ESSENTIAL READING FOR TRAVEL INSURANCE INDUSTRY PROFESSIONALS

International Travel Insurance Journal

Page 18 Page 40Page 21 Page 36

ISSUE 59 • DECEMBER 2005

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A new report from the Department of Transportshows the number of air rage incidents on boardUK aircraft more than doubled in the last year. IanYoungman investigates the rise in airborne anger

In 2004-2005, airlines have reported 1,486 disruptivepassengers they believed posed a threat to the aircraftand those on board, compared to 696 the previousyear. Police and security officials were called in on 406incidents, double the previous number, while 183assaults were made on passengers and crewcompared to 106 in the previous year. Five aircrafthad to be diverted and 22 had to abandon take-off

because of unruly passengers.There are now so many incidents that unless acelebrity is involved or there is serious injury,newspapers no longer regard it as news. Airlinesare keen to play down the problem, which isrising worldwide, particularly as a major cause isbudget passengers over fuelling with alcohol whileawaiting flights.Several UK insurers are therefore adding air ragecover into their policies. Travellers can now becovered against a range of injuries they might sufferat the hands of a passenger, with payouts of up to£25,000. Insurers will also pay out to those who

suffer a delay if their aircraft is diverted or delayedbecause of an air rage incident.Endsleigh Insurance specifies cover for air rageincidents in policy documents, includingcompensation for a delay due to air rage andpayment for injuries. Saga Travel Insurance coverscustomers to a maximum of £1,000 against delayon either the outbound or inbound flight, directlyresulting from violent or drunken behaviour byother passengers.Insurers outside the UK, and some within, take theattitude that infuriates brokers, travel agents andcustomers of dealing with each case on its merits.Many mistakenly believe there is rarely any delay orattack, as airlines simply eject troublesome

Air rage tackled by insurers

Over-65s deniedtravel insuranceTourists over 65 are being denied travel insuranceand, as a result, go on holiday uninsured,according to new research by the BritishInsurance Brokers’ Association (BIBA). LeonieBennett reports

More than nine million people in the UK aged over65 struggle to find an insurer or end up paying sky-high premiums, the insurance watchdog discovered.BIBA revealed that people in this age bracket couldexpect to be turned down for around 30 of the 140annual insurance policies on offer. Those who are70 years of age do not qualify for as many as 105 ofthe insurance policies on offer. A spokesperson forthe charity Age Concern criticised the findings,arguing that insurance assessments should be basedon health and not age.The company also found that over-65s have moresuccess when applying for single trip policies, withonly 30 policies out of 150 excluding them if theyare taking just one trip. However, over-65s areoften faced with high premiums, as insurers believeolder people make more, bigger claims, particularlyfor medical problems.Peter Staddon, the head of technical services atBIBA, warned older travellers not to risk travellingabroad without cover. “They need the protectionoffered by travel insurance because their claims canbe more severe,” he said. “The over-65s shouldseek help and advice to find the best policy forthem. A broker will save them time and money.Travel insurance is as important as their suitcase andthey should always attempt to arrange cover.”Despite the risk they could be turned down for travelinsurance because of an illness, BIBA advises thatolder travellers should inform insurers of any medicalconditions or they risk invalidating their insurance.

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British Columbia speeds up bed repatriationsCanadian travel health insurers haveconvinced the government of BritishColumbia to speed up the process of findinghospital beds for sick or injured travellersabroad waiting for repatriation. MilanKorcok reports

Traditionally, assistance companies will notrepatriate a patient unless an appropriatehospital bed has been secured in thepatient’s home community or province. Butsuch repatriations have been hampered byCanada’s chronic hospital bed shortage andby the provincial health authorities’ tendencyto give preference to domestic patientswaiting in emergency rooms over thosealready in hospital beds abroad. This has putconsiderable pressures on health insurerswho must continue to pay foreign hospitalsfor treatment their patients would receive forfree once in the jurisdiction of their provincialhealth authority. In the case of the US, thesefees could easily top $3,000 per day.Though the severity of bed shortages variesacross Canada, the province of BritishColumbia is generally considered to have theworst of the shortages and the longestwaiting times for beds.Reporting on continuing discussions withrepresentatives of B.C. Bedline (BCB), theprovincial bed assessment agency, THIA pastpresident Kieran Bridge noted that BCBdirector Linda Lemke agreed to immediatelyimplement new streamlined call procedures tospeed up the process for getting patients outside thecountry on waiting lists for beds. The new process would allow an insurer or itsclaims administrator or medical director to speak

directly with the patient’s attending doctor and BCBstaff on a conference call to determine the patient’ssuitability and needs for transport, withoutnecessarily involving BCB’s three medicalconsultants. BCB staff would then locate a bed forthe patient. The compulsory involvement of the

medical consultants, who do not work in BCBoffices, is cumbersome and time consuming. Thestreamlining is expected to cut down the time andred tape required to get patients back home. Inaddition, some claims are payable partly or entirelycontinued on p.4

WHAT’S INTHIS ISSUE?

REGULARSNews 1Editorial comment 4Grapevine 5Insurance matters 7Health matters 10Travel matters 12Company brief 14Air ambulance news 16News analysis: What a flu pandemic would mean 18ITIC review 20ITIC gala dinner 34ITIJ AWARD winners 36World markets: Cuba 40Profile: Michael Starko 44Hot spots 45Dick’s hotline: Beware of what you carry 45Service directory 46Smile corner 50Diary dates 51On the move 51Contributors 52

FEATURES

Who’s opinion should prevail?Part one: the hospital doctor 42

ITIJ TEAMEditor-in-chief: Ian CameronEditor: Sarah LeeSub-editor: Leonie BennettStaff writer: Hannah LangfieldDesigners: Eli Butler

Chris MarkeUS correspondent: Milan KorcokIndia correspondent: Saby GangulyLegal correspondent: Dick AtkinsConference manager: Denise ClementsProduction: Adele BrownProduction assistant: Helen WattsAdvertising sales: Jude Edwards

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Bupa travelsimplifies its serviceFor many years, health group Bupa has operated atravel insurance subsidiary as a separate business,but its underwriting and assistance services havebeen a source of confusion. Ian Youngmanunravels the complexities

Unlike almost all its health insurances, the travelproduct has always been branded Bupa, butunderwritten by SunAlliance, and then RoyalSunAlliance. Travel assistance has also beenoutsourced to the Royal SunAlliance group. Thiswas continued by FirstAssist when it bought itselfout in 2004. Further moves have seen FirstAssistreplace Royal SunAlliance as underwriters withMunich Re, resulting in more structural and strategicchanges at Royal SunAlliance than most of us cankeep up with.Bupa Travel has decided to simplify life and bring in-house all underwriting, pricing, claims and productdesign, although it will retain FirstAssist as assistanceproviders.Nick Potter, general manager of Bupa TravelServices, said: “This is a great step forward. It willenable us to be much more flexible in meeting ourcustomers’ demands and needs, especially in thecompany and corporate arena.”Bupa is reluctant to reveal premium figures, otherthan vague, hard to prove comments about havingone per cent of the UK travel insurance market. Ithas been more successful at gaining business travelthan individual. The move gives it the opportunity tobuild the business and maximise the brand name.Bupa Travel has the usual mix of individual andbusiness, trip, annual and extended period travel.What few people know is that it offers travel policiesto individuals outside the UK. With Bupa expandinggreatly in Australasia and Europe, the move in-house gives them a superb opportunity to offertravel insurance to millions of health insurancecustomers, and add travel into the health offering.It also means they can consider writing business fortravel agents, who have previously seen no merit inusing Bupa Travel, rather than dealing directly withRoyal SunAlliance.

Men forget travelinsuranceLast-minute planning of short breaks leaves almosthalf of people stressed out, new research by theUK Post Office travel services claims, and itappears that purchasing travel insurance is usuallyleft to the woman. The findings showed 46 per cent of peopleexperience high levels of stress preparing for theirholidays, while 61 per cent leave less than a weekto prepare for their trip.And it seems that women are more travelinsurance conscious than men – a third (34 percent) of men are unlikely to take out travelinsurance for a short break, compared to just 16per cent of women. For 18 per cent of those takingshort breaks, travel insurance is viewed as nothingmore than an additional expense, particularly whentrying to keep associated costs to a minimum,according to the research.

France gripped by riotingThe images of riotingyouth and burning cars inpoor Frenchneighbourhoods may takea while to fade in thecollective memory of thetourist industry, but thedamage is not expectedto create a huge much ofa hole in insurers’pockets. BarbaraCasassus reports fromParis

After two weeks of night-time violence that shookParis suburbs and anumber of large cities across France at the beginningof November, the French Federation of InsuranceCompanies (FFSA) estimated total damage at €200million, of which nearly 8,000 burnt out carsaccounted for €20 million. New figures areexpected after the rioting petered out, as a result ofthe state of emergency and curfews in the worsttrouble spots.However, there is a worry that tourists will abandonplans to visit France at the end of the year and theimpact that could have on government finances,which are already groaning under the weight ofmushrooming deficits and debt. Eleven days into the crisis, Tourism Minister LeonBertrand said the riots could damage France’s

reputation if they lasted: “It is clear that if thismovement ... continues, we will have to addressconcerns about our image.” He sought to quell fearsby asserting that France was safe to visit, since theareas affected by the violence were not on thetourist map. As for the causes of the outburst, experts from alldisciplines have been at pains to deny reports thatIslam is the problem, even though most rioters ortheir parents originated in Moslem countries. Themain causes are alleged to be poverty,unemployment and discrimination, as thegovernment has acknowledged with the raft ofmeasures it has recently adopted to tackle theseproblems.

Wilma closes 2005 hurricane seasonIn the wake of Katrina, the hurricane that killedmore than 1,200 people and obliterated NewOrleans, Hurricane Wilma received only moderateinternational press coverage even though shevirtually wiped the tourism infrastructure ofMexico’s Yucatan peninsula off the map andblacked out the southern third of Florida for manylong, hot days. Milan Korcok reports on the fallout

But in terms of its impact on tourism in Mexico andFlorida, the effects of Wilma have already had crucialshort-term effects and may cast an ominous shadowover the entire 2005/2006 winter travel season.Even before all of the lights were turned back on inSouth Florida, some of Canada’s travel healthinsurers, meeting at the ITIC annual conference inSeville, Spain, were suggesting a possible slowdownof sales to date by the 500,000 snowbirds whonormally head to Florida after mid-October for theirwinter vacation. Indeed, leaving Cancun andCozumel on Mexico’s Yucatan Peninsula in ruins,and paralysing Florida’s high-end winter tourismdestinations of Palm Beach, Fort Lauderdale,Hollywood, Miami and the Keys, Wilma closed outthe disastrous 2005 hurricane season with apremonition of what next year might bring.In Mexico, where about 35,000 European and UStourists were left stranded in primitive shelters fordays after fleeing flattened luxury beachside resorts,reconstruction will take months at the earliest,years in many cases. Here the entire tourisminfrastructure, which accounts for half of Mexico’s$11 billion annual tourism revenue, was literallyblown away. So were all the support services thattourism needs to sustain itself – police,transportation, hospitals, doctors, and food andbeverage suppliers. Almost immediately, touroperators began detouring their incoming clients toresorts on the less turbulent Pacific coast –Acapulco, Mazatlan, Cabo San Lucas. As soon aspower returned, stunned Mexicans and strandedtourists were shocked by televised images ofuncontrolled looting of appliances, beer, cars, evenpizzas, raging through the streets. Not the kinds ofreminders that would bring many tourists back.And though airports in the stricken area openedwithin days of the storm’s passage, the relief oftravellers getting out was tempered by the prospectthat there was little left to come to for those

planning high-season winter vacations along theMayan Riviera.Across the Gulf of Mexico, Florida, hit by the samestorm as devastated the Yucatan, offered a quitedifferent prognosis. In that state, where sevenmillion people had their power knocked out fordays, even weeks by flying roofs, windows,shattered signs, awnings, and broken and uprootedtrees, and where the daily routine for manyamounted to scrounging for water, candles, ice andgasoline for portable generators (never mind theircars), tourism officials put on a brave face andpredicted inevitable rebound. Unlike Katrina, which left over 1,200 dead andcaused as much as $125 billion in damages alongthe Gulf Coast, Wilma left only 14 people dead inFlorida and killed 18 in Haiti, Mexico and theBahamas. But in Florida, which since the early1990s has rebuilt to strong building codes and hasendured repeated storms, infrastructure remainedintact, few buildings or resorts were leveled(although some shut down temporarily to refit forthe peak tourism season), and supporting civilinfrastructure such as healthcare, law enforcementand traffic control returned to near normal withinweeks of power returning. Almost three weeks afterthe storm, however, many traffic lights remainedout, sand piles covered beachside roads, giganticmangrove trees lay upturned, their roots baking inthe sun. Despite the residue, tourists kept coming.The estimated $12-billion cost to insurers will makeWilma one of the most expensive storms onrecord. But few Florida officials felt the damage wasbeyond the state’s capacity to handle, except forthe intangible element of image. That would takelonger to assess.Speaking to Reuters news agency, Hank Fishkind,Orlando based economic analyst said of Wilma:“This is not like Katrina in New Orleans. We don’thave extreme damage to infrastructure andbusinesses.” Fishkind noted also that property inSouth Florida was widely insured and rebuildingand repairs fueled by insurance payments wouldspur retail sales and demand for workers. And despite sustaining massive damage from sevenkiller hurricanes in the past two years, Florida’sstate government retains substantial budgetreserves and remains financially very solid goinginto the 2005/2006 tourism season.

Editorialcomment

It was a pleasureto meet so manyof you at theInternationalTravel InsuranceConference(ITIC) in Sevillein November.The hotelAlfonso XIII wasa fabulous venue, which drew delegatesfrom all over the world. The agenda waswide-ranging and provided plenty of foodfor thought, as was evident by the numberof comments and questions raised in theopen forum sessions. The focus groupsalso provided an ideal way for nicheindustry sectors to get together anddiscuss common issues. I sat in on many ofthem and was impressed by theenthusiasm of the attendees, whosenumbers also meant standing room only insome sessions. It was also a pleasure toco-present the ITIJ awards. The winningcompanies are fine examples of how ourindustry continues to innovate and thriveeven in sometimes difficult circumstances.Elsewhere this issue, we have an analysisof the bird flu threat. Also, our WorldMarkets feature this issue focuses on Cubaand finds a country that has begrudginglyembraced tourism, but that is starting toreally appreciate its full promise. Potentialfor investment in the country’s insurancesector and the possibilities for expandingthe country’s travel insurance market arealso explored. As usual, our news sectionsbring you the latest world travel insurance,general insurance, and travel news, andour regular columnists keep you updatedwith other industry areas, such as the airambulance sector, potentially hazardoustravel destinations, and legal matters.We hope you enjoy this issue and I lookforward to meeting many of you again atnext year’s ITIC, wherever it may be.

Sarah LeeEditor

International Travel Insurance Journal www.itij.co.uk

NEWS4

Healthcare worldwideunder the microscopeMore than half the countries evaluated in a newsurvey have a good level of medical infrastructure,according to a new report published for the secondconsecutive year by Mondial Assistance Group.The company has evaluated 895 hospitals andclinics in 114 countries and 370 cities, including sixnew countries (Philippines, Azores, Qatar, SaudiArabia, Kuwait and the United Arab Emirates) and95 additional establishments since the 2004 report.The evaluation revealed that 69 have a good levelof medical infrastructures, including 15 in Asia Pacific,18 in Africa and the Middle East, 19 in Europe and

17 in Latin America. Compared to the evaluation in2004, this year’s situation is considered stable.The number of average establishments hasprogressed from 30 to 31.8 per cent, while thenumber of acceptable establishments has increasedfrom 32 to 34.8 per cent. In contrast, the numberof excellent establishments has decreased from 38per cent to 33.4 per cent in 2005. A total of 73 percent of all establishments maintained the sameposition as the previous year, while 15 per cent sawtheir ratings drop and 12 per cent recorded animprovement.“Due to this continually updated survey, we have allthe information we need to make the best decisionsfor our patients, according to their illnesses and theimmediate medical resources available,” said GuyBellaiche, medical director of the Mondial AssistanceGroup. “More often than not, an immediatemedical repatriation does not represent the bestsolution because there is the additional worry as towhere to transfer the patient to the best, nearbyquality establishment.”The information available regarding these countriesand the healthcare facilities is available on Mondial’sintranet site for the 500 doctors and personnelresponsible for managing these medical cases. Thedatabase provides details gathered within eachestablishment, such as quality of healthcare, hygiene,equipment, personnel, contact with local doctors,administrative data and languages spoken.

Tourism underthreat in Zanzibar

Zanzibar, the famous tourist island onthe eastern coast of Africa, is underheavy military surveillance after riotingtook place following the victory bycurrent President, Amani AbeidKarume, in the recent elections. Theisland receives over 115,000 touristsper year, but hotels and beachesremain vacant with only a fewtourists, as the heavily armed securityforces patrol the streets and targetareas believed to harbour membersof the opposition Civic United Front.

