A doctor said Allianz’s question had the effect of eliciting an unfair… (ARMIN WEIGEL, AFP/Getty…)
Barbara Butkus bought an airline ticket in November to fly from Palm Springs to Washington, D.C., a month later for a family reunion.
Just to be on the safe side, Butkus, 80, also bought travel insurance while booking her flight through Orbitz, the online travel agency. The coverage was from Allianz, a leading provider of travel insurance.
As it happened, Butkus had to cancel her trip for health reasons. She began experiencing shortness of breath in early December, and her doctor advised her not to travel. Butkus filed a claim with Allianz for a refund of her $451.20 airline ticket.
Allianz denied her claim last month, concluding that she had an existing medical condition when she bought her airline ticket.
To reach that conclusion, however, the insurer had to engage in some impressive sleight of hand, forcing Butkus' doctor to give it the answer it wanted.
"It's ridiculous," Butkus told me. "You buy insurance in case something happens. And when it does, you can't collect on it.
"I know my claim doesn't seem like a lot of money," she said. "But it's a lot to me. I live on Social Security payments and a small pension from working as a school secretary."
Nancy Kincaid, a spokeswoman for the California Department of Insurance, said officials are eager to take a close look at the case.
Butkus' experience highlights the lengths to which insurers sometimes go to deny what would seem to be a perfectly reasonable claim — a complete reversal from the friendly, sympathetic tone they adopt when selling policies.
"Life is unpredictable," Allianz says on its website. "Some trips need to be canceled. With travel insurance, travelers don't have to pay for a trip they are unable to take."
Butkus' $29.33 policy excluded coverage for existing medical conditions, which Allianz defined as any condition that involved seeking or receiving treatment within 120 days of making travel arrangements.
Butkus' cardiologist, Dr. Philip J. Patel, is chief of cardiology at Eisenhower Medical Center in Rancho Mirage. After advising Butkus not to travel, he submitted a statement to Allianz saying that her shortness of breath could be attributable to heart or kidney trouble.
She had a heart attack in 2003 and was diagnosed with high blood pressure in the 1990s. Both conditions are now under control thanks to medication and regular exams.
On his statement, Patel listed all of Butkus' visits to his office going back to March 2011. The most recent was in June 2012.
Patel was instructed by Allianz to circle the dates of any visits in which he treated Butkus for his diagnosis of possible heart or kidney trouble. No dates were circled.
At this point, you would think, the insurer would be satisfied that Butkus' trip cancellation was not caused by an existing condition, as per the terms of its policy. But Allianz wasn't finished.
The company sent a new form to Patel with a simple yes-or-no question: "Was the patient symptomatic of or receiving treatment for the primary or underlying conditions" in the four months before booking her trip?
In other words, was she being treated either for her current breathing troubles or for ongoing heart and kidney issues?
The doctor checked "yes."
Daniel Durazo, a spokesman for Allianz, said that "based on this information from her physician, we determined that the event which caused Ms. Butkus to cancel her trip was due to an existing medical condition."
But Patel told me the insurer had boxed him into a corner.
"Obviously she's receiving treatment for her underlying condition," he said. "She's been receiving treatment for her underlying condition since I started seeing her in 2003."
That doesn't mean his diagnosis of her breathing troubles represented an existing condition, Patel said.
Her shortness of breath was new, he said. "It's a new symptom. It's not an existing condition."
Patel told me he would have said as much to Allianz had they offered him the opportunity. But he could give only one answer when asked by the insurer whether his patient was being treated for "the primary or underlying condition."
"I had to say yes," Patel said. "What else can you say?"
Dr. Robert A. Kloner, a cardiologist at USC's Keck School of Medicine, told me that Patel indeed had no choice but to give the insurer the answer it wanted.
"Of course you would check 'Yes,'" he said. "Anyone simply taking medicine would be considered to be receiving treatment for an underlying condition. You couldn't check 'No.'"
Allianz's Durazo said the company was just double-checking when it sent Patel the second form, even though the doctor had pointed out the first time around that he wasn't treating Butkus at the time for existing heart or kidney problems.
Durazo said Allianz wasn't trying to steer Patel toward a certain answer with the reframed question. "We were just trying to get to the bottom of why she canceled her trip," he told me.
However, Durazo told me that Allianz would make another attempt to contact Patel, presumably to ask in a straightforward manner whether Butkus' breathing difficulty represented a new condition.
By press time Monday, the insurer still hadn't reached him. But we already know what will happen when it does. As Patel told me, he won't hesitate to say — as he did in his initial statement to Allianz — that Butkus' shortness of breath didn't constitute an existing condition.
Allianz will then have to decide whether to revisit its claim denial or stick to its guns, based on its questionable tactic of forcing a medical professional to give it the answer it wanted.
I'll keep you posted.
David Lazarus' column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5 and followed on Twitter @Davidlaz. Send your tips or feedback to email@example.com.