Insurance claim denial

[confused456]

Here's the situation:

- My mother visited me in Canada.
- In good faith, we purchased insurance for travel to Canada. She has what would was considered a "pre-existing condition" but, under the definition provided in the policy, pre-existing conditions are covered if they are stable for X number of days. I looked up their definition of stable and she met that definition for coverage. I confirmed this with the insurance broker to be sure. Satisfied, I purchased the insurance for her. Note that while I paid for the insurance policy, the policy was for her and in her name.
- Several months into her visit to Canada, she had to be hospitalized for nearly a week and have several diagnostic tests and medical procedures done. A claim was made to the insurance company for these expenses.
- Shortly after her hospitalization and when she was physically able, she left Canada to return home, months earlier than planned, since according to the insurance company, she would no longer be covered and would be liable for that condition should she require hospitalization for it again in the future.
- Several months after her hospitalization, we received a phone call from the hospital stating that the claim had been refused MONTHS earlier. We never received any notice from the insurance company at all. At present we have no paper documentation received from either the insurance or the hospital, only a phone call.
- We will be disputing the refused claim since, as mentioned, we did our due diligence before buying the travel insurance, and even received confirmation from the broker (albeit only verbally, which was a mistake) that the insurance would cover this exact situation. It is the reason I purchased this particular policy, despite being more expensive than some other options.
- I hope we will be able to resolve the issue with the insurance company. However, my question is: IF, after all is said and done, the insurance company gets itself out of paying this debt, who is responsible for the debt? Since it is my mother's hospital bill in her name, would it not be her debt? Does the hospital have the right to demand payment from us?

Thanks to anyone who might be able to provide some guidance!

 

[amit.124]

I think you should take legal advice....I am not an expert but I think as you sent her an invitation letter and you might have mentioned that you will manage all expenses...so this can go against you...

its just my personal view of the situation....

 

[kriv]

who is responsible for the debt?
Only your mother is responsible for the debt as the insurance was issued on her name. And the hospital will bill your mother as she was the patient.

Does the hospital have the right to demand payment from us?
No they cannot demand payment from you. As in the records of the hospital the contact number and address is yours so that's why they called you or will send a letter/bill/invoice to your address because logically that's your mother's address in canada. hospital can only demand payment from you if you have signed a paper at the hospital that you are agreeing to be financially responsible for your mother's hospital bills. just the invitation letter for visa purposes will not make you responsible to make the payments.

About your invitation letter:
invitation letter is not a legal responsibility document, undertaking or sponsorship document. infact a visit visa cannot be sponsored by anyone or issued on the base of any undertaking given by the person to whom the applicant is visiting. an invitation letter can just help as:-
a) a proof of relationship in canada.
b) the address at which the visa applicant will be staying
c) helps the visa office in determining the reason of his/her visit.
d) helps the visa office in determining the amount of funds require by the applicant to make his/her trip (invitation letter establish a fact that the visa applicant will be provided with food and shelter by the host).

So the visit visa is issued/granted on the personal circumstances of the visa applicant; not on the base of the stability, affordability and undertakings of the host.
In other words even if you wrote the letter of invitation for your mother, you are not financially responsible for her in any way while she is/was here on the TRV.

Now even if you are not responsible to pay your mother bills still you must follow up on her behalf both with the hospital and the insurance company to make sure your mother do not face any problem in visiting canada again. if you leave this matter unsolved your mother may face problems in returning to canada in the future.

hope it helps

 

[confused456]

Thank you for the replies.

Kriv, what you said is what I thought, but I wanted some reassurance on the topic.

We do intend to fight the insurance company in question. We strongly feel the wrong decision was made and that we have every right to the insurance claim that was made. We did everything by the book and answered every question honestly based on what anyone knew. I also cannot believe that they have failed to even inform us of the decision since February -- it is only through a phone call from the hospital that we had any idea something was wrong. Not a single piece of paperwork has been received. Granted, we have not yet called the insurance company to follow up, but one would think such information would be a given. We are seeking legal advice and will pursue the matter legally if necessary.

The reason I asked about who is responsible for the debt, should the claim ultimately be refused, is not because we do not intend to have it paid. My mother will never be returning to Canada in the future, even if she does have the visa allowing her to do so, but she did benefit from the health care system in Canada and, as a responsible citizen, I do believe the bills should be paid. I have no issue with the hospital asking for payment per se, but I did find it questionable that they were demanding payment from us. My main argument is that it should be the insurance company that pays for it because it is precisely that coverage we paid for and we acted in good faith when obtaining that insurance. I've heard horror stories about insurance companies and how they will try everything conceivable to get out of paying. I've never believed in any horror story -- until now.