Travel Insurance and Policy Exclusions

In 2006, Mr. and Mrs. Levy (the plaintiffs) decided to take a vacation, including a cruise to the Caribbean Islands. For this trip, they purchased a Travel Insurance Policy through a travel agent – ISSTA. The policy was bought over the phone and no questions about the plaintiffs’ health condition were asked, nor were they required to complete a form regarding their health. The policy was sent to the plaintiffs through regular mail.

On the first day of the cruise, Mrs. Levy felt dizzy, had nausea and started throwing up incessantly until she began to dehydrate. She went to see the ship’s doctor, who after examining her and finding her dehydrated, sent her to the nearest hospital - in Jamaica. At the hospital the doctors discovered she was pregnant, and because of her condition of dehydration, must be hospitalized for three days.

Neither of the plaintiffs was aware that Mrs. Levy was pregnant when they bought the policy and they first found out from the doctor in Jamaica.

The plaintiffs contacted the insurer by phone, AREL Insurance company (the defendant), and they were told that the policy would indeed cover their expenses. But when the plaintiffs submitted their bills, the defendant refused to pay based on the fact that the policy had an exception clause for pregnancy; therefore the policy did not cover such an event (damages caused by pregnancy).

There was no doubt or any controversy that the policy (like all others issued by other insurers) did not cover any type of damages resulting from a pregnancy. In spite of this fact, the Honorable Judge Mrs. Irit Cohen from the Small Claims Court in Jerusalem, decided on August 22nd, 2010 for the plaintiffs, based on the Israeli law of contract.

The insurer representative was obliged by law to ask relevant medical questions/issues, especially those concerning the pregnancy. Are you pregnant? It’s an essential question for a woman (insured) in this type of insurance.

It is also important to know, as the Judge emphasized, that this specific exception clause can be bought off, for a small extra insurance premium.

After hearing both sides, the Judge decided to give preference to the plaintiffs’ version of the events. Therefore, the defendant was to pay all the expenses of the plaintiffs except the expenses of the flight back from Jamaica to the ship and compensation for “Pain and Suffering”. Those damages are not covered by the policy.

Conclusion: If you buy a Travel Insurance Policy it is advised to purchase it from an insurance agent who holds a permit/license to sell insurance and knows his job. Don’t travel without reading the policy and if you see any section or exclusion you think you need to cancel, do ask about it. If possible the insurer will cover it for an extra premium.

In case of necessity don’t hesitate and call the insurer immediately. Ask the name of the person you are talking to, his position in the company, write down dates and the time. Be organized and keep track of all conversations and documents you receive abroad.

And most importantly: Have a safe, healthy and wonderful vacation.

 
Sincerely,

 
Tzvi Szajnbrum, Attorney at Law