Medical Questionnaires of some Insurance Companies contain Ambiguities

Misinterpretations in some medical questionnaires and the refusal of claims have made news in recent years.

Insurance companies appear to be cold, calculating entities with no heart and they would probably agree with that assessment. After all they are huge profit driven corporations.

The best way to buy insurance is through a broker. Think of them as financial advisers who specialize in insurance. They want your business and the insurance companies want the broker to choose their products - finding a broker you can work with is vital.

When completing the medical questionnaire, if there are items you feel unsure about insert a 'yes' instead of 'no' and save a copy without submitting it. This way your broker can also open the saved file and you can discuss any doubts, knowing you are both looking at the exact same items before you finalize and submit the questionnaire.

Our broker sent us an online medical questionnaire for our stay in the US south-west for 2017 – 2018. One questions was -  “In the last three years have you been diagnosed with or treated for any of the following....” one was “Heart condition” and one of the definitions for treated was “Have you undergone investigative testing for..”. 

I had asked for a stress test earlier in the year as I hadn’t had one for thirteen years and I wanted to be pro-active. The results were satisfactory yet I was unsure whether to answer ‘yes’ or ‘no.  

Could it be deemed untruthful? The stress test was for cardio – vascular performance - in other words a heart condition and therefore the insurance company assessors might consider it treated and a 'no' answer might deny a claim.

Our broker suggested another insurance company. She sent the new questionnaire and it was much clearer and the definitions were not ambiguous so we went with that insurance company.

Here’s a comparison of the first and alternative medical questionnaires and their definitions

Medical questionnaire

The first company questionnaire links the words 'Treatment, Treated' with ‘investigative testing’ then the question uses the word ‘treated’ so there's the problem.  The alternative questionnaire makes no such link - no problem. This is why the alternative insurance company was chosen.

The Take Away

  • Don’t be intimidated by medical questionnaires
  • Make sure you understand the questions and definitions
  • The insurance companies are mega corporations but they are not out to get you personally, they just want clarity
  • Your broker is your advocate. Remember, they have a file with notes of conversations with you and they are there to help you throughout the whole process including possible claims. Contact them from wherever you are at any time about any concerns before or after signing a contract. And if you have to receive medical treatment, contact them as soon as possible so they can help you make the best decisions.
  • Take charge, lighten up and remember- never answer questions about extreme picnicking.

Happy Travels!