Tourism is the only source of real economicrevenue for the island after the falling price of spiceexports forced the government to concentrate onthe tourism trade. However, concerns frompotential visitors about the political stability ofZanzibar are hampering efforts to improve theisland’s image for visitors.“It is unfortunate to find this beautiful island plungedinto chaos at this time when tourism is picking upwith more tourists worldwide looking to visit itsbeautiful beaches and enjoy its rich heritage,” said anItalian hotel investor on the island.The National Democratic Institute, a US-basedelection organisation, said that their team witnessedmultiple voting, underage voting, illegal voting bymilitary personnel and failure by electoral authoritiesto release the voters’ register to the public beforethe election.Observers believe that tourism to the island willsuffer a further slump after the opposition party’spresidential candidate, Seif Shariff Hamad, vowednot to recognise, or co-operate with, Karume’snew government following the election. Expertsbelieve this will see an escalation in the violence thathas already seen more than 30 people shot andinjured by the police.

passengers at the next stop.Cover applies to ‘innocent’ passengers, not air rageperpetrators, but insurers become vague when askedabout the situation where over-zealous securityguards delay an ‘innocent’ passenger by mistake.Earlier this year, Chubb Insurance added air rage toits special policy for well-off individuals and coverincludes the cost of counselling if caught up in an airrage attack. Other travel insurers include a helplineoffering legal advice and stress counseling followinga hijack or mugging – adding air rage incidents tothis would be sensible.

Air rage tackledby insurers

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Kenyan ministerblasts travel alertsKenyanTourism andWildlifeministerMorrisDzoro hasdemandedthewithdrawalof traveladvisoriesagainstKenya bythe US and Japan. He condemned the recentupdate on travel alerts, describing them as unfairand unrealistic.He said: “It is disheartening to note that updatingthese travel advisories against Kenya is putting thecountry in a bad light.”The US government issued a recent publicpronouncement against Kenya, alerting its travellersof potential violence related to the referendum inKenya on 21 November. Meanwhile, Japaneseofficials also issued a general warning and voicedtheir concerns over the alleged worsening securitysituation in the country due to the ongoingcampaigns on the proposed constitution.Mr Dzoro said the Kenyan government hadimplemented measures to ensure peace andsecurity in the country and added that there wasno reason for foreign visitors to be alarmed. Hesaid that appropriate action had been taken tonullify the isolated incidents of trouble during thecampaigns, adding: “The government is taking allpossible measures to ensure that the campaigns arefree of violence and it has already taken action inisolated cases.”He warned that the renewal of travel alerts had anegative impact on the tourist market as a whole.

by patients because of exclusions, and so manywant to return home as quickly as possible. Bridge noted that THIA is continuing its discussionswith BCB to establish a long-term health ministrypolicy that no patient seeking repatriation from theUS should wait more than 48 hours for a bed, andthat overseas patients should not wait more than72 hours. Although BCB does not allocate or rationbeds, it does work with hospitals and regionalhealth authorities to determine what beds areavailable to provide specific types of care andBridge says Ms Lemke has expressed support forsuch a policy.

British Columbiaspeeds up bedrepatriations

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www.itij.co.uk International Travel Insurance Journal

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GGRRAAPPEEVVIINNEE Tourists warned towatch out for spiesUK tourists are being warned by MI5, the Britishintelligence service, they are at risk from spiesabroad and it has published advice on its websiteon how to prevent being duped. It claims peopleshould be on their guard at all times: “Lavishhospitality, flattery and the ‘red carpet’ treatmentare used by some intelligence services to soften upa target for recruitment who may then feel obligedto co-operate rather than offend the hosts.” MI5 also urges caution when it comes to holidayromances, as having sex with a stranger couldmake them vulnerable to blackmail. Tourists arewarned to be careful when discussing nationalsecurity within earshot of hotel staff or taxi drivers,who in some countries are required to report tothe local security service. MI5 believe a widevariety of people could be of interest to foreignintelligence forces, including politicians, businessmenand women, civil servants, police and scientists. Tourists are even being told to be alert on theirreturn to the UK and should consider contactingtheir organisation’s security co-ordinator and/or thenearest British Mission, however trivial it mayseem, if they come across people who prefer tomeet face-to-face, want to become friends, or askpersonal questions. A senior Whitehall official said: “Espionage is andremains a threat to the national security of the UKand MI5 is reminding people going on holidaysabroad that it is not just spies and politicians but alsobusinessmen and academics who do notnecessarily see themselves as of interest to foreignintelligence services.” The MI5 advice adds: “We estimate that at least 20foreign intelligence services are operating to somedegree against UK interests. Of greatest concernare the Russians and Chinese. The number ofRussian intelligence officers in London has not fallensince Soviet times.”

No ticket necessaryIn this age of heightened security aboard planes,it sounds unbelievable that a New Jersey manrecently managed to get on an American Airlinesflight from Newark to Fort Worth without hisboarding pass – but he did. The man, identified as Danis Ballard, was foundand taken off the flight before it took off after aheadcount at the beginning of November. Theman had been able to board by showing staff aprinted flight itinerary as a pass. He was chargedwith criminal trespass, but questions have arisenas to who is to blame: the airline or theTransportation Security Administration (TSA). Thecarrier said the blame should be placed on theTSA, but the TSA countered that they were notresponsible for matching passengers IDs withboarding passes. In the end, whoever is at ‘fault’,the most important thing is to ensure a lesson hasbeen learnt.

What’s in a name?

We will never forget Katrina or Wilma, but whatwill the next hurricane be named? It’s a tricky onebecause the World Meteorological Organisationsays it has run out of names for hurricanes! In 1951, a method using the phonetic alphabet asa way to identify storm was adopted. There aresix lists of 21 names used in rotation and thenames alternate between male and female.The letters q, u, x, y and z are missed outbecause there are not enough short, distinctivenames starting with these letters. If a storm isparticularly deadly, the name is taken out ofrotation: On the 2001 list, Lorenzo replaced Luisand Rebekah replaced Roxanne. This year, it issuspected Katrina and Wilma will be replacedtoo. Officials have said they might have to startusing letters of the Greek alphabet… so look outfor Alpha!

Bird flu used byimpersonatorsFarmers in Turkey are being warned of thievesposing as veterinary experts investigating bird fluto con them into handing over their chickens, aTurkish agricultural official said.People claiming to be agriculture departmentagents have turned up in villages in thenortheastern province of Igdir to collect chickensfor ‘tests for the presence of avian flu’, localagriculture official Aysel Agayar said. “There is no avian flu in Igdir. Neither thedepartment of agriculture, nor the governor’soffice nor the local council are collecting chickens.Our citizens should not give their poultry toanyone,” Agayar added.

Tour operators at riskfrom extreme sportsThe increasing passion for extreme snow sports iscreating an environment that is continually pushingtour operators and insurers to take more liability risks,according to an expert on travel and tourism law.Michael Gwilliam, head of the Travel and Tourism unitat Vizards Wyeth solicitors, warns operators tobeware of taking on more dangerous excursions to

sate the appetite of thepublic for thrills whenon the slopes. He said:“Once upon a time, off-piste skiing wasconsidered daring, thesedays it is commonplaceand the torch-lit descentis tame. But touroperators providing

more varied, and risky, winter sports activities shouldbeware as they may be incurring extra injury liabilitywithout realising it.”“In resort, holidaymakers are enticed with extraoptions, such as excursions for heliskiing, cross-country skiing, recreational racing, bob sleighing, iceskating and tobogganing, to name a few. Touroperators are offering excursions of an increasinglyrisky nature, and need to be doubly confident thatthey will not be left open to liability in the event of anaccident,” he added. “Many tour operators believethat an excursion, booked and paid for in resort, is notpart of the UK package and that they areconsequently absolved of liability. This is not alwaysthe case. Tour operators may still be held liable as theexcursion may be considered a separate contract.”Vizards Wyeth has published a newsletter for travelagents, tour operators and travel insurers, entitledRiSki Business, which highlights some of the legalproblems that can arise through skiing holidays andadvises on steps travel companies and their insurersshould take to reduce the risk of expensive incidentshappening to them and their employees.

Travel insurancemore vital than everTourists are frequently targets of crime when abroad,making travel insurance even more of a necessitythan ever, according to Lloyds TSB insurance. Thetotal cost of theft to holidaymakers from the UKcould be as high as £200 million for this year alone,a survey by the insurance provider added.The survey revealed that a third of theft occurred inhotels, while a fifth of tourists were confronted inthe street and had items such as cameras andmoney stolen. One in ten of these people said thatthe instances of theft had ‘ruined’ their holiday.Phil Loney, Lloyds TSB managing director, said: “It isabsolutely vital that anyone travelling abroad, checks,checks and checks again that they are insured.”

Double tragedystrikes in IndiaIndia was recently struck by two tragedies in oneweekend as a bomb blast in Delhi killed more than60 people, before a train crash south of Hyderabadleft 113 people dead.The terrorist attack saw three bombs explode atdifferent locations in the Indian capital Delhi on themorning of 29 October. The blasts left over 60people dead, with two going offalmost simultaneously in marketscrowded with shoppers in central andsouth Delhi, while a third hit theGovindpuri section of the city. Afurther 100 people were injured,many seriously, in the busymarketplaces as people prepared forthe Hindu Festival of Lights known asDiwali and the Muslim festival of Eid.Earlier on the same day a train derailed south ofHyderabad, in the southern state of Andhra Pradeshand plunged into a river swollen by recent rains.Rescuers recovered 113 bodies from the wreckage.Indian Prime Minister, Manmohan Singh, describedthe blasts as terrorist attacks and promised to huntdown those responsible. Suspicions have focusedon Muslim groups opposed to the recentimprovement in relations between India andPakistan over Kashmir (See Hot spots – Af ter theearthquake: Hope for India and Pakistan,p.33). The two countries opened the border tospeed relief efforts following the recent earthquakein the region and have taken steps to allow long-divided families to visit their relatives.

UK man killed afterrebel attack in UgandaA British man was killed during a rebel attack on agroup of tourists in Uganda’s national park at thebeginning of November. The rest of the groupwere taken hostage and robbed, but later released.Keith Steve Willis, who ran a safari camp in the area,had been travelling with UK and New Zealandholidaymakers through Murchison Falls Park whentwo rebels from the Lord Resistance Army (LRA)ambushed the vehicle and opened fire. Mr Willis diedinstantly. Three of the tourists, part of a group oftravellers on a rafting holiday from Egypt to thesource of the Nile, were injured in the shooting andwere treated in the northern Ugandan town of Gulu. According to a spokesperson for the UgandanArmy, Lieutenant Chris Magezi, the incident was nota deliberate strategy by the rebels to target tourists;they had simply ‘bumped into the vehicle’.In recent months there have been an increasingnumber of attacks on foreigners in retaliation forarrest warrants issued against LRA leaders. TheUgandan army and Wildlife Authority said it isstepping up patrols in the area.

Cognac for creditcard thievesCredit card fraudsters’ specific spending patternsmay improve the chances of cutting crime in thefuture. According to Retail Decisions, a fraudprevention software company, UK credit cardfraudsters like to spend their ill-gotten gains primarilyon one-way business class flights, pricey digitalcameras and camcorders and caseloads ofCourvoisier cognac. American fraudsters, on theother hand, prefer to go for gift cards, cashmere,exercise equipment and baseball paraphernalia. The stereotype that has been given for the averagecredit card bandit on each side of the Atlantic is amale city dweller with a Yahoo or Hotmail emailaccount and a penchant for buying electronic goodsin bulk. In the US, fraudulent transactions tend to befor 5.7 times the value of a genuine purchase, whilstin the UK, the fraudster displays a slightly more

restrained patternof purchase,spending 3.5times the amountof a validtransaction.Fraudsters like tospend theirprocured wealthon eccentric,expensive andeasily re-saleableitems. With such profiles

on offer, both UK and US retailers stand a betterchance of fighting Internet and telephone card theft.The data from Retail Decisions was based on figuresfrom 100 retailers, including US and UK high-streetnames hit by ‘card-not-present’ scams. This type ofscam has been highlighted as the largest type of cardfraud in the UK, amounting to £150.80 million inlosses last year.

International Travel Insurance Journal www.itij.co.uk

NEWS6

Alcohol a majorcause of ski accidentsAccording to latest research from the Foreign andCommonwealth Office (FCO) in the UK, more than athird (36 per cent) of young skiers and snowboardersget into trouble abroad due to the ‘lethal combination’of alcohol, altitude and adrenaline.A poll of 1,000 people found that nearly 45 per centof young people are not aware that alcohol can affectyou more quickly when drinking at high altitudes,such as at many popular ski resorts. Of the 36 percent of people who drank themselves into trouble, athird injured themselves, over two thirds were finedfor causing damage and over half were even asked toleave the resort, according to the FCO. Even more interesting to travel insurers, over 30per cent fail to take out travel insurance that coversthe sports they intend to take part in, and two thirds(66 per cent) would not bother taking photocopiesof important documents, suchas their passport and creditcard details. The FCO’s Dean Hurlocksaid: “Winter sports holidaysare becoming more andmore popular with youngpeople but many don’t realisethe dangers of drinking on thepiste. If you injure yourselfwhilst under the influence ofalcohol, it is very likely yourinsurance policy will beinvalid. This could mean highcosts – if you break a leg on the Alps, a trip in an airambulance and treatment could set you back£10,000. “Being aware of this and making some simplepreparations, like ensuring your insurance policycovers you for everything you are likely to do, couldmean the difference between a holiday toremember and one you’d give anything to forget.”

Jordan hotels hit by terroristsAt least 57 people were killed and hundreds injuredin terrorist attacks on three hotels in Amman, thecapital of Jordan on 9 November. Suicide bombersare suspected of carrying out the bombings at theRadisson, Grand Hyatt and Days Inn hotels. Al-Qaeda has claimed responsibility for the attacks.Since the attacks, security in the country has beenheightened and its land borders shut. A statementfrom the Rezidor SAS hospitality group soon afterthe attack confirmed that their hotel had beentargeted after abomb exploded atthe Radisson. Thecompany said:“This was one of aseries of explosionsin the city. Theextent of thedamage and thenumber of injuriescannot beconfirmed at thistime. The hotel isworking closelywith the localauthorities and emergency workers to provide aidto those who were injured. Guests have beenevacuated and the hotel is working to ensure theirsafety and security.”To some extent, the bombings were notunexpected. It follows several smaller attacks in thecountry, most recently in Aqaba on the Red Sea.However, what set these attacks apart from othersis that it seems to be the first attack in Jordan bysuicide bombers.In a country that relies heavily on the incomegenerated by tourism, this attack is sure to haveeconomic repercussions. Latest tourism figures forJordan show a nine per cent growth in the first sixmonths of 2005, after reaching 2.8 million in 2004,a 21 per cent increase over the previous year.

Tourism contributes more than US$803 million tothe country’s economy, equivalent to about 10 percent of Jordan’s GDP.The World Tourism Organization (WTO) has addedits condemnation of the bombings and said it was‘shocked’ by the terrorist attacks.In a letter to the Jordanian Minister of Tourism andAntiquities, Dr Alia Hatough-Bouran, WTOSecretary General Francesco Frangialli said: “Wewere shocked and saddened to hear the news of

the bombings andwould like toconvey ourheartfelt sympathyto the bereavedfamilies of thevictims and to thegovernment ofJordan.”He also promisedthe minister “anyaid you may needin assessing thesituation orsupport that could

help Jordan recover from this tragic situation.”Amr Abdel-Ghaffar, WTO Regional Representativefor the Middle East, added his belief that tourism willnot bow down to the bombers. He said: “I amconfident of the capacity of the Jordanian tourismindustry to recover quickly and strongly.”These sentiments were echoed by the World Traveland Tourism Council (WTTC), which added that itwas ‘deeply saddened’ by the suicide bombings.Jean-Claude Baumgarten, WTTC President, said: “Ourhearts go out to all Jordanians at this difficult time. Wefully condemn this attack, which was not an attack ontravel and tourism, but an attack on humanity itself. Wepledge our full support to the government of Jordanand the ministry of tourism as they come to terms withthis tragedy and move forward.”

Old Mutual facesinvestigationSouth Africanfinancial servicesgiant, Old Mutual, isto face aninvestigation by theStockholm StockExchange todetermine if their bid for Swedish insurer Skandiafollowed best practice. They could even refer thematter to Sweden’s securities council who, althoughthey don’t have the power to fine or punishcompanies that break their code, play a large part inbest practice operations. Details into the investigationof Old Mutual’s Skr45 billion ($6 billion) cash-and-shares bid have not been disclosed. The mostinformation that has been sought expresses concernregarding leaks amongst other things.Although Old Mutual only formally announced itstakeover bid for Skandia at the beginning of September,the media have been following talks between the twocompanies as far back as May. The worst that canhappen, however, is a letter of reprimand, as OldMutual is not listed in Sweden. Old Mutual said: “Wehave not been notified of any formal inquiry, but wewould welcome one and we will cooperate fully.”

IIABA adopts newdisclosure policyAfter a year that has seen scandals galore withregards to contingent commissions, the nationalboard of the Independent Insurance Agents andBrokers of America (IIABA) has adopted a newpolicy on producer compensation disclosure bycarriers. The policy seeks to avoid disparate andconflicting company requirements, and to encouragecarriers to consult with IIABA before implementingany producer compensation disclosure.“Insurance agents, brokers and companies must allmake independent decisions about whether andhow to disclose the way they are compensated,”said IIABA CEO Robert A Rusbuldt. “Werecognise this fact, and we acknowledge thateveryone in the industry must take all necessarysteps to comply with their legal obligations. Butwe also recognise that a wide range of divergentcompany requirements could create inefficienciesthat would disrupt the way insurance agencies andbrokerage firms do business, and that is what wehope to avoid.”The national board policy encourages insurers tohave their disclosures notify insurance purchasers inthe following instances:• The insurance policy was placed by anindependent insurance agent or broker, not anemployee of the company.• The company believes it is efficient and effectiveto distribute its policies through independentinsurance agents and brokers.• The agent or broker that is placing the policy withthe company may receive commission for thatplacement.• If applicable, the agent or broker may be eligibleto receive additional incentives.• Any questions about the nature of the compensationshould be put directly to the agent or broker.“This policy makes it clear that we fully encourageall carriers to fulfill their obligations under the lawand to the public, and to do so in a way thatrespects the business needs of the independentagent and broker that sells their products,”commented William G Stiglitz III, president ofIIABA. “We will continue to reach out to thecompanies and provide them with input as theymake decisions about producer compensationdisclosure. Working together on this issue will helpthe industry and the public.”

US must wake upto catastrophesWhat if, while Katrina was pounding New Orleans,California had been hit by an earthquake? Actuallythis did happen, and there were three on the sameday. That is an example of one of the messages thatpersonal lines insurer Allstate is delivering.In a new campaign, Allstate has taken a stand to raiseawareness and spur a national dialogue about betterpreparing and protecting Americans from catastrophicevents. The campaign offers ideas about how UScitizens can help better manage their nation’sresponse to devastating events before they strike.“Allstate is a vocal proponent of developing a newway for how America deals with catastrophes andthis campaign is intended to bring our message toconsumers,” said Thomas J Wilson, president andchief operating officer. “The risks we all face fromnatural disasters are on the rise. In order to helpordinary Americans manage those risks and thefinancial consequences that result fromcatastrophes, a stronger public-private partnershipat the local, state and federal levels must be forged.Insurance companies and individual Americanscannot solve this problem alone. Stategovernments and our leaders in Washington musthelp develop a solution. The damage fromcatastrophes can be mitigated. But the countrymust act now – before another catastrophichurricane or a major earthquake strikes.”

Network risk asignificant challengeAccording to the latest Corporate BusinessBarometer, conducted by the Economist IntelligenceUnit, and sponsored by Ace USA, companies areincreasingly concerned with identity theft and thethreat to corporate data security. The survey gaugedthe opinions of 230 senior risk managers in Asia,Europe, and the Americas, who rated network risk asignificant threat facing them today. “The combination of increased consumer concerns,growing criminal threats and tougher regulations hastransformed corporate data security from just anotherproblem for the IT department to a crucial riskmanagement challenge for the whole enterprise,” saidBrad Gow, vice president of Ace USA ProfessionalRisk. “Data security threats are continually evolving.Without a constant focus on actively managing dataand protecting personal information, data securitybecomes a growing challenge not just from atechnological standpoint, but also from the perspectiveof legal liability, regulatory compliance, corporatereputation, and, ultimately, profitability.”The survey also revealed that making a seniormanager responsible for monitoring regulatoryactivities was critical to the organisation’s financialwellbeing and strength.

Yet more Spitzer subpoenasNew York Attorney General Eliot Spitzer’sinvestigation is certainly experiencing a second wind.In last month’s ITIJ, (ITIJ 58, November 2005, EliotSpitzer keeps industry on its toes) we reported onthe furthering claims against Marsh & McLennan andnow we have learnt of yet more subpoenas.Californian-based ABD Insurance & Financial Servicesand Cleveland-based CBIZ Benefits & InsuranceServices Inc. said they received subpoenas from

Spitzer at the end of October, requesting informationregarding their compensation practices. CBIZ Inc. noted in a statement that its insurancebrokerage unit has not been named or referenced inany lawsuits stemming from any investigation and thatit believes its compensation arrangements areappropriate and in compliance with all existinginsurance industry laws and regulations. Both firms have agreed to co-operate with Spitzer.

ermuda-based Max Re Capital Ltd has issued apreliminary statement indicating that, despite

recent natural catastrophes, it hopes for a net incomefor the first nine months of the year to be between $10and $20 million – the figure includes an estimatednegative impact on earnings of $90 million fromHurricane Katrina and $20 million from Hurricane Rita.

tandard & Poor’s Rating Services has raised itslong-term counterparty credit and insurer financial

strength ratings on Sweden-based If P&C Insurance Ltdand Finland-based If P&C Insurance Co Ltd, the coreoperating entities of the If P&C Insurance Group, to ‘A’from ‘A-’. The rating outlook is stable.

unich Re Group, which has a total stake of 18.3per cent in HypoVereinsbank, has accepted

UniCredit’s exchange offer. On completion of theexchange, Munich Re Group’s stake in UniCredit will beat least 6.3 per cent, approximately half of which will beheld by Munich Reinsurance Company and half byERGO Versicherungsgruppe AG. It will not be possible toquantify the exact size of the stake until it is clear towhat extent the shareholders of HypoVereinsbank, BankAustria Creditanstalt and Bank BPH have acceptedUniCredit’s exchange offer.

wo more former directors of Equitable Life havereached a settlement with the society. Now

negligence and breach of duty claims are continuingagainst 10 individuals compared to the original 16.

xa is to pay $17 million to compensate thedescendents of victims of the Armenian killings of

1915. Axa will pay $11 million into a fund tocompensate the descendants of Armenian victims whohad insurance policies with companies since acquired bythe French group. It has also agreed to pay $3 million toArmenian charities based in France, with another $3million for fees. Meanwhile, Standard & Poor’s hasaffirmed its ‘AA-’ insurer financial strength ratings on AxaRe and its subsidiaries Compagnie Generale deReassurance de Monte-Carlo, Axa Re Asia-Pacific PteLtd and Axa Corporate Solutions Insurance Co. Theoutlook on all is positive.

ontpelier Reinsurance Ltd has been downgradedto ‘A-’ from ‘A’ by A.M. Best, after concernsabout the property catastrophe reinsurer’s

hurricane losses. Bermuda-based Montpelier, which hasestimated its losses from Hurricane Katrina at between£450 million and $675 million, has recently raised $600million in a share issue. Although successful, A.M. Bestbelieves a reduction in the company’s risk profile and/oradditional capital over the near term will be necessary tostabilize the current ratings.

osemont Reinsurance Ltd has been downgraded to‘B’ from ‘A-’ by rating agency A.M. Best. The move

follows the announcement that the reinsurer may beplaced in runoff after attempts to raise new capital orsell the company failed.

hubb’s reinsurance business will be moving toBermuda. The Chubb Corp. and investment firm

Stone Point Capital LLC announced the formation ofHarbor Point Ltd, a global reinsurance company. It thenhopes to acquire the ongoing business of Chubb Re, Inc.,a Chubb subsidiary.

he National Association of Professional InsuranceAgents has debuted a Spanish language website to

provide additional service to members of the associationwhose primary language is Spanish – the PIA LatinoAgents Community Center.

isk Management Solutions has increased itsestimate for US insured losses from hurricane

Wilma to $8 to $12 billion, from its original estimate of$6 to $10 billion. The new estimate includes onshoredamage resulting from wind and coastal storm surge,business interruption, and increased costs for materialsand services needed for repairs.

llmerica Financial Corp. has changed its name toThe Hanover Insurance Group Inc. and will trade

on the New York Stock Exchange. Allmerica is a holdingcompany for insurers including The Hanover InsuranceCompany and Citizens Insurance Company of America.

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INSURANCEMATTERS 7

Strong P&C displayforecast for 2007Property and casualty (P&C) insurance industry resultsshould be relatively strong from 2005 through 2007,despite 2005’s hurricane activity and an increasinglycompetitive market, according to a new report byConning Research and Consulting, Inc.“While the effects of the 2005 hurricane season willbe dramatic, and are not yet fullyrealised, we still anticipate thatindustry-wide insurers will reportstrong results for the 2005-2007period,” said Clint Harris, analyst atConning Research & Consulting.“Property and casualty industryperformance will degradesomewhat over the next threeyears due to increasing pricecompetition, but it will still be strongby historical standards.”The Conning Research report,Property-Casualty Forecast & Analysisby Line of Insurance-Third Quarter2005, provides projections of keyunderwriting and financial results forthe entire property-casualty industry as well as themajor lines of business.“Our detailed forecast for the property and casualtyindustry and its major lines of business has beenmodified in the third quarter edition with anincreased expectation for losses,” said StephanChristiansen, director of research at ConningResearch & Consulting. “Conning’s forecast variesby line of business but generally assumes increasingcompetition in 2005 for most lines of business andaccelerating price competition for a number ofcommercial lines in 2006, with a possiblecontinuation to 2007 for some. While thecatastrophes will mitigate price competition insevere windstorm exposed areas, the broader trendis toward continued softening.”

hree Lions underwriting Ltd has been appointedrepresentative of Great Lakes Reinsurance (UK)

Plc, Hiscox Insurance Company Ltd and Hiscoxunderwriting Ltd, which are authorised and regulated bythe FSA.

xis Capital Holdings reported a third-quarter netloss of $468.1 million, or $3.32 per share, after

the Bermuda-based insurer and reinsurer suffered bighits from Hurricanes Katrina and Rita. A year ago, Axismade $6.3 million, or four cents a share. Net lossesfrom Katrina and Rita were $804.5 million for thequarter, Axis said. Katrina alone cost the company$723.6 million. Operating losses, which exclude netrealised investment gains and losses, came in at $462.2million, or $3.27 a share, the company added.

artner Re Ltd has estimated that its exposure tolosses in Florida from Hurricane Wilma will be

approximately one per cent of the total insured loss –currently estimated at between $4 billion and $10billion. Partner Re also said it would face claims forapproximately three per cent of the estimated $2 billionto $2.5 billion total insured loss in Mexico.

unich Re and Württembergische Leben haveagreed on the sale of the Karlsruher Insurance

Group. As a result, Munich Re will sell its 90 per cent-plus stake in Karlsruher Leben to WürttembergischeLeben. For Munich Re, the aim was to find a future-oriented solution for all parties concerned. With this newpartnership between Württembergische Leben andKarlsruher Leben, a new group emerges, which bycombining the shared strengths of the twocompanies,has a greater competitive edge.

.M. Best has affirmed the financial strength ratingof ‘B++’ and issuer credit rating of ‘BBB+’ of

Converium AG. The outlook for all ratings remains stable.The rating agency believes that Converium is likely toreturn to profit in 2005.

urich Financial Services Group (Zurich) announcedthat, based on preliminary assessments, it expects

aggregate claims payments related to Hurricane Katrinaof approximately $600 million after tax. This figure is netof reinsurance recoverables. The task of estimatingKatrina claims payments at this stage involvesconsiderable judgment calls. Since claims adjusters wereable only recently to access the areas affected byKatrina, the current estimate is based on a combinationof analytical approaches as well as calculations includingexposure models and actual loss appraisals.

annover Re anticipates a net loss burden resultingfrom the recent hurricanes of €250 million before

tax. It is noted that the financial year had alreadywitnessed an above-average intensity of major claimsprior to Hurricane Katrina. As has been explained onprevious occasions, Hannover Re bases its profitexpectation on a number of factors – including projectedmajor loss expenditure in the order of six per cent of netpremiums earned in property and casualty reinsurance.This figure reflects the multi-year average burden ofmajor losses.

kandia AB, Sweden’s largest insurer, and the targetof a takeover attempt by Old Mutual Plc, has

announced that its Q3 sales increased 34 per centbecause of higher sales of unit-linked insurance productsto 32.4 billion kronor (US$4.1 billion) from 24.2 billionkronor a year earlier.

mlin plc has formed a reinsurance company inBermuda with capacity of $1 billion, and its

Lloyd’s of London syndicate 2001 has increased itscapacity for 2006 by 17.6 per cent to £1 billion ($1.77billion). The company intends to be up and running by 1January 2006, and will focus on underwriting regional USand international catastrophe reinsurance, the groupsaid.

arsh & McLennan has said that Q3 profit hastripled, the first increase since the company gave

up contingent commissions. Net income rose to $65million, or 12 cents per share, from $21 million, or fourcents per share, a year earlier. The company set aside$232 million a year earlier to settle a lawsuit from EliotSpitzer.

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Good results forLatin AmericaAccording to a recent report by Standard andPoor’s Rating Services (S&P), Latin Americaninsurance companies have maintained adequateprofitability in recent years, despite the challengespresented by their economic environment, and areworking to improve performance.The report, entitled The Evolution of Profitability InThe Latin American Insurance Industry, says thedifferences in profitability from country to countryare linked to the development stage of eachcountry, regulatory issues and the segmentbreakdown in each market and provides detailedinformation on insurance markets in Brazil, Mexicoand Chile. “Trends toward sound underwriting conditions,price increases, more efficient use of reinsurance,and cost controls are reflected in strengthenedunderwriting earnings,” S&P notes. “Insurers,however, still have to demonstrate the capacity tocapitalise from these changes and to increaseunderwriting profits, as financial income remains animportant driver of bottom-line results in most ofthe countries.”

A guide to D&Oliability worldwideProving that directors and officers all over the worldare accountable for damages, not just those in theUS, Willis Group, the global insurance broker, haspublished The Willis Worldwide Directory of Directors’and Officers’ Liability. The publication is a uniqueguide detailing the potential personal liabilities of

directors in 51countries in Africa,Latin America,North America,Asia, Australia,Europe and theMiddle East.“It is vital for seniorexecutives toidentify andunderstand theirliabilities whenconsideringinternationalexpansion oracquisition activityand prior to

accepting overseas board appointments. The WillisD&O team, bringing its specialist knowledge, haspartnered with leading law firms around the worldto bring this material together in one easy tomanage reference tool,” Willis said in a statement.“With the number of claims against directors andofficers reaching an international all-time high, this600-page compendium, the most extensive of itskind to date, will be an invaluable reference forsenior level executives, corporate counsels,company secretaries and risk managers.”The publication, which will give readers importantinformation as well as a competitive edge, provideschapters on each jurisdiction, setting out key issuesas well as matters relating to corporate governanceand regulatory requirements.

EC ups the ante onthe IMDThe European Commission has decided to launchinfringement procedures against the 10 EU memberstates that are yet to implement the InsuranceMediation Directive (IMD). The Commission hasnow sent so-called reasoned opinions to thecountries that have yet to adopt the directivesnearly 10 months after the 15 January 2005deadline.The countries yet to implement the directiveinclude Belgium, France, Germany, Greece, Italy,Luxembourg, Malta, the Netherlands, Portugal andSpain. Delays in adopting national legislation inaccordance with the directive is creating legaluncertainty and confusion over insurance brokers’rights to operate in other EU countries. EuropeanCourt of Justice rulings mean it is likely that brokerscan claim damages directly from governments ifthey are not able to operate in other EU countriesand consumers can also claim damages fromgovernments for not being protected by thedirective.David Harari, chairman of the European Federationof Insurance Intermediaries’ (known as BIPAR) EUcommittee, said: “It is about time. I congratulate andsupport the efforts of the Commission to ensurewithout more delay the implementation of theInsurance Mediation Directive, which is crucial forbringing about a meaningful Single Market forinsurance intermediaries.”The British Insurance Brokers’ Association’s (BIBA)regulation and compliance manager, Steve White,added: “We entirely support the position taken byBIPAR and wholeheartedly applaud the decisiontaken by the EU Commission. The UK insuranceindustry has already fully implemented the IMD andat BIBA we are heartened by the Commission’shard stance on members who are dragging theirheels.”So far, just 60 per cent of EU member states haveadopted the directive, making it one of the mostpoorly implemented measures of the FinancialServices Action Plan agreed by heads ofgovernments in June 1999. French brokers havealready suffered as a result of delays by theirgovernment and were recently refused passports tooperate in the UK and Spain.BIPAR is urging the Committee of EuropeanInsurance and Occupational Pensions Supervisors(CEIOPS) to agree provisional arrangements toallow all EU brokers to benefit from passportingrights. It is also asking CEIOPS to liaise with theCommission to issue information on theconsequences of failing to implement the directivefor brokers.

www.itij.co.uk International Travel Insurance Journal

INSURANCEMATTERS 9

Surfing over emaillawsA study into the new laws regarding privacy andelectronic communications has found that thegeneral insurance sector is one of the worstindustries for flouting email privacy laws.The European directive, brought in two years ago,regarding email privacy laws, bans companies fromsending unsolicited email messages. Companies canonly send email messages to non-customers whohave actively chosen to receive them. Wheneversomeone’s details are recorded – such as in amoney-off promotion or a competition – they mustbe asked if they want to receive further marketingmessages. However, 34 per cent of the UK’sleading consumer-focused companies are still failingcomply, says data management company CDMS. The CDMS study, which looked at 200 of thebiggest consumer businesses, found great variationbetween sectors. Banks were the only sector with100 per cent compliance, while general insurershad the lowest rate at only 15 per cent. Phil Jones, assistant commissioner at the InformationCommissioner’s Office (ICO), commented: “Weare seeing very little in the way of complaints aboutbig established UK companies. Although they maytechnically be in breach of the rules, they do notappear to be sending messages in a way that isprovoking people to complain. Most of ourcomplaints tend to be about smaller, more

ephemeral companies.”Companies that breach dataprivacy can be fined up to£5,000, but no penalties havebeen imposed as yet by theregulator, partly because ofthe cumbersome courtprocedures involved. TheICO is, however, asking thegovernment to increase itspower from next year.

US terrorism insurance extendedTo the great relief of America’s insurance industry,the US Senate has passed legislation that wouldextend the Terrorism Risk Insurance Act (TRIA) –backstopping terrorist-related catastrophicinsurance losses – beyond its scheduled 31December 2005 scheduled cut-off date. MilanKorcok weighs up the extension

TRIA was put in place by the Bush Administrationand Congress in 2002 to stabilize the insurance, real

estate and constructionindustries in the wakeof 9/11. Originallyintended as atemporary measure,TRIA was due toexpire at the end ofthis year, but strongadvocacy by theinsurance industry, andmany legislators, kept ita priority issue,although theAdministration hasinsisted on reducing

the federal role by raising deductibles, limitingcoverage, and raising the levels at whichgovernment subsidies kick in.Despite these limitations, the Senate version of thebill, which extends TRIA through 2007, requires thegovernment to cover 90 per cent of property andcasualty losses through 2006 and 85 per cent in2007 after the deductible is reached. It also limitsgovernment exposure in any one attack to $50million through 2006 and $100 million in 2007. Similar legislation has already passed a House ofRepresentatives committee and was expected topass the House as a whole shortly after theThanksgiving holiday. Though the House and Senateversions differ in respect to coverage limitations andinsurance industry responsibilities (some leading

Democrats would make TRIA permanent), Houseand Senate negotiators were expected to achieve acompromise that would win White House approvalin time to wave off the 31 December terminationdeadline.Leigh Ann Pusey, senior vice president of theAmerican Insurance Association, said of the Senatepassage: “The Terrorism Risk Insurance Act of 2005... is significant and a critical step toward gettingworkable legislation to the President before the endof the year …We are encouraged by the Senate’sswift and broadly bipartisan action.”Virtually all segments of the insurance industry havelobbied zealously throughout the summer for anextension of the 21 December 2005 deadline.Its supporters saw TRIA as essential in temporarilystabilizing large segments of the insurance industryand the economy generally in the wake of 9/11,which generated some $40 billion of insured losses.Following those attacks, many insurers beganexcluding terrorism related coverage fromcommercial policies – actions that reverberatednegatively through the real estate and constructionindustries.Opponents of a TRIA extension have argued thatthe programme was an unnecessary bail-out of theinsurance industry and that it deferred the privatesector’s incentive to strengthen its own abilities toprovide terrorism coverage. On the other hand,Senator Charles Schumer, Democrat from NewYork, who would liketo see TRIA madepermanent, toldSenate colleagues:“Insurance companiesknow if, God forbid,the worst happensthere will be abackstop, and they are(now) willing to issuepolicies.”

Chinese insurershead overseasFour insurance companies in China will soon beapproved as qualified domestic institutional investors(QDIIs), allowing them to invest their foreignexchange assets in overseas financial markets.The four issuers are Ping An Insurance, China Life,PICC Property and Casualty Company Limited(PICC P&C), and American International Assurance(AIG), according to Sun Jianyong, a departmentdirector at the ChinaInsurance RegulatoryCommission (CIRC).“The CIRC and theState Administration ofForeign Exchange(SAFE) have reachedconsensus on theregulatory rules and weare now working outsome technical details,”the director said. Early last year, theCIRC issued a draftcircular allowingqualified insurers to use their foreign exchange tobuy bonds on overseas markets, mainly treasuresbonds. This June, the CIRC announced it wouldallow qualified insurance companies to use foreignexchange to buy stocks issued by Chinesecompanies on overseas markets. But it was not untilthe beginning of November that the regulatornamed the first batch of QDIIs. “When the detailedcircular is issued, every insurance company canapply as long as they meet the standards,” Sun said. According to the regulation, insurers must have atleast five billion yuan (US$600 million) in total assetsand US$15 million in forex-denominated funds.Although there are many restrictions on theinsurers’ overseas investments, the CIRC said itwould gradually offer more financial instruments.

International Travel Insurance Journal www.itij.co.uk

HEALTHMATTERS10

Preparing for jet lagA new study, published in the Journal of Clinical

Endocrinology and Metabolism, has suggested thatthe best way to beat jet lag when flying east is tobe prepared, and carry a light box and somemelatonin – a hormone that plays a role in thesleep-wake cycle of the body’s internal clock.Researchers, including Dr Charmane Eastman,from the Biological Rhythms Research Lab atChicago’s Rush University Medical Center, studied44 healthy non-smokers who were 19-45 yearsold who got eight hours of nightly sleep and didn’thave sleep problems, major caffeine habits, or hadrecently travelled overseas or worked in night-shifts. Participants didn’t fly anywhere exotic or evenleave their time zone, but spent time at a sleeplab. For the first few nights at the lab, participantsslept normally. Then, they were sent to bed onehour earlier every night for three nights andweren’t allowed to get out of bed if they didn’t fallasleep on time, or to nap during the day.First thing in the morning, participants had to sit ata desk in front of a light box, which pumped outbright light for 30 minutes at a time, thenswitched off for half an hour – this was repeatedfor four cycles. In the afternoon, each participanttook two pills.

One of the pillswas a placeboand for some,the secondcontained half amilligram ofmelatonin, whileothers got ahigher dose ofmelatonin (threemilligrammes). Athird group justgot anotherplacebo pill. Noone knew which pill was which. The study found that the body clocks of those whotook melatonin adapted better to the new schedule.The higher dose of melatonin fared best in thatregard, but not by much and people who took thehigher dose were sleepier in the evenings aftertaking the pill.“Therefore, we recommend using the 0.5 mg dosein combination with morning intermittent bright lightand an advancing sleep schedule in any situation inwhich people need to advance their circadianrhythms,” the researchers noted.

TB-free certificatesrequired to enter UKWith an increase of tuberculosis (TB) reported in theUK, Tanzanians applying for entry visas to UK for

more than six months will be required toundergo medical examination to diagnosetheir TB status from now on.The British government has added Tanzaniato five other world countries – Sudan,Thailand, Cambodia, Bangladesh and Laos– picked by the British Foreign ServiceOffice (FSO) in London, UK, for a pilot TBscreening arrangement. Tanzanian visaapplicants must now undergo a US$55medical check-up at the InternationalOrganization for Migration clinic in thecapital, Dar es Salaam, to be issued with a

TB-free certificate before processing their visas.The UK government has defended its request bypointing out that TB cases and HIV/AIDS in UK havebeen increasing at an alarming annual rate of 20 percent, forcing the UK government to screen foreignersin efforts to reduce more infections. However, humanrights campaigners in Tanzania have termed the UK’smove as anti-human and discriminatory. The UKintroduced a finger-printing arrangement to Tanzanianvisa applicants and sparked a row of controversyamong travellers and business community only lastyear, so it is assumed that Tanzania will not accept thenew TB arrangement without some protest.

The destructive pathof a biting flyEver heard of Robles disease, craw-craw, oronchocerciasis? No? They are all aliases for ‘riverdisease’. But to travellers and people who live inone of the many regions listed as endemic to theparasitic disease, it means painful skin lesions leadingto blindness for many and scientists are calling forbetter public health campaigns to reduce thenumber of people affected.Human onchocerciasis is caused by a biting black flyfound across large parts of Africa and the Americas.The disease is transmitted by certain species offemale Simulium flies, which bite by day and arefound near fast-flowing rivers and streams. Riverdisease is a major public health problem in manyparts of the world – endemic in 36 countries.According to the World Health Organization(WHO), it is the world’s second leading infectiouscause of blindness. The total number of peopletreated – with ivermectin, a drug that attacks themicrofilariae (pre-larva) that cause the disease – hasincreased from around 11 million worldwide in1996 to some 45 million in 2004. But the disease isstill a major concern for health communities.Now, a team of European and South Americanresearchers have developed a mathematicalmodel, published online in Proceedings of theNational Academy of Sciences, which measuresexposure to the disease by looking at how oftenpeople were bitten by the flies carrying theparasite. “This new model could be an importanttool in developing effective health campaigns toreduce the numbers affected by river blindness,”Dr João Filipe of Imperial College London (ICL),UK, and first author of the paper said. “Currently,there are at least 18 million people worldwideaffected by this parasite, and more action isurgently needed. This model will help in the fightagainst the disease by providing a better

understanding of the role of exposure to the bitingflies that transmit river blindness.”The flies carry a parasite called Onchocercavolvulus, which lays microscopic worms in thehuman host, leading to eye opacities, eventuallycausing blindness, and in many cases, skin disease.Symptoms are usually visible on the skin and canoccur months even years after exposure, whichmakes treatment difficult. At present, no vaccine isavailable. Prevention is the most effective measureby avoiding black fly habitats or otherwise wearingprotective gear during the day in the fly’s habitat.

Dengue fever hits butno one knows whyA dengue fever epidemic that has infected morethan 110,000 people this year, from eastern India tothe Philippines, has killed at least 890. The rate ofinfection has jumped 50 per cent since last year,according to the World Health Organisation, andnobody has a good answer as to why. “Singapore is the main concern because they shouldnot have this [problem],” says Dr Kevin Palmer, theWorld Health Organization’s regional adviser ondengue. “They have very sophisticated monitoringand surveillance, which does not seem to haveworked … If Singapore can’t control dengue, whocan? It’s a developed place, it’s a country of tarmacand buildings designed to get rid of potential watersources. But as a model, it’s not doing very well,”he added.The viral infection is transmitted by the Aedesmosquito. It is sometimes called bone-breaker’sdisease because it causes severe joint pain alongwith high fever, nausea, and a rash. If it developsinto dengue haemorrhagic fever it causes internalbleeding. There is no known cure or vaccine but itcan be managed if treated.Dr Duane Gubler, director of the Asia-PacificInstitute for Tropical Medicine and InfectiousDiseases in Hawaii, said in some ways Singapore isa victim of its own success as Singapore’s role as atransportation hub means it will find it extremelydifficult to erase the disease. “Many more travellersbring dengue fever to Singapore than malaria. Youhave thousands of immigrant workers coming toSingapore from dengue-endemic countries bringingthe virus with them,” Gubler said.Although it is difficult to obtain accurate numbers,because reporting dengue incidence can have aeconomic impact on a country, Palmer said this yearhas been the worst in the region since 1998, whenmore than 1.2 million cases, with 3,442 deaths,were reported.

Monitoring ER dataAn electronic surveillance system that will monitorhospital emergency room data for early signs ofdisease outbreaks and bioterrorism threats thenupdate health officials of emerging threats has beenunveiled inNorthCarolina, US.Thesurveillancesystem canlook for flu-likeillnesses,gastrointestinalsymptoms,respiratory-systemcomplaints,fevers and rashes, among other medical symptoms. A couple of months ago, the state used it to trackvictims of Hurricane Katrina who were relocated toNorth Carolina. As a result, public-health officialswere able to identify and treat a case of vibrio, apotentially deadly waterborne illness, after anevacuee sought treatment in a hospital emergencyroom. Also, recently, the system helped stateepidemiologists pinpoint a case of hepatitis A inWake County. The information allowed the Divisionof Public Health to respond within 24 hours tocontain an outbreak. Before the system, it mighthave taken weeks for the case to reach the division.

Winter sunprecautions neglectedSkiers andsnowboardershit the slopeswith zest inwintertime, butare forgettingthey are still atrisk from skincancer – evenmore so thanin summertime– according toresearchcarried out byCancerResearch UKand Ski Club ofGreat Britain. With awhopping 65per cent ofskiers admittinggetting burntwhilst on theslopes, it is important for people to recognise therisks, says Cancer Research. Ultra violet rays, whichcause sunburn, are stronger at high altitudes – farmore harmful than on a beach. They advise thatsunscreen should be applied more than once a dayas winter sports often produce sweat and frictioncaused by physical exertion, which reduceseffectiveness of sunscreen. Moreover, it is notwidely recognised that during light snow or awhiteout there is still a high risk of getting burnt.“People who would never dream of bakingthemselves on a sun-drenched beach will hit theslopes with little regard for the hazards of thestrength of the sun,” explains Sara Hiom, Head ofHealth Information for Cancer Research UK.

www.itij.co.uk International Travel Insurance Journal

HEALTHMATTERS 11

Older travellers needan EHICAge Concern, in the UK, is urging older travellers toapply for the new European Health Insurance Card(EHIC) to ensure they will be covered for basicmedical care while abroad.“If you are planning to take a short break early in2006, then it’s important to get one of the newcards as soon as possible. Otherwise you couldexperience difficulties accessing free or reducedprice medical care,” said Alex Richards from AgeConcern. Travellers are also being reminded to takeout travel insurance because the EHIC will notprovide a sufficient level of cover in the event of anemergency and, importantly, does not cover follow-up treatment or repatriation.

Airline water under the microscopeWater on US airlines is to undergo increasedscrutiny from now on due to an increase in thenumber of people reporting coliform infections afterair travel. Twenty-four airlines have agreed that ifthey fail to comply with the Safe Drinking Water Act,and fail to monitor and disinfect drinking water, theycan be subject to fines of up to $27,500.Last year, an Environmental Protection Agency (EPA)investigation found coliform bacteria in 15 per centof the 327 airplanes tested. The Air TransportAssociation has said, however, that drinking waterfound on airlines is generally as safe as the municipalwater sources that supply it. “We think the drinkingwater on aircraft is safe to drink and has been,” saidKatherine Andrus, a spokesperson for the airlines’trade group. “It will generate a tremendous amount

of monitoring data, which we believe will establishthat there is no systematic problem with theaircrafts’ drinking water … We don’t think that EPA’ssample results provided enough meaningful data todraw any conclusions.”In the agreement, airlines must collect total coliformsamples from at least one galley and one bathroomfrom every aircraft at least once a year and at least25 per cent of an airlines’ fleet must be monitoredevery three months. Disinfecting the water systemsmust be done at least once every three months;water trucks, carts, cabinets and hoses must becleaned at least once a month. If any total coliformor other bacteria such as E.coli or fecal coliform,which cause diarrhoea, are found it must bereported to the EPA immediately.

Airlinesthat havesigned theagreementinclude:AirTranAirways,AlaskaAirlines,Aloha Airlines, American Airlines, America West,ATA Airlines, Champion Air, Continental Airlines,Continental Micronesia, Falcon Air Express, FrontierAirlines, Hawaiian Airlines, Miami Air International,Midwest Airlines, North American Airlines,Northwest Airlines, Pace Airlines, United Airlines,US Airways, USA 3000 Airlines, and World Airways.

Yellow fever outbreakin South AmericaThe Ministry of Health of Venezuela reported twocases of yellow fever in October and with anoutbreak of yellow fever in the state of Merida lastyear, authorities are already responding to the newcases with a vaccination campaign.Yellow fever is a viral disease that is transmitted tohumans through the bite of infected mosquitoes.Illness ranges in severity from an influenza-likesyndrome to severe hepatitis and hemorrhagicfever. The Center for Disease Control and Prevention,US, recommends yellow fever vaccination for mosttravellers to yellow fever-endemic countries in Africaor areas in South America in the endemic zone,especially at this time. Proof of vaccination isrequired for entry into certain countries.

Airport plans aquarantine roomA quarantinestation has beenplanned atBoston’s LoganInternationalAirport, US,where officialsfrom theCenters forDisease Controland Prevention(CDC) canevaluate thehealth threatsposed byincomingtravellers.“We are most interested in people with feveraccompanied by rash, stiff neck, jaundice, cough, orunusual bleeding and severe diarrhoea with orwithout fever,” said Maria Pia Sanchez, officer incharge for the CDC at Logan. “While avian flu iswhat is on most people’s mind right now, the mostcommon quarantinable disease we pick up throughour quarantine stations is tuberculosis … A case ofTB can be imported from just about any country.”CDC officials say a quarantine station will not impacton travellers arriving at the airport, since only a tinypercentage are actually pulled aside for evaluation.But if avian flu were to become a pandemic or abioterrorism attack occurred, quarantine stationswould be the first line of defence in containing thethreat from other countries. “It is our hope to beable to respond to whatever comes up,” said MartyRemis, deputy branch chief for the CDC’squarantine and border health service in Atlanta.As well as monitoring travellers, Mr Remis saidCDC officials will work with state and local healthofficials to prepare for a medical emergency, dealwith imported animals, and handle calls from portofficials throughout the rest of New England.

International Travel Insurance Journal www.itij.co.uk

TRAVELMATTERS12

Bankrupt Deltaboosts serviceJust a month after entering bankruptcy, DeltaAirlines has announced a major expansion of itsinternational service – a move it believes willmake it ‘the world’s largest airline across theAtlantic’. Milan Korcok tracks the transformation

The announcement by Delta cited an expansion ofa non-stop wide-body service to 11 new markets inEurope and the Middle East from its two trans-Atlantic gateways, John F Kennedy InternationalAirport in New York, and Hartsfield-Jackson AtlantaInternational Airport.The move would allow Delta to eclipse AmericanAirlines andBritish Airwaysas the largestcarrier acrossthe Atlantic,while at thesame time, giveit more accessto the moreprofitableinternationalroutes thatlarge Americancarriers aretryingdesperately totap into.Concurrently, Delta is cutting back on many smallerdomestic routes, assigning them to their subsidiaries,ComAir and SkyWest – a tactic other US carriersare also implementing.Analysts have noted that on trans-Atlantic flights, USairline profits have increased 5.8 per cent this yearwhile they have declined to 0.8 per cent ondomestic routes. They attribute that to favorable(higher) pricing on international routes.The expansion, which will be phased in over thefirst six months of 2006, will include non-stop wide-body service from Atlanta to Tel Aviv, Dusseldorf,Copenhagen, Edinburgh, Nice, Athens, and Venice;and from New York to Budapest, Dublin,Manchester and Kiev. Some of these are still subjectto government approvals.In addition to the trans-Atlantic, Delta hasannounced an expansion of its Central Americanand Caribbean services, with added flights fromAtlanta to Managua, Nicaragua; Roatan and SanPedro in Honduras; and Santo Domingo in theDominican Republic. Delta’s executive vice president, Glen Hauenstein,said of the expansion: “With next summer’sadditions, Delta will serve 66 internationaldestinations in 40 countries from Atlanta – makingDelta’s Atlanta hub the third largest internationalgateway in North America.”

Catch 22 for airlineterror insuranceEuropean insurers have begun excluding cover foraircraft hull in the event of a terrorist attack with aweapon of mass destruction, including dirty bombs– those that scatter radioactive material,electromagnetic devices or biological and chemicalweapons. The insurers say that in the event of suchan attack, they would be financially ruined, and arelooking at the possibility of governmentintervention. In the US, the federal government hastold airlines that it would act as an insurer of lastresort should a terrorist attack occur; but in Europe,airlines must, at present, depend on commercialinsurers.If, however, European governments decide they willoffer the kind of back-up that the US governmentdoes, they stand to breach the European Union (EU)ban on state subsidies. In a recent speech, head of theEuropean Commission’s Air Transport Policy unit,Ludolf van Hasselt, said that any governmentintervention could be as a ‘short-term solution’ only.Ireland has said it will step in for insurers: but it is theonly European government yet to do so. Airlines are, naturally, worried about flying withoutadequate insurance. In fact, they cannot legally do sounder EU rules. These stipulate that no commercialaircraft can fly unless it is fully insured for third-partyliability, according to the International Air TransportAssociation, but most London insurers have said theyintend to stop providing ‘related’ liability coverage nextyear. Around 60 per cent of the world’s aviationinsurance is written in London – estimated to beworth $2.5 billion in annual premiums.While some airlines are threatening to ground theirfleets, others are continuing to fly despite lackingsufficient insurance coverage. Some are waiting tohear from their insurers if their policies are about tochange, and other airlines have warned theirgovernments of the serious problems they are likelyto face should the worst occur.

EU-US talks toliberalise air travelDespite failed attempts in the past, governmentofficials from the US and European Union (EU) haveresumed talks aimed at creating an open transatlanticaviation market. Air travel remains under anoutmoded system of bilateral, government-to-government agreements, but the talks that will takeplace over the next couple of months aim to replacethese agreements with a single air services agreementalong the lines of the US’s ‘open skies’ model. Theagenda for discussion is long and complex, but theliberalisation that could result if both sides can reachagreement will bring enormous benefits for all.Liberalisation would remove governments from their

archaic role as theauthority on who flieswhere and when, andwho has ownershiprights over whom.The resultantrestructuring, it ishoped, will lead togreater cost cuttingabilities for the airlines,leading to cheaperfares, and asubsequent increase inair travel. With 60 percent of world air traveloriginating in either theUS or the EU, these

markets have huge potential for further development.The first phase of an agreement would see theimplementation of the single air services agreement,which would permit European airlines to fly fromanywhere in the EU to any point in the US. MergingEuropean airlines would no longer be in danger oflosing part of their traffic rights to the US. Incompetition and security would also be discussed inthis first round of talks, as would Europe’s ace card –restrictions at Heathrow. At present, only the UK’sBritish Airways and Virgin Atlantic, and the US’sAmerican Airlines and United Airlines are permitted tooperate direct flights into and out of Heathrow. TheUS is looking to have these restrictions lifted, so thatany European or US airline could fly between theairport and the US. The EU is a little nervous, however, that if the firstround of talks reaches all of these conclusions, the USwill not be guaranteed to return to the table to discussa hot issue for European airlines – foreign ownership.Currently, foreign entities can control just 25 per centof a US airline, whereas the EU has a limit of 49 percent. Under the present bilateral agreements, nationalcarriers must have majority ownership of their airlinesto sustain their traffic rights, so the first step towardsmaking the bilateral agreements redundant is toremove limits on ownership and control, accordingthe Europe.So, we wait anxiously to see whether Europe and theUS can reach agreement on how to best offer eachother greater access to the transatlantic aviationmarket. Will European hardliner the UK trade someof its precious rights at Heathrow for a US promise tochange its fundamental ownership and control rights?One thing is for sure, both sides have much to gainthrough compromise.

Staff shortages meanlonger queues

Major airports across the US are still seeing long waitlines for customs clearance, and the problem hasbeen attributed to staff shortages. A recent analysis bythe Government Accountability Office (GAO) ofcustomer wait times at 20 airports found that 20 percent of international flights arriving at Miami had towait more than an hour to make it through customs.Other major airports did not fare much better. Thenegative image being cast of US airports due to theconstant presence of irritated passengers, many ofwhom miss connecting flights due to being held up atcustoms, is making airports take a closer look at howthey manage their staffing levels.CEO of the Metropolitan Washington AirportsAuthority, James Bennett, said that US Customs andBorder Protection (CBP) wasn’t keeping up with theincrease in international arrivals and that staffingpatterns weren’t designed to match peak travel times.Sometimes, he said, even in busy periods, not allcustoms stations were open. A recent GAO report condemned the CBP’s staffingpolicies, recommending it stops deploying itsworkforce according the principal of which airportscomplain the loudest. Talking to USA Today, WilliamAnthony, CBP spokesperson, said: “Working with thetravel industry, [we] strive to make the inspectionprocess as short and as pleasant as possible,” withoutcompromising security.

Tsunami warningsystem brokerageTwo professors in Germany have created a tsunamiwarning system that they are selling to travelagencies in the country. With a patent for theproduct pending, one of the companies involved inthe provision of this new service, Heindl InternetAG, has been working to provide this new serviceto travellers looking for a little extra piece of mindwhen venturing abroad.The aptly-named Tsunami Alarm System is beingsold through travel agencies on a brokerage basis.The service receives data from a number of stationsmonitoring seismic activity, enabling constant up-to-date information that is used to detect and assessthe threat of possible tsunamis. For an annual ormonthly subscription fee, travellers can then haveany tsunami warnings sent directly to their mobilephone. In this age of increased severe weather andnatural phenomena, the service is sure to dispeldoubts and to provide a welcomed relief forworried travellers.

Airfares on theincreaseAccording to American Express Business Travel,continued travel growth – particularly in the businesssector – will push up worldwide airfares and hotelrates in 2006. Globally, short-haul fares are forecast torise three to six per cent, and long-haul fares areforecast to rise three to five per cent. In NorthAmerica, the division of the American Expresscompany expects domestic economy fares will rise bybetween five and eight per cent. Hotel rates aroundthe world are apparently set to rise by one to threeper cent at mid-scale hotels, and by between threeand five per cent at upscale properties.

www.itij.co.uk International Travel Insurance Journal

TRAVELMATTERS 13

China completesrailway to TibetChina has announced that the world’s highest railwayline, which links Lhasa in Tibet to Gormo in Qinghaiprovince, China, will open to passengers soon –hopefully by as early as next year.Work started on the railway in June 2001, but wassuspended twice, in 2002 and 2003, to allow themigration of Tibetan antelopes and snow leopardsfrom June to August. It was completed on the 15October 2005.The pan-Himalayan line runs across Tibet’s snow-covered plateau, climbing as high as 5,072 metres,with about 550 kilometres of the tracks running overice. It will have special cars, sealed like aircrafts, toprotect passengers from altitude sickness and have anair system to provide sufficient oxygen in the cars.Chinese President, Hu Jintao, praised the landmarkrailway as an ‘unprecedented triumph’ in the humanhistory of railway construction. At the completionceremony, Vice-Premier Huang Ju urged railwaybuilders to continue their efforts in a bid to ensure testruns can be conducted as planned in July next year.The official Xinhua news agency said $3 billion hadbeen spent on the challenging 1,142-kilometre (710-mile) final section, after four years in construction –with workers having to breathe bottled oxygen tocope with the high altitude. It is planned that in fiveyears, the railway will stretch further into Tibet,extending from Lhasa to Xigaze and Nyingchi,according tothe ministry.China saysthe line willpromote thedevelopmentof Tibet andthe railwayworkers willbe recruitedfrom Tibet.

Airlines angry overParis price hikeAirlines are up in arms over plans by the Parisairports operator ADP to boost airport fees by sixper cent a year between 2006 and 2010 to financemost of the €2.5 billion of investments slated forthe period. Barbara Casassus reports from Paris

The Board of Airlines Representatives (BAR) and theNational Commercial Aviation Federation (FNAM),which encompass almost all the carriers servingFrance, say such an increase is out of the question inview of the sector’sfinancial situation andthat it should becapped at the annualinflation rate. Theynote that theInternational AirTransport Association(IATA) is understoodto have demanded acut in fees of threeper cent a year.The carriers rejectthe passenger trafficforecasts on which the increase is based. They saytraffic will grow by 4.5 per cent during the five years,whereas ADP says it will grow by only three per centto 3.5 per cent. Air France fears it will not haveenough capacity at CDG-Paris by 2010, and isdemanding productivity gains by the operator, whichanyway is intending a 13 per cent improvement. Theairlines are putting together a counter-proposal, andwill include a new international study of airport fees.They believe the fees are higher in Paris thanelsewhere, while ADP believes them lower.Meanwhile, Air France was reported by the Frencheconomic daily, La Tribune, to be prepared to pay theheavier fees if ADP agrees to bring forwardcompletion of its S4 terminal to 2011 instead of 2014.

Double-decker service ready to goThe Airbus A380 fleet is being assembled in Toulousein the South of France from parts manufactured allover the world. Miles Clarke reports on its progress

There’s a cathedral-like atmosphere in the gianthanger, where up to eight of the largest passengerplanes in history can be assembled simultaneously, at acost of $350 million each. The goal is to commissionfour aircraft a month when production is fullyunderway. Some 190 workers are engaged for 16hours a day in two shifts on each aircraft, bringing thehundreds of thousands of components together with

nothing less than 100 percent precision. The aircraft are movedduring assembly, with severalbays named for the numberof days left to complete eachaircraft. They will allow 18weeks for assembly once fullproduction is achieved.Across its ‘family’ ofpassenger and militaryaircraft, Airbus is currentlycompleting the constructionof an average of one aircraft

a day. Two test planes are already flying ahead of thelaunch late next year, when Singapore Airlines will bethe first to fly the aircraft, which will be fitted with 480seats for the London/Singapore/Sydney route. Some60 airports around the world will be capable ofhandling the A380, with millions being spent onupgrading facilities.Airbus executives trotted out hundreds of statistics tobolster the superior quality of the aircraft over theirfierce rivals at Boeing, but when it came to how thecabin would look in the first aircraft to go intocommercial service, their lips were firmly sealed.Singapore Airlines plans to milk the global interest inthis new generation aircraft for all its worth and theyare giving nothing away, apart from saying it will be a

three class cabin and that there will be 50 per centmore floor space than the Boeing 747. There were some clues in the full-scale mock-up atAirbus HQ in Toulouse. At the rear of the plane was awide, sweeping stairway which was enhanced by aself-contained waterfall. Upstairs there is a bar andcomfortable lounge seating. On the lower deck thereis a boutique with luxury goods and clothing similar tothose sold at most international airports.Lighting is set to play a big part in the A380, withsubtle adjustments being made throughout the flight tohelp passengers better acclimatise to the changingtime zones. Perhaps best of all for travellers coopedup for many hours on intercontinental flights, there is alarge area below the lower deck for the toilets. Whilethere will still be some toilet facilities on the passengerdecks, those endless queues will hopefully becontained away from the seating areas. The ratio oftoilets to passengers in the economy cabin will be thesame as today, around 31 passengers for one toilet.The A380-800 does not appear to be significantlylarger than the rival Boeing 747, which hastransformed the face of travel in the past 35 years, andshe is actually a metre shorter than the Boeing 777-300. The wingspan, at almost 80 metres, is widerthan the plane is long. The A380 stands almost fivemetres taller than the B747 and the cockpit is at a‘mezzanine level’ between the two passenger decks.The cylindrical shape of the wide-body aircraft makesit at first glance look smaller than the B747 with itsraked upper fuselage.The design of the A380 is such that all the necessaryservices are provided throughout the length of theaircraft, meaning that galleys, toilets and other in-flightfacilities can be positioned almost anywhere the airlinechooses. It can be expected that the A380 may be likesome of its other Airbus counterparts and have thegalleys located below the main deck and linked byelevators.• Qantas has 12 of the A380s on order, with the firstdelivery expected in April 2007. Emirates wants 45.

International Travel Insurance Journal www.itij.co.uk

COMPANYBRIEF14

AIG WorldSource, part of American InternationalGroup Inc. (AIG), has opened a local claimsoperation headquarters in Dubai, UAE, to enhanceregional claims capabilities in the Middle East for itsDefense Base Act (DBA) insurance programme.The headquarters will provide services such asinvestigating and adjusting claims of insuredemployees – including Iraqi nationals injured orkilled while working under DBA contracts – andinvestigating and adjusting claims of missing personsor equipment. Evacuation and state-of-the-artmedical care for seriously injured employees ofinsureds, including Iraqi and third country nationals isalso provided, along with local claims handling inArabic and Turkish for Iraqis and third-country

nationals, andreferral torepresentativesin Baghdad thatcan contactbeneficiaries toensurepayment ofDBA benefits.In addition toenhancingclaimscapabilities, AIGWorldSource isworking withHouston-based

AIG Assist to provide emergency travel serviceswithin the DBA programme. These services provideinsureds with comprehensive travel and medicalassistance in the event of an emergency, includinglegal referral, language interpretation, medicaltransport and security evacuation.The WorldSource DBA programme also offersNatural Causes Group Term Life coverage for deathnot incurred due to an accident to DBA contractorsand their employees. Mandated by the DefenseBase Act of 1941, all primary and sub-contractorsworking in overseas locations on contracts fundedby the US government must secure workers’compensation coverage known as DBA insurance.

AIG handlingclaims in Dubai

St. Paul Travelers has announced the addition ofaccidental death and dismemberment (AD&D)coverage to the array of international coverages

offered through its GlobalCompanion product. Global Companion provides acomprehensive portfolio ofproducts to cover theinternational property andcasualty insurance needs ofbusinesses, includingcoverages for employeeswho travel, the export ofproducts or services, andsales offices, distributionoffices or manufacturingoperations – all outside the

US and Canada.“Our goal by adding the accidental death anddismemberment coverage is to provide addedfinancial security and peace of mind for employersand their employees when work requires them totravel internationally,” said Rick Smith, president ofGlobal Underwriting for St. Paul Travelers. “Withthis additional coverage, our Global Companionproduct is one of the most comprehensive in themarketplace that protects businesses as they expandinternationally. This AD&D coverage provides anemployee and his or her family with the peace ofmind that they will receive financial support andsecurity if an accident occurs while they travelbeyond the United States.”

Covering death anddismemberment

ZUJI, the online travel portal, haspartnered with Mondial Assistance tointroduce a range of travel insuranceoptions that can now be purchasedonline by its customers across theregion, including Australia,Singapore, Hong Kong, Taiwan andKorea.The portal now offers a range oftravel insurance products from basicto comprehensive travel medicalcover. The products have alreadyproven popular, with 23 per cent ofvisitors to the Australian sitepurchasing travel insurance since itwas launched online in August.An impressive result according to ZUJI generalmanager of partnerships, Chad Howard: “Millions ofpeople book their travel online across the AsiaPacific region and many of these travellers want topurchase their travel medical insurance online too.By working exclusively with Mondial Assistanceacross Asia Pacific and with the development ofpurpose-built exclusive technology, customers cannow purchase comprehensive travel insuranceonline,” he said.Mondial Assistance region director, Asia Pacific, FrankO’Neill, said: “We’re pleased ZUJI has chosenMondial Assistance to offer its customers such acomprehensive range of insurance options, at a timewhen adequate cover for travellers is more relevantthan ever and global trends to purchase travelonline continue to increase.”

Mondial insuranceprovided by ZUJI

Customers booking a CheapCaribbean.comvacation package to the Caribbean or Mexico won’thave to worry about hurricanes, tropical storms or

winter blizzards affecting their travel. The Internettravel company is including comprehensive travelinsurance with every hotel and air package bookedon its website. James Hobbs, president and CEO, said: “We wantour customers to experience worry-free tripplanning – they know they’ll receive a full refund ifthey have to cancel their vacation package trip dueto hurricane damage in either their travel destinationor hotel, or in their own local area. If their dates areflexible and they can reschedule their vacation whena hurricane, tropical storm or winter blizzardinterrupts or delays their travel plans, they won’tincur the penalties or fees imposed by the air carrieror hotel. We waive our own fees in theseunfortunate situations, but wanted to take ourcustomer service one step further. Our customersknow we take the term ‘customer service’ asseriously as our commitment to offer the mostaffordable packages to the Caribbean.”

Caribbean preparesfor hurricanes

TravelSafe Insurance has developed a new ‘cancelfor any reason’ cancellation policy: No matter thereason, if you cancel an insured trip, you canrecover up to 90 per cent of your non-refundablepayments. The insurance is available regardless ofage for trips costing up to US$50,000 per person.The insurance policy enables people to cancel theirtrip without the worry that they will lose theirmoney. TravelSafe offers versions of the programmethat cover you at thelevels of 50 per cent, 75per cent or 90 per cent ofthe amount of paymentsat risk. If you purchase the‘cancel for any reason’option, you can cancelyour trip for any reasonnot otherwise covered bythe policy, and bereimbursed for yourchosen percentage of theprepaid, forfeited, non-refundable payments ordeposits you paid for yourtrip, provided: 1. Your enrolment form and your premiumpayment are received within 15 days of the dateyour initial deposit/payment for your trip is received.2. You insure all prepaid trip costs that are subject tocancellation penalties or restrictions and also insurewithin seven days of the payment for thosearrangements the cost of any subsequentarrangements (or any other arrangements not madethrough your travel agent) added to your trip. 3.You cancel your trip two days or more beforeyour scheduled trip departure date.Beyond those limitations, you may cancel for anyreason, including business reasons or non-medicalfamily matters.

Cancel for anyreason policies

UK and Dublin-based insurance broker, BlueInsurances, is fighting back against the UKgovernment’s recent refusal to allow a consumerprotection levy by introducing their own freedynamic packaging protection cover. The cover provides agents with protection up to£2,000 per passenger for the insolvency of anytravel arrangements booked in the UK or Irelandwith a bonded travel agent (not forming part of aninclusive holiday) including hotels, accommodationproviders, car hire companies, ferries, scheduledairlines, theme parks and coach journeys.

Joint managing director, Ciaran Mulligan, said: “Weare delighted with our success since our launch inthe UK in March 2005, having already surpassed allforecasts with prestigious clients that include theConsort Group who have signed a three-year dealwith Blue Insurances, Sunworld Holidays andBudget Travel. We pride ourselves on being a youngand innovative company that is able to react quicklyto market needs. The introduction of this newdynamic packaging protection cover is just anotherway we distinguish ourselves from ourcompetitors.”

Offering a solution to £1 levy

The Ski Club of Great Britain and Acumus InsuranceSolutions have launched a comprehensive insuranceproduct aimed at seasonal workers spending four tosix months working in a resort. The policies cover a wide range of wintersportsactivities as standard, including off-piste skiing andsnowboarding, and the option to upgrade cover forpersonal belongings and ski equipment up to thevalue of £4,000. Fiona Sweetman, marketing manager for Ski ClubGreat Britain, said: “Travel insurance is a vital part ofanyone’s ski or snowboarding holiday. For seasonalworkers who often spend many months in resort itis essential. We’ve created an affordable productwhich covers more than just skiing andsnowboarding and includes activities such astobogganing, snow parks and snowmobiling.”

Ski Club launchesseasonal insurance

State-owned Irish health insurer Vhi Healthcare hasentered the group business travel market, and isshaking up the ideas of other travel insurers, afterclaims they can offer companies a saving of up to amassive 47 per cent on what they are paying now,raise market standards, and be market leader by2007. Ian Youngman looks into their claims

The group business travel worldwide cover issimilar to current market products, but onedifferentiator is that the group provides immediatecover for employees with pre-existing medicalconditions with no waiting period. Tim McKeown,head of diversified business at Vhi Healthcare,commented on the new product: “Up until nowcompanies have not been credited whereemployees are Vhi Healthcare members andtherefore already have significant cover for medicalemergencies. Group business travel cover will endthis duplication and will potentially allow VhiHealthcare to cut costs in half for companiesengaged in business travel.” The company’sargument rests on the principal that claims costs forbusiness travel insurance are predominently medicalemergencies and repatriation. For decades, the company had a monopoly onhealth insurance but now it sees its main businessunder attack by rivals. BUPA Ireland, established in1997, has gained 10 per cent of the health insurance

market and BUPA claims that about 40 per cent ofits 400,000 members are former members of Vhi.In October 2004, a third major health insurer beganoperating in the Irish market with the launch of VivasHealth, attacking the market by innovative offerings,and another new rival, UK health group HSA, isgearing up to enter the market soon. The Irishgovernment recently rejected Vhi’s attempts todestroy the competition by using risk equalizationlaws to make rivals pay huge sums to Vhi.There is limited potential to get more healthbusiness locally, they are losing business tocompetitors, and the government is hinting atprivatization or outright sale.The company is desperate to diversify into newareas such as travel, and grab market share quickly.McKeown added: “We are applying the sameprinciple that we brought to multi-trip travelinsurance in 2004, which saw us revolutionise thatmarket, reducing costs by an estimated 50 per centand capturing a massive 26 per cent of the marketwithin one year of launch. Since the launch of MultiTrip we have been approached by large numbers ofour corporate members, asking for a businessversion of this product, so have developed GroupBusiness Travel to specifically meet these needs. Wehave ambitious plans in the business travel insurancearena and expect to be the number one playerwithin eighteen months.”

Vhi enters business travel market

Navigational equipment that allows emergencymedical services to go out and set up GPS co-ordinates or global positioning co-ordinates off asatellite position has been stolen from anemergency helicopter in Hill County, Texas, US. The equipment is used to enable EMS workers togive co-ordinates to emergency helicopters like

StarFlight and Critical Air. “With thedevice the helicopter service has, theycan fly right to that location,” LorenStagner with Marble Falls Area EMS said. Recently, a similar device disappearedfrom a Critical Air helicopter in MarbleFalls, Texas. Authorities say someonecarefully removed it from the aircraftleaving other valuables behind. CriticalAir officials say they have replaced theGPS equipment. In the meantime,authorities are looking for suspects.

Equipment stolenfrom helicopter

In last month’s issue, we reported on the news thatDRF’s (Deutsche Rettungsflugwacht e.V./German AirRescue) Christoph 51 had crashed during a mission(ITIJ 58, November 2005, Tragedy strikes medicalair industry), and told of the ongoing investigationsto find out what happened. The Public Prosecutor’sDepartment of Stuttgart has since announced thatthe cause of the Stuttgart helicopter crash on 28September remains unclear following thetermination of the medical investigations. In order to investigate the circumstances of theaccident, the Public Prosecutor‘s Department ofStuttgart instructed an autopsy of the fouroccupants’ remains and the creation of a chemical-

toxicological survey. It found that the pilot indicateda dysfunction of the pilot’s capacity to act caused bymedicine or drugs could not be taken intoconsideration. The experts of the German FederalBureau of Aircraft Accidents Investigation,meanwhile, have excluded a technical defect of thecrashed helicopter of code D-HBBB.”The tragic crash of our Stuttgart helicopter remainsincomprehensible. We will never find out whathappened in the last seconds before the accident onboard of Christoph 51. Together with the bereaved,we are mourning four special persons. This losscannot be replaced by anything,“ explained SteffenLutz, general manager of DRF.

Cause of accident remains unclear

International Travel Insurance Journal www.itij.co.uk

AIR AMBULANCENEWS16

More people carry aeromedical insurance nowthan ever before. More people travel to placeswhere they may very well need it. Contributingfactors include poor surface transport andchallenging geography in the developing world,but medevac saves lives in the richest parts ofthe globe too. Robin Gauldie looks at thefinancial and political aspects of setting up anaeromedical company

The launch of India’s first dedicated air ambulanceservice (See India ’s f i rs t a ir ambulancelaunched p.17) reflects not only the growingprosperity of India’s middle class, but also thecountry’s increasing popularity as a destinationoffering high-quality, low-cost elective healthcareto Westerners – a trend that will increase demandfor aeromedical transport between airports andhospitals even in non-critical cases. In critical cases,aeromedical transportation will be a huge lifesaver.In the potholedstreets of India’smega-cities, anambulance may takehours to make ajourney that ahelicopter will crossin minutes.Clearly, this is goodnews for thoseIndians who canafford it. But it isequally good news for visitors to India, providing awelcome addition to the sub-continent’s relativelyrudimentary aeromedical infrastructure.International insurance companies should be eagerto use the air ambulance’s facilities, encouragingthe company to branch out across India and, inthe long-term, encouraging more companies tomove into the aeromedical sector across the sub-continent, making emergency medical evacuationmuch more widely available to Indians and visitorsalike. It should be one of those rare cases whereeverybody wins. There’s a hunger among travellers of all ages foradrenaline sports in remoter regions of thedeveloped world, and a broken ankle on a wintryScottish mountain slope just a few miles from thenearest town, or an avalanche on an Alpine pistewithin sight of luxury resorts can be just as lethalas a car crash deep in the heart of Africa. By the same token, in a world increasinglydominated by mega-cities, a helicopter evacuationcan be just as much a life saver for a guest in aPark Avenue hotel as for a gap-year traveller in atent in the Andes.For insurers, aeromedical transport can be a viableoption even when the client is not critically ill. Inthe US, for example, Florida’s mellow winterclimate attracts large numbers of long-stayCanadian retirees, many of them elderly. Some of

these ‘snowbirds’ are refused health coverageoutside Canada if their insurance company deemsthem a high medical risk – and while the level ofmedical care in the US is as good as Canada’s, it isa lot more expensive. It tends to work outcheaper to fly the patient home to CanadianMedicare than to shell out for even a few days in aUS hospital. According to Skyservice Lifeguard, aMontreal-based aeromedical transport company,more than 80 per cent of its adult patients are in astable condition and require no in-flightintervention.Ensuring that aeromedical services are availablewhere and when they are needed should be ano-brainer – or should it? In practice, companiesseeking to provide such services, along withinstitutions that want to use them, still face issueswith financing, bureaucracy, and local politics.Bizarre as it may seem in a city that aspires to be aworld-class capital, London’s Air Ambulance (LAA),

based at the Royal LondonHospital, UK, has to appeal tocharitable donors to keep itflying.It receives some funding fromthe UK National HealthService, and half its helicopterlease is sponsored by Virgin.But LAA still needs anadditional £500,000 a year tostay in the air – and demandfor its services is ever-

increasing. With the New Labour government stillintent on more ‘reforms’ to the UK’s NHS, thereis no prospect of greater state funding for LAA –although Londoners are being asked to findmillions to pay for their Olympic Games.Finance and local politics can merge to createissues for aeromedical transport providers. Coststo local authorities that pay for such services arehigh, and it’s easy for political opponents ofcountry, city and state governments to turn suchservices into a political football – sometimes withallegations that local elected officials have too closea personal interest in the service supplier.In other cases, red tape can threaten to delay gettinga new operation off the ground. In the US’s mostnortherly state, where Security Aviation intends tobegin a new community-based air ambulanceservice by February 2006, local officialdom is stillwrangling over how the new service will be co-ordinated with the established LifeGuard Alaskaservice operated by the state’s Providence AlaskaMedical Centre. But in the US, there is still a ‘can-do’ ethic that runs counter to bureaucracy.“We’re just going to do it,” Security Aviation’sdirector of operations Craig Wolter told the localmedia. In a world full of obstacles, that’s arefreshing attitude. Maybe Wolter should talk toLondon’s Mayor Ken Livingstone about a moveinto the UK.

Growing aeromedical transport operations

A second Airlift Northwest medical-evacuationhelicopter has crashed within a month. The latestcrash happened near the Providence-St. PeterHospital, Washington, US, on the 28 October –there were no serious casualties.The Airlift Northwest helicopter took off, with apilot, two nurses and a patient on board, from thehospital roof enroute toHarborviewMedical Center inSeattle. “They hadthe patientsecured, the crewsecured and asthey started totake off, the pilotgot a messagethat the rotarywas slowing,” said Mardie Rhodes, spokespersonfor Airlift Northwest, which owns the helicopter. “Ittook off, lost power and the pilot landed it in aflower bed.” One of the three crew members washospitalized overnight but was released thefollowing day. The National Transportation Safety Board isinvestigating, but it could be monthsbefore they know what happenedand why, air safety investigator TomLittle said. Airlift Northwest hasgrounded another helicopter that itpurchased at the same time until ithears back from investigators, buthas no plans to cut back on service.Airlift Northwest has had two fatalcrashes in its 23-year history. Thefirst was 11 September 1995, nearBainbridge Island. The second wasthis past 29 September, when ahelicopter with a pilot and two nurses disappearedafter dropping off a patient at Harborview MedicalCenter. All three crew members died.

Airlift Northwestmedevac crashes

PHI Air Medical of Kentucky,US, has announced theintroduction of Night VisionGoggles (NVG) technologyto its fleet.“The safety of our patientsand crew has always been akeystone of PHI’soperations,” said a companyspokesperson. “With theaddition of NVG technology,the safety of flight will be

dramatically bolstered. [Our company] is the first airmedical programme in the State of Kentucky toemploy this technology.”

PHI completes firstnight vision flight

Finance and localpolitics can merge to

create issues for aero-medical transport

providers

Escorts Heart Institute and Research Centre (EHIRC)has signed an agreement with Deccan Aviation, whichoperates the budget carrier Air Deccan, to launch ‘AirRescue One’ – India’s first dedicated air ambulance.Deccan Aviation will provide eight helicopters and twofixed-wing aircraft, besides full logistical and groundsupport, and EHIRC will be responsible for totalmedical rescue operation and equipment. “It is goingto be a concerted effort from two leaders in the fieldof medical evacuation services,” Deccan Aviationmanaging director Captain Gopinath said. However, atthe moment, the cost of the service is pegged atRs45,000–50,000 for an hour’s flight and Rs30,000for fixed medical charges.However, Gopinath said he is in talks with a generalinsurance firm to work out a policy to cover airambulance costs. “Once the policy is in place, thepremium would work out to be as low as Rs2,000,making it affordable to the common man,” he said.“As the number of policies increase, the premium costwould drop further. We are looking at the Rs1,000mark,” EHIRC executive director, Naresh Trehan, said.

India’s first airambulance launched

www.itij.co.uk International Travel Insurance Journal

AIR AMBULANCENEWS 17

As natural disasters become more frequent, there isthe danger that developing countries will suffer mostwith their lack of an advanced communicationsinfrastructure. Indeed, the onset of Hurricane Wilmadistracted many from the ongoing harsh realities ofthe earthquake in Pakistan. International financial aidto the Pakistan cause has been heavily criticised andas subzero temperatures threaten, approximatelythree million lives are at risk if they do not receivefood and medical supplies.Upon request of the Luxembourg ministry of co-operation, the government has sent a LuxembourgAir Rescue (LAR) helicopter and medical crew toassist with the relief effort in Pakistan. The MD 900helicopter with a crew of two pilots, an engineer, amedic and a logistics expert was loaded on board amilitary C17 cargo aircraft and was flown to Lahore in

Pakistan. From there, the helicopter reassembled andflew to Islamabad in order to assist with the UN reliefby flying supplies to the mountain regions and takingthe wounded to the nearest hospitals. The LAR crew,who will be replaced with a fresh team after 10 days,aim to reach the victims sheltering in their houses, themajority of which now lie in ruins in the clutch of themountains, cut off from the rest of the world.In the latest update from the LAR crew, fitted outwith special medical equipment, tents, satellitetelephones and digital maps of the region, theyreported that they have been flying an average of fivehours per day in the earthquake-struck region inPakistan. “As soon as we arrived we started flying forthe Red Cross, the United Nations and NATO,”explained Didier Dandrifosse, chief flight attendant ofLAR, from Islamabad.

Two full days were spentintervening with a road accident inthe mountains between anoverloaded bus full of people tryingto evacuate the freezing mountainregions, and a truck deliveringsupplies. The truck, which wasknocked off the road, fell 50 metresdown a hill killing nine andwounding many others. As well asevacuating the wounded, the LARcrew are flying to several smallregions that larger militaryhelicopters cannot reach, largely due to the fact thatthe MD 900 helicopter has no trail rotor. This alsohopes to prevent a repeat of the many fatal accidentsthat have occurred with civilians on the ground who,

in desperation to be evacuated, have run at thehelicopters straight into the path of the tail rotor.The remaining three helicopters of LAR remain inLuxembourg.

Air ambulance reaches heart of tragedy

The DRF (Deutsche Rettungsflugwacht e.V./GermanAir Rescue) has been saving lives on its air rescuemissions, both with helicopters and ambulanceaircraft, for over 30 years. On 17 November thenon-profit air rescue organization flew its 325,000thmission. Approximately 700 emergency physicians,500 paramedics, 180 pilots and 80 engineers are onduty for the TEAM DRF. The DRF and its TEAMDRF partners operate over 42 HEMS bases withmore than 50 helicopters for emergency rescue andintensive care transports between clinics. Fourambulance aircraft are used for the worldwiderepatriation of patients.

DRF flies its325,000th mission

East West Rescue, an Indian air ambulance andemergency medical assistance company has beengranted permission for clearance in Afghanistan. Theyaccompanied their announcement, to provide airambulances in this new territory, with their first rescue. On 21 November, a Nepalese National with acomplicated fracture femur was air lifted by EastWest Rescue medical team from Kabul, Afghanistan,and brought to New Delhi the same day fortreatment. Afghanistan is the fourteenth territory tobe added to the East West commercial planerepatriation services offered. The round-trip flyingtime (fixed wing) from Delhi to Kabul and back toDelhi is reported at seven and a half hours and themedical equipment, team and aircraft will remainbased in New Delhi, India.

East West Rescueenters new frontiers

International Travel Insurance Journal www.itij.co.uk

NEWSANALYSIS18

The subject of bird flu has been on the minds ofpeople in Asia for some time. As Europe preparesfor the possible onset of a bird flu outbreak, (ITIJ58, November 2005, Europe panics at avian fluthreat) it is now at the forefront of everyone’smind across the globe. Ian Youngman looks at theconsequences for the travel insurance industry inthe case of a bird flu pandemic

Every major health scare sees the doom mongerspredict untold deaths, and the end of most travel.SARS, AIDS and terrorism have taught us that even ifpeople and businesses reduce the number of tripstaken in the short-term, pent-up demand eventuallyexplodes with more trips taken as a form of catch-up.At present, bird flu has not led to any bans on travel,or any suggestions from governments that theirnationals should avoidgoing to any namedcountries. A handful ofpeople have died, whichalways makes the news,but compared to normalroad, rail, air and winterflu deaths, numbers areinsignificant. Insurers arenot being panicked intorefusing to offer cover forany country. The terrorof airborne disease isgood news for some; funeral group Destinyannouncing it is producing cheap coffins 24 hours aday and could cut crematorium services from 45 to30 minutes as the bodies pile up.

The good news is that governments around theworld are putting in place contingency plans. Thebad news is that most of this action is by country,with far from enough co-operation betweencountries in producing stocks of vaccine.Governments are giving advice to travellers, e.g.avoid poultry farms, do not pick up dead birds, butit is not a great help. Educating business travellers ismostly a waste of time, as it is the uneducated inpoor countries who could be most at risk and helpcause widespread problems. This latter groupcarries live animals and food through ports andairports despite banning notices.

Dispelling myths surrounding the virusThere are myths building up around avian flu: Themost worrying is that a normal flu injection will

protect you againstcatching bird flu. Butactually, the bird flu virus isnot a development of thestandard human flu.Although antiviral drugs,such as Tamiflu, which arealready available and beingstockpiled by countriessuch as the UK, may helplimit symptoms andreduce the chances thedisease will spread, this

protection is a mixture of hope and guesswork bypoliticians and scientists, with the added bonus thatif people think they are safe, a panic will be lesslikely. One other common myth is that if you stop

eating chicken you will be safe; but it is not a food-borne virus.At the moment, the reality is that there is novaccine to prevent bird flu in humans – currentlyavailable vaccines are not effective against the H5N1strain of the virus. Scientists are working ondeveloping a vaccine, but even if they succeed, andif mass production procedures are ready, it will takethree to six months to produce quantities ofvaccine. The worrying fact is that a year’sproduction of vaccine would at most protect 450million people, out of a world population of manybillions, and this virus is typical of flu viruses in that itis mutating fast: Water birds were carriers but notinfected, until a mutation meant they caught it too.Another myth is that it is all the fault of the worldbird population, whosomehow managedto create a virus thatkills them andhumans. There areseveral types of flu:Birds, animals andpeople all get flu, butthis type is rare in thatall three arevulnerable. Thecurrent virus can betraced back to 1918when ten millionreturning soldiersspread a virus aroundthe world. Theoriginal virus killed

most people who caught it and then it mutated tosurvive, becoming much weaker, but still managingto kill one per cent of the world population, over50 million people. Since then we have had twoworld pandemics, each killing a million people.Ready or not, scientists say we are long overdue aworld flu outbreak.

Planning for a pandemicIt was thought that humans could not catch thecurrent bird flu. Either the scientists were wrong, orit mutated. Several hundred people have caught theflu, originally from close contact with infected birds,and latterly from contact with family members whohad the disease. The original mortality rate was 75per cent, but this has fallen to less than one in two

What a flu pandemic would mean

There are myths buildingup around avian flu: Themost worrying is that anormal flu injection will

protect you againstcatching bird flu

www.itij.co.uk International Travel Insurance Journal

NEWSANALYSIS 19

dying. A pandemic is when a new,highly-infectious form of a flu virus isformed that can rapidly infect a largenumber of people. The result is anillness that rapidly spreads around theworld and may cause widespread loss oflife. The ability of bird flu viruses to infecthumans throws up this worryingpossibility. It could merge with human fluvirus to create a new virus. This newvirus could then be passed betweenhumans. If this happens, the result couldbe a pandemic of highly contagious flu.What governments and scientists arerightly terrified of is a mutation becomingan airborne disease, allowing it to spreadquickly. If it does this, it would be muchweaker, but even a weak version killingone per cent of the population would killmany millions.Travel insurers can just sit back and waitor they can make contingency plans: Thecommon reaction is the simple responsethat they will not cover people travellingagainst government advice, will notcover those who cancel because ofpanic, will cover those wherecancellation is beyond their control, andwould provide emergency treatment tosufferers. This micro management of apotential crisis is inadequate, as if apandemic occurs events will move atbreakneck speed with individuals,businesses and governments panicking.The simple reaction to an outbreakwould be to close borders. But expertsargue that the devastating economic costof stopping international travel would at best buyonly a few days protection before the disease iscarried through. Shutting routes into a country fromone or more countries would result in abandoningtravellers, business people and diplomatic staff tothe flu. It would also be hugely detrimental to theaffected area, potentially stopping the flow of aidand medical supplies. Most businesses where employees travel are doingnothing. However,a few havecontingency plans:Some firms havestarted supplyingstaff travelling toAsia and otheraffected areas withanti-viral drugs, inthe hope that theyhelp. Multinationalcorporations,including globalbanks DeutscheBank, HSBC andUBS, are preparingdetailed contingencyplans, includingrepatriation routinesfor their workers, if they are allowed to get themout of an infected country.Many countries have developed plans to protectagainst the possibility that the virus will start tospread between humans. These include rapidresearch, stockpiling drugs, vaccinating key workers,killing poultry and banning older workers fromchicken farms. Unfortunately, this lot is about aseffective as throwing a bucket of water on a burningbuilding. The real, secret, contingency plans areprotecting government and politicians, working outwhat sections of the population you allow to die,and how to avoid panic by keeping the real truth ofrisk and deaths from the public.Many countries plan to screen people entering atairports, ports and roadways. This is more aboutcalming local populations than being an effectiveplan. The main problem is that diagnosing flu is noteasy; people can have and spread flu, beforeshowing any symptoms – some might developsymptoms during the journey, while others maycarry the flu without ever showing symptoms. Youcould quarantine people in the same way that liveanimals are quarantined but this extreme measurewould be unpopular and, most of all, illegal.Travel insurers need to plan what happens if a major

outbreak occurs. Borders would close almostinstantly, as no device or system can tell if a travelleris a carrier or infected. This would leave travellersstranded – what do you do for accommodation andany medical treatment? Evacuation would bebanned, even for incidents unrelated to bird flu.Since the original outbreak in December 2003, thebird flu strain identified as H5N1 remained largely inSoutheast Asia until this summer, when Russia and

Kazakhstan both reportedoutbreaks. Outbreakswere first spotted inVietnam and Thailand in2003 and it has nowestablished a foothold inwestern Turkey andRomania.Businesses worry thattourists could grow waryabout visiting rural areas oreven entire countrieswhere the virus has beendetected. Turkey’slucrative tourism industry isgrowing at more than 10per cent a year and a paniccould cause problems.This is where

governments have a real difficulty: how do youbalance providing information and worrying peopleenough so they take care, and avoiding a panic? If apopulation becomes frightened, it would sendmillions out of cities into rural areas, spreading thedisease fast with them.

Hope for the best, expect the worseAlthough everyone is hoping for the best, manyscientists fear it is more a case of when, where andon what scale, than if. Once the virus gains theability to pass easily between humans the resultscould be catastrophic. People will not haveimmunity to a pandemic flu because it will be a newtype, and many will die. Others will spread itunknowingly. The biggest unknown is how bad it isall going to be. The UK government is working witha range of outcomes from under 20,000 deaths upto 750,000, and worldwide, experts predictanything between two million and 50 million deaths. Through the doom and gloom, however, tourismindustry insiders are hoping that at the end of theday, people will continue to travel. As we have seenin the past, people are resilient in the face ofcatastrophes and there is no stopping the worldtravelling.

THERE IS LIGHT ON THE HORIZON

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A pandemic is when anew, highly-infectious formof a flu virus is formed thatcan rapidly infect a largenumber of people. Theresult is an illness that

rapidly spreads around theworld and may causewidespread loss of life

Day one – 9 November

Disaster and rebuildingKeynote speaker: Mr Rubén Cano – Spanish RedCrossAs Allan Jones rightly mentioned in his introductionto the first morning’s conference sessions, naturaldisasters are going to keep occurring; and theireconomic, social and psychological impact is goingto continue to be felt. These disasters can have abig impact on travel, but we are a resilientindustry and it is how we learn to deal with theaftermath of such events that will enable us tolearn and to improve our response. Our keynotespeaker this year, Rubén Cano, has worked forthe Red Cross for seven years and has a greatdeal of experience in organising relief efforts andaid to those most in need when a disaster like theAsian Tsunami or the Pakistan Earthquake strikes.He gave us a three-part presentation on thestructure of the Red Cross, how the Red Crossresponds to disasters, and what the organisation isdoing to aid the recovery process in the tsunami-struck regions of Asia.The Red Cross is essentially made up of threeparts: the International Committee of the Red Cross,

which intervenes in times of conflict or war, takescare of prisoners of war and incorporates aCentral Tracing Agency that uses a database ofmissing persons to reunite families displaced byconflict; the National Red Cross and RedCrescent Societies assist, amongst others, drugaddicts and AIDS sufferers; and also, theInternationalFederation ofRed Cross andRed CrescentSocieties –consisting of 181separate societies– who take theleading role indisasters.The Red Cross ispresent in almostevery country inthe world andcan, thus, respond to most disasters within twohours. Cano told us that, as it takes two to threedays to get planes and ships to disaster areas, it isimportant to be prepared in advance. Funding forsuch charities, therefore, is better if it comes in a

steady stream, as opposed to all at once after adisaster has struck. However, when a disasteroccurs, the National Red Cross Society based in theaffected country will request international help if it isneeded. A FACT (Field Assesment and Co-ordination Team) will then be deployed to thecountry to assess the needs of the population,determine what relief items are needed, and decide

how the operation can be managed in the field.Emergency Response Units (ERUs) are generallythen deployed within a couple of days. These consistof the people as well as the equipment – computers,generators, tents, blankets – that will be needed, andthey are standardised, so all the equipment iscompatible in any country. The ERU equipment isstored in warehouses and is ready to go as soon as it

is requested. The final stageof assistance provided bythe Red Cross is the longerterm healthcare needs andrebuilding support providedby the charity.So, how did the Red Crossimplement this strategy inAsia in the wake of thetsunami? In Sri Lanka, RedCross volunteersimmediately beganproviding healthcareassistance, giving feedback

as to what was needed in the field. A FACT teamwas then deployed to gather information from teamsaround the country; and ELUs organised fromGeneva were deployed, along with otherinternational Red Cross teams. In Indonesia, many

ITICREVIEW20

International Travel Insurance Journal www.itij.co.uk

This year’s conference in Seville was a lavish affair, withrecord delegate numbers enjoying the spectacular neo-mudéjar architecture of the Hotel Alfonso XIII – an aptvenue for the 13th International Travel InsuranceConference (ITIC). The welcome function, sponsored byHygeia, took place in the beautiful courtyard area of thehotel, where delegates old and new and from all cornersof the world mingled around the Moorish white marblefountain. It was an enjoyable start to a full conferenceprogramme. This year’s agenda covered many topicalissues, includinga look atcatastrophemodels,changing travelpatterns, makingtravel insurancecompulsory, andpre-existingconditions. Somelively debatesensued –moderated by

Allan Jones, pictured above, and conference chairmanIan Cameron, pictured right – and this year’s focusgroups also gave us a deeper understanding of some ofthe niche areas of this industry. Sarah Lee reports

International Travel

Insurance Conference

Seville 2005

International Travel

Insurance Conference

Seville 2005

In Sri Lanka, Red Crossvolunteers immediately

began providinghealthcare assistance,

giving feedback as to whatwas needed in the field

Red Cross volunteers were killed in the tsunami, soother volunteers came from societies in other partsof the country and from Bali, where the recruits arevery well trained following the bombings there in2002. Two FACT teams were deployed, and thenERUs. Cano went on to explain the role that theRed Cross plays when the emergency stage is over,and how it helps with recovery and the furtherdevelopment of an affected area. The general objective of the organisation is to reducethe vulnerability of a population and strengthen itscapacity in order to enable a better quality of life. Thisis carried out on the principle of social, environmentaland economic sustainability, fully involving the localpeople in all projects. Thus, when the Red Crossembarks on a redevelopment project such as buildinghouses for those that have lost their homes, it has tobe careful not to cause an imbalance in thecommunity and must take into account the unaffectedneighbours to avoid creating differences amongst thepeople. In Sri Lanka, the Red Cross is building 85,000new homes for people currently in temporaryshelters, and helping the people to restore theirlivelihoods. It has also implemented community-basedhealth projects, is helping to restore basicinfrastructure, such as schools, and in places likeSumatra, is rebuilding the city’s water network. Cano concluded by talking about disastermanagement and the new early warning tsunamidetection system being put into place. It is the hoteland resort managers, he said, that need to takeresponsibility for receiving and interpreting data fromthese systems in order to evacuate tourists, otherwisethis multi-million pound system will be useless.

Forecasting future catastrophesDavid Kerridge, manager of the Seismology &Geomagnetism Programme – British GeologicalSurveyDavid Kerridge began his presentation by talkingabout the various types of natural hazard that plagueour world – namely avalanches, earthquakes, floods,

near-Earth objects, tsunamis and volcanoes. Therehave been some astonishing examples of such eventsover the course of history, and Kerridge pointed outsome of these, including the San Fransisco earthquakeof 1906, when the San Andreas fault shifted sevenmetres, and the catastrophic Lisbon earthquake andtsunami of 1755, which led to the first collection ofdata following a quake and was thus the precipitatorof the science of seismology. This event rung churchbells in Paris, France, unsettled the water at LochNess, in Scotland, UK, and the resultant tsunami killedtwo people in Brazil. And, of course, there was theexample of the recent earthquake and resultanttsunami off Sumatra in 2004. It is the fires andtumbling buildings that are the main cause of deathfrom earthquakes. Kerridge pointed out, however,that earthquakes are also problematic due to thespeed at which they happen: the tectonic plates arestill or move very slowly for a long period of time,and then all at once they will slip and cause a quake.This is known as the stick-slip model. The vast range

of energy that can be released in an earthquake alsomakes their magnitude hard to predict. But, saidKerridge, we do have global seismic hazard mapsshowing plate boundariesand the locations ofrecent earthquakes,which give us an accurateidea of where hazardousareas lie. These areconstantly updated andcombined with ourknowledge of geology toestimate factors such asany acceleration in themovement of certainplates within a certain timeframe, and the changes inplate stress following a quake. Kerridge also lookedclosely at tsunamis and how they are caused, howlong they take to travel across the water (they canmove at jet liner speed!), and where future tsunamiscould potentially occur (by looking at known

subduction zones). He used an exampleof the debate over a model showing howa landslide in the Canary Islands mightpossibly produce a tsunami wave thatcould hit Florida. Are these events gettingworse? Earthquakes apparently are not,but extreme weather and events in theoceans do seem to be getting worse andto be happening more frequently.But has our ability to predict such eventsimproved? With regards to atmosphericand oceanic events, Kerridge explainedthat our prediction of their occurrence isquite well developed as we can seethese things coming. Events that originateunder the ground and under the sea aremore difficult to predict, however, and asKerridge stated, earthquakes may neverbe totally predictable. It is for this reason,he explained, that in Japan the bullet trainnetwork is investing a great deal of

money in developing real-time response solutions toearthquakes. With tsunamis, however, when theepicentre is out in the ocean away from the coast, an

earthquakedetection alarmcan be receivedwithin minuteswith adequateinstrumentalmonitoring, andwarnings ofhours given tothose likely tobe affected by aresultant

tsunami. An international group was established in2003 that has set up the Global Earth ObservationSystem of Systems, which monitors geologic, seismicand weather-related events and monitoring systemsaround the world, with the idea of establishing moretsunami early warning systems and co-ordinatedresponses to technical data readings. What we alsoneed, Kerridge finished by saying, is more deep-ocean monitoring, as many of the tide gaugescurrently in use are too near to the shore to beaffective in the event of a tsunami. We need thetechnology to provide us with data that will allow riskassessment, so we can then educate localpopulations to react effectively and put responseplans into place.

Travel reinsurance implicationsPaul Nunn, Catastrophe Modelling – Lloyd’s RiskManagementCatastrophic events and the losses they inflict oninsurers are becoming a serious threat to insurers’profitability and seriously testing insurers’ ability tocontinue trading. In his presentation, Paul Nunnlooked at the insurance industry’s efforts tounderstand catastrophe risk and, in doing so,monitor and manage accumulations of exposure.After giving a brief introduction to the Lloyd’s

The World Trade Centre(WTC) disaster affected 22

different categories ofinsurance – from property

damage to passenger liability

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ITICREVIEW 21

marketplace and its capacity, Nunn introduced thenotion of catastrophic risk and the various partiesinterested in it – such as ratings agencies, who, hesays, are not yet comfortable with their ownunderstanding of the newcatastrophic era or insurancecompanies’ capabilities and are inthe process of learningthemselves; and also internalparties such as boards of directorsand insurance buyers. The strainof catastrophic risk comes fromthe fact that catastrophes usuallyaffect several different lines ofbusiness in ways that aregenerally not expected. Forexample, the World Trade Centre(WTC) disaster affected 22different categories of insurance –from property damage topassenger liability. As differentclasses of business are managedseparately, we need, said Nunn,to learn how to correlate theseclasses and, hence, the losses.Nunn also gave the example of Hurricane Katrina,which, he said, broke the WTC’s record of mostexpensive insured event, and highlighted theimportance of disaster relief. Hurricane Wilma and itslong-term effects on Mexican tourism was also usedas an example of why it is important to know whathazards are out there. If we know they are there,

how do we then manage these risks?Lloyd’s uses a reporting framework called RealisticDisaster Scenarios, which helps the marketplace tounderstand cumulative risk. It looks at historical

disasters and, based on a range ofhypothetical scenarios, requires allsyndicates to carry out disasterplanning by looking at theirpotential exposure in each ofthese different benchmarkingscenarios. This then enables thesyndicates, and marketplace as awhole, to look at the probabilityof a catastrophic event happeningand, hence, the probability ofsustaining a loss within a certainnumber of years. Financial levelscan then be set for impendingevents so that the market canensure it can continue to operatehealthily after a large loss. Nunn used the example of theinclusion of the Gulf of MexicoWindstorm scenario in the list ofcompulsory scenarios for 2005:

due to the lessons learned from losses resulting fromHurricane Ivan in 2004, insurers anticipated lossesfrom Katrina, and were therefore financially prepared.Terrorism, explained Nunn, is also a relatively newcompulsory scenario, introduced after 9/11. By usingcatastrophe models to estimate losses, therefore,insurers can create an insured loss and arrange

reinsurance where they deem it necessary. Nunn concluded his presentation by reminding theaudience that we are moving into a new riskenvironment, where climate change will play a largerrole. It is essential, he said, for the industry to bear thisin mind and to keep up with new potential risks bymaking sure it procures good data. And the relevanceof catastrophe modelling to the travel insuranceindustry? Well, besides helping with capital setting andratings processes and the correlation of potentiallosses with other lines of business, Nunn rightlypointed out that with the increase in popularity ofannual travel policies, insurers no longer know exactlywhere their customers are at any point in time.Policies, therefore, need to take into account that thetraveller could be anywhere in the world – includingan area with a high risk of impending catastrophe.

Panel session:Changing the way policies are written to reflectnew travel booking patterns

The three panellists below each made a briefpresentation on the ways they have interpretedevolving travel trends and then fielded questionsfrom the audience. Here is a synopsis of theirpresentations:

Simon Powell, director travel insurance distribution– EbookersOver the last few years, began Simon Powell,consumer habits have changed dramatically: People

are buying their holidays and their insurance throughdifferent channels, such as the Internet, and movingaway from the traditional travel agent retail shops.There are less package holidays being bookedthrough agents and more independent travel, withan increasing number of more affluent holidaymakerslooking for ever more thrills. With the advent ofcheaper air travel, people are venturing abroad morefrequently, and they’re travelling further afield. Theinsurance industry, said Powell, has accordingly alsogone through major changes in the last 15 years.Despite some benefits, such as cancellation, medical,and baggage, remaining the same, benefit levels haveincreased with inflation. Changing travel patterns andnew risks have also played their part in shaping

ITICREVIEW22

International Travel Insurance Journal www.itij.co.uk

Focus groupsThis year’s focus groups were extremely popularand provided specialist forums for debate. Coveringa variety of industry areas, these meetings andworkshops allowed niche areas of the market to bediscussed in further detail and brought togethercommon segments of the industry to discusscurrent matters and ideas

Marketing clinic – Michael Smith, SeaMountainMichael Smith’s introduction to marketing offered anengaging and lively debate. Opening with a generalsurmise of what people think marketing is, with plentyof opinions coming from around the table, MichaelSmith then provided his framework for marketing insuccinct terms. Starting with the four P’s – product,price, place and promotion – he outlined these fourfundamental terms, adding an additional three forconsideration, people, process and physical evidence.The whole purpose of marketing, according to Smith, isto attract customers – once the customers are securedthey must then be kept and become profitable. This iswhere GREAT marketing comes into play, in order tokeep customers satisfied which will inevitably result inprofitability, one must be ahead of the game. Michael Smith then showed the room four adverts inorder to back up his teachings and offer differentmethods of capturing audience attention. He usedfour very different examples, all of which had theirown style of effective marketing. In all of theseadverts the most effective method was to differentiatethe product, set it apart from its competitors, even ifthe image that is created isn’t necessarily true itdoesn’t matter so long as people believe in it. Forexample, Stella – ‘reassuringly expensive’ – is apremium larger in much of Europe, but in Belgium itis just another, middle of the road lager: themarketeers didn’t reach Belgium in time!To come up with a concept like this, Smith continued,it is necessary to ask questions relating to the product(market research). Digging under the surface will leadto good insight; for example, a survey carried out byBritish Airways with its customers discovered that whatthey wanted most was a good nights sleep. Hence,they introduced flat beds. This wasn’t a direct requestof customers; it resulted from a deep understanding ofthe product and what people wanted.The intention is to engage people, to do this oneneeds to understand the psychology of human naturefirst and foremost, as people think emotionally ratherthan rationally. When asked how this could apply totravel insurance Smith clearly indicated that it is simplyabout how people are trained to think. Currently, the

general population think about price, but if insurerscan get them to think emotionally about insurance, tobelieve in the importance of it, then they will believethat the price is important too. For example, as onedelegate pointed out, in Canada, where travelinsurance is very successful, his company has beencleverly marketed. It is membership only, it is not thecheapest and that is its strong point. The consumerhas been educated to believe in it as a brand andtherefore buys into it. The group ended up coming to the joint conclusionthat branding is very important as it creates a market.Customers might not know what they want, but it isup to insurers to educate them so that they dobecome preferential and wish to make a choice.Travel insurers are the only people who can changethat market and they must develop a new angle andmake it positive. It will stay the same as long as theystay the same.

Hospitals and the impact of pre-existing conditions– Allan Jones, United Medical CorporationParticipants in this focus group included Europeanand North American hospital operators, physicians,representatives of assistance companies, costcontainment companies and insurers, who debatedsome of the common perceptions and definitionsof pre-existing conditions, and some of the issuesarising from related claims. There was an opening discussion regarding the

different perception of ‘pre-existing conditions’ byhealthcare providers and insurers. Providers oftenbelieve that insurers work to develop pre-existingconditions, particularly on large claims as a ruse toavoid payment for services properly provided; andinsurers, in turn, expressed that hospitals often seethe insurer as a ‘pot of gold’ and seize theopportunity to over-test patients. One hospitaloperator was critical of apparent arbitrary and poorlyevidenced disallowances of high-value claims resultingin large losses for hospitals unable to collect payment.Insurers, on the other hand, credited poor providerand client communication and a lack of co-operationin obtaining critical clinical information on a patient’shistory as the primary cause for untimelydisallowances and provider dissatisfaction.The question of patient honesty when reporting pre-existing conditions also came up and it was estimatedby insurers in the focus group that 20-30 per cent ofclients do not disclose pre-existing conditions whenapplying for travel insurance. They do this in order toobtain the coverage and in expectation that if amedical situation develops, the pre-existing nature ofthe condition will not be discovered.Next on the agenda was the issue of obtaining patientinformation from GPs. The group felt strongly that amajor problem in the determination that a claimanthas a condition that is pre-existent is the lack of co-operation by the patient’s private doctor. It was statedthat often the insurer is unable to obtain all of the

required information from the GP in order to make atimely determination. The patient is, nevertheless,treated and discharged and the provider is left withlittle recourse for recovery of payment from a patientthat has returned to another country – with time,language and legal barriers to the collection ofpayment. It was felt that the GP often sees theinsurer’s request as an annoyance and an interruptionand does not place any priority in assisting him inbuilding a case that could result in the disallowance ofan insurance claim for his patient. After all, the GP hasidentification with and does not want to jeopardizehis continuing relationship with the patient.Should the insurer, however, help the provider in thecollection of a disallowed claim? What sense ofobligation does the insurer feel to assist the providerin recovering costs if a claim is disallowed due to apre-existing condition that wasn’t declared? Thegroup was divided on this issue, with some feelingthat insurers in the spirit of cooperation should assistby providing claims related information and contactdata to the hospital or doctor. Others felt that suchassistance would be precluded by various patientprivacy considerations. The group concluded that it was critical for providersand insurers to develop relationships that will enablethen to communicate effectively in the resolution ofclaims and in the timely determination of pre-existingconditions. A relationship that is contract based is bestfor ensuring that all parties understand the process

product development. Annual and multi-trip andGAP policies are more commonplace today andcater to the frequent traveller or backpacker. Suchpolicies, pointed out Powell, are more popular insome countries – for example the Netherlands –than in others. Interestingly, he said, the main part oftravel insurance purchasing in Europe and the US istrip cancellation only.Where, asked Powell, could we go with travelcover? Underwriters’ and reinsurers’ attitudeshave already changed towards terrorism cover,which is no longer excluded under many policies.The fact that people are increasingly travellingwith more advanced technological gadgets, suchas iPods and laptops, has lead insurers to considercosts associated with wear and tear and ofreplacing products with ‘new for old’. Impairedlife policies and equitable premiums are anotherway forward, believes Powell. With an ageingwestern population who wants to continue totravel, what Powell believes we will see is greaterlifestyle underwriting in travel insurance, in line withthis trend already being seen in private medicalinsurance. And, lastly, an attempt to write global orpan-European policies is a real option, especiallygiven new EU-wide regulations, and despite thelevels of medical expenses benefit varying widelyacross the globe. In conclusion, stated Powell, giventhe bad media coverage that the travel industry andthe insurance industry often receive, it is essential tosucceed through successful partnerships – forexample, recent collaborations around policy

wording – and we need to communicate regularly tomeet our own and our customers’ objectives.

Samantha O’Connor, head of development – AllClearInsurance ServicesSamantha spoke mainly about older travellers andthose with pre-existing conditions, and reiteratedsome of the points made by Simon Powell about the

increased frequency of travel of such groups, due,predominantly, to the fact that air travel is muchcheaper today. Seventy-five per cent of people agedbetween 50 and 79 in the UK take two holidays ayear, O’Connor told us, and people in the 45-65 agebracket are those most likely to buy travel insurance.Also, there are six million people registered asdisabled in the UK and there are 2.6 million peoplein the country living with heart disease. But whatabout the 15 per cent of people who still travelabroad with no insurance? With an ageing western

population and older people ‘behaving like themiddle aged’, more and more people are travellingwho are potentially a greater risk, and have pre-existing conditions. What we need to do, saysO’Connor, is make policies more personal. A moremodular approach to insurance underwriting isneeded in order to give these travellers what theyreally need; for example mobility aid cover instead ofwar and terrorism cover. By educating thesecustomers, they can choose what cover they needfor themselves. Insurers do, however, need tobalance the time taken to buy a policy with theamount the policy will cost: if sold through travelagents, is itworthspending allthe extratime withthe clientjust so theycan save afewpounds? Itis up to theindustry to educate customers and to gauge just howmuch the client really wants or needs to know.Insurers, added O’Connor, also need to bear inmind that word-of-mouth is an important method bywhich people direct their friends and family towardscertain cover or policies. So if insurers can offercover that fits the traveller and handle complex callsin one stop, they are surely moving towards

adopting the right strategy.

Frank Fotia, vice presidentInsurance and AutomotiveAlliances – CanadianAutomobile AssociationFrank began his presentationwith some interesting statisticsregarding Canadian travel andthe purchase of travelinsurance, in a population of 35million:• Canadians spent $21 billion

in internationaltravel in 2004on 17.1million trips. • Over $500 million in travelinsurance premium was purchased.• Most winter travel is to the USand the Caribbean; most summertravel is to the US and Europe.• 74 per cent of Canadian travellershave or purchase travel or ‘out of

country’ medical insurance: 41 per cent are coveredthrough their employment plan; 38 per centpurchase a travel insurance policy; and eight per centare covered through their credit card.Known for its snowbirds (older travellers that leaveCanada in the winter months and head south towarmer climates), Canada has also had to take intoaccount the fact that people are generally travelling

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ITICREVIEW 23

and timing of pre-existing determinations. Outlier orcases with special circumstances should always bereviewed by provider and insurer co-operatively.

Injury Claims in the US – Dick Atkins, InternationalRecoveriesThis lively focus group focused on the importance ofsubrogation to reduce bottom line expenditures. Thesubstantial differences in the 50 states’ personal injurylaws were discussed, including the impact of the‘Made Whole’ doctrine, which, in many states,severely limits insurance company reimbursement,and the fact that several states prohibit subrogationentirely under certain circumstances. A possible legalchallenge to such anti-subrogation laws was thendiscussed, along with the fact that while some statesrecognise the right of subrogation without a specificclause in the policy, others require a contractual rightto subrogate. Participants’ verified that the lawscovering personal injury and subrogation claims varywidely from state to state and that the statutes oflimitations in the US vary from one year to four yearsfor such claims. The important role of local counselwas then covered by the group. Next for discussionwas the proliferation of no win/no fee arrangementsin countries around the world, recognising thatcontingent fee type of representation encouragesaccess to justice for injured insureds and provides acost effective way for insurers to obtain recoveries.Finally, the discussion turned to the importance ofidentifying injury claims with a subrogation potential asquickly as possible in order to maximize the likelihoodthat the insured will co-operate and that pertinentevidence will be presented.

International Air Ambulance Operators Forum –Volker Lemke, Flight Ambulance International (FAI),and Craig Poliner, Medescort InternationalThis focus group looked at the concept of wing-to-wing transfers and how they provide an interestingmodel for future repatriations. Wing-to-wing transfersuse two operators to accelerate case response times,reduce the length of shifts for medical crews, andoffer increased availability. But, is this acceptable to theclient? If a client requests a flight from FAI but anotheroperator is used for another segment of the flight,would the client mind? Basically, decided the forum,they shouldn’t – due to the benefits alreadymentioned – but there are some considerations tothink about. The prior auditing of partner companiesis very important, as is determining whether theyhave the correct levels of insurance cover. It is alsoimportant to establish how compatible equipment is,especially between Europe and the US, and to ensureoperators carry necessary adaptors and transformers.

Finding out such information prior to commencing aflight, including knowing details such as crewqualifications, can only help to avoid problems oncethe repatriation is in progress. With regards toworking out costs for such transfers, this could becalculated per flight hour for each operator involved,but some form of standardization would have to beput in place. Costs could also be limited by usingcommercial airlines, where possible, and using aircraftwith relevant capacities for different legs of thejourney, i.e. using a short-range craft for a shorterjourney. Although the European Aeromedical Institute(EURAMI) has some written standards covering thisarea, Volker suggested that it should be a goal of theair ambulance industry to write down standards forwing-to-wing transfers, especially as they have provento be extremely successful in the case of long-haulrepatriations. This could be done through the work ofan established air ambulance operators forum. It wasalso mentioned that National Environmental HealthScience & ProtectionAccrediation Council(EHAC) has started tostandardize certain criteriafor the air ambulanceindustry, and that airambulance operators arealso governed