|The girls use clips, cloth, cups, chairs, and all manner|
of things to create forts, stores, restaurants, and pet
homes on the deck.
I contacted Seven Corners. Their worldwide catastrophic comprehensive medical insurance policies are underwritten by Certain Underwriters of Lloyd’s of London. I disclosed all our family’s infirmities, per the application. I expected the underwriters to come back with a list of exclusions based on the information I provided. I did not expect the exclusions to be unnecessarily comprehensive.
For example, on the application, they asked:
“Within the past ten (10) years, have you or any applicant been medically advised, referred, counseled, treated, had surgery or been treated, diagnosed or currently taking prescription medical for diseases or disorders of the eyes, nose, ears and throat (including, but not limited to: nasal septum deviation, chronic sinusitis, cataracts, glaucoma, allergies or hay fever)?”
I disclosed my half-dozen bouts of iritis over the years. (Iritis is a spontaneous and painful inflammation of the iris muscle. Nobody seems to know what causes it, but if untreated, it can lead to terrible cataracts and ultimately blindness--though it is so painful, I cannot imagine anyone not receiving treatment. Fortunately, treatment is both effective and straightforward, involving steroids.) Following my disclosure, Seven Corners offered us coverage, but with the following exclusion (and there were others):
“Any illness, disease, or physical disorder of the eyes, including any complications thereof - Michael, Permanent”
It seemed like a pretty broad exclusion given my disclosure, so I asked for more specificity and offered an example to clarify: “If Michael accidently stabs himself in the eye with a fork, that injury will be covered, yes?”
A manager underwriter got right back to me:
“For the eye rider there is a chance there could be coverage for an accident depending on the medical facts and the diagnosis from the doctor. The eye rider excludes treatment for any illness, disease or physical disorder of the eyes and also any complications of illnesses, diseases and physical disorders of the eye. The most the plan would likely cover would be to stabilize the eye injured during the accident but once stable coverage would typically cease. This would be determined by the medical facts and diagnosis, it is pretty difficult to adjudicate a hypothetical claim as there is/are no actual fact(s) to review.”
Whoa. Not exactly the response I was looking for. In short, I injure my eye in an accident and they will only cover the costs of "stabilizing" the eye because I have a history of eye muscle inflamation? And too, what have the Plain English Campaign folks been doing since 1979? They clearly have a lot of work remaining.