CAIB 1 - Chapter 8

Protects brokers from financial loss caused by negligence towards clients or insurers.

Brokers can be held legally liable if their actions cause financial loss to their clients or insurers due to negligence, errors, or omissions.

E&O insurance protects a broker from the financial consequences of a large E&O claim.

Insurance pays for legal liability stemming from negligence, errors, or omissions of the broker or those they are legally responsible for.

Most policies cover claims made during the policy period, meaning that claims filed after the policy expires are not covered.

E&O insurance does not cover dishonest, fraudulent, criminal, malicious acts, or failure to collect, pay, or return premiums.

A deductible encourages brokers to prevent and control errors and omissions, making them more careful.

It's crucial for brokers to inform their insurer immediately about any potential E&O claim, as failure to do so could jeopardize their coverage.

Provincial health plans in Canada have reciprocal agreements, but coverage and conditions can vary between provinces.

Provincial health plans may not cover ambulance charges, family visitation, repatriation costs, vehicle return costs, and other costs regardless of the location of injury or accident.

Provincial health plans typically only pay a prescribed fee for medical costs incurred outside of Canada, regardless of the actual charges.

Travel insurance fills the gaps in coverage that provincial health plans may not cover, such as ambulance charges, family visitation costs, and repatriation expenses.

Individuals and families traveling away from their permanent residence in Canada for business or pleasure can purchase travel insurance.

Travel insurance policies vary in terms of coverage, age, health, and individual needs, so it's crucial to choose one that suits the traveler's specific requirements.

Travel insurance policies can cover individual trips from 2 weeks to 180 days and multiple trips of 30-45 days throughout a year.

The insuring agreement outlines the company's commitment to insure the named applicant, spouse, and dependent children against injury and sickness contracted during trips outside of their province of residence.

The insuring agreement protects the insured against expenses incurred due to injury or sickness, subject to the limitations and provisions of the policy.

Coverage starts when the insured leaves their province of residence after the effective date of the policy, ensuring the policy is purchased before departure.

For single trip policies, coverage ends when the insured returns to their province of residence or after a specified number of days from the departure date.

For annual policies, coverage terminates when the insured returns to their province of residence after each trip within the policy period.

A legal spouse is a person the insured has lived with in a conjugal relationship for at least 12 consecutive months.

Dependent children are defined as unmarried children under 20 years old, who are fully supported by the insured and reside with them.

Extended family members include dependent children, spouse, parents, guardians, siblings, and grandparents of the insured or their spouse.

An accident refers to an unforeseen, unintended occurrence that results from external, violent, sudden, and fortuitous causes beyond the insured's control.

An injury is defined as a bodily injury resulting from an accident while the insured is covered under the policy.

A hospital is defined as an institution with organized facilities providing care and treatment for sick or injured people, capable of diagnosing, performing major surgery, and offering 24-hour nursing service.

A supervised condition refers to a diagnosed medical condition requiring ongoing medical treatment and control with medication, lasting for at least 3 months before departure for those under 60 or 6 months for those over 60.

Traveling companions are individuals sharing the same travel arrangements with the insured, and they may be eligible for reimbursement of specific unrecoverable expenses.

The maximum payment limit represents the total aggregate amount payable by the insurer to the insured, which may vary based on individual requirements and underwriting factors.

Emergency hospital insurance covers necessary emergency hospital expenses incurred due to injury or sickness, including semi-private accommodation during the inpatient period.

Emergency Medical Insurance covers necessary outpatient emergency medical expenses such as emergency room charges, treatment by a qualified medical professional, and other approved services.

Emergency dental expense reimbursement covers necessary emergency dental treatment for injury to whole or sound teeth resulting from an accident, up to a specified limit.

Emergency prescription drug reimbursement covers prescribed drugs and medicines for injury or sickness treatment, with certain exclusions such as oral contraceptives, vitamins, and chronic care medications.

Emergency air ambulance evacuation covers the cost of emergency air ambulance transport to the nearest adequate medical facility or back to the province of residence, subject to physician approval.

Emergency air transport expenses include coverage for returning the insured home if their injury or sickness requires medical attention, as well as covering airfare for a medical attendant, spouse, or dependent child to accompany them home.

The trip interruption expenses cover non-refundable prepaid travel costs if the insured's trip is interrupted by injury or sickness, subject to a maximum limit.

Trip cancellation for medical reasons covers non-refundable prepaid travel costs when the insured cancels their trip due to a qualifying medical reason, such as injury, sickness, or death of the insured or an extended family member.

Hotel convalescence/extended stay for medical reasons covers accommodation costs after the insured is discharged from the hospital and a physician prohibits travel home.

Expenses for return of auto covers the cost of returning the insured's vehicle to their home if they or their traveling companion are unable to drive it back due to injury or sickness, subject to a maximum limit.

Repatriation benefit covers the cost of returning the insured's remains to their home province or territory after death, including preparation and a standard transport container.

The ID of deceased benefit covers the cost of reasonable travel, accommodation, and meal expenses for one person to identify the remains of the deceased in the event of death from injury or sickness while traveling.

Involuntary extension automatically extends coverage for up to 72 hours without additional premium if the insured's return to their home province is delayed due to factors such as transportation delays or inclement weather.

Travel insurance does not cover expenses incurred directly or indirectly due to pregnancy, childbirth, mental and emotional disorders (unless hospitalized), professional sports, participation in hazardous activities, and pre-existing conditions, among other exclusions.

The insurer has the right to subrogate against a third party for recovery of payments made under the policy if the insured's injury or sickness was caused by a third party's negligence.

It's crucial to contact the insurer before seeking medical services or advice in the event of an emergency, as it helps ensure that services are covered and appropriate treatment is received.

Insurers may impose a limitation on coverage if the insured fails to notify them about hospitalization or emergency surgery within 48 hours of the event.

The insured must provide original receipts for all medical expenses and submit them to the insurance company along with a completed claim form.

Travel insurance policies are subject to statutory conditions outlined in the Insurance Act, which apply to accident and sickness policies, similar to property and auto insurance.

The policy terms and provisions are subject to change and improvement by insurers, who may enhance coverage by adding benefits such as accidental death and dismemberment and assistance for out-of-pocket expenses.

Travel insurance is classified as supplemental, meaning it covers expenses that are not covered by other policies, and claims are coordinated with other insurance plans to ensure that the total paid doesn't exceed 100%.