But they will say in advance whether you are covered.
If you are covered for high cholesterol then it doesn't matter what caused your heart attack as you are insured anyway.
It only matters if you go uninsured and then you are opening yourself up to having a valid claim denied because as you say it's not always easy to categorically find or prove a single cause.
My feeling is that if there is doubt then some insurers will tend towards NOT paying your claim if there is doubt.

but it'd be a lot simpler if the insurance company did say in advance whether a heart attack was covered by standard insurance if slightly high cholesterol was declared

Agreed, but I'm sure you can see that it would be difficult for them to list every condition against every severity and every event.
It's simply impossible (I don't work in insurance, just can see the problem).
Hence you tell them the condition and severity and they will check it out and get back to you.
Why don't you use a broker (I'm not a broker either).
They will have experience of this and it might save you doing the legwork chasing round companies. They might even have had a client with a similar situation or know which insurers are more sympathetic to minor conditions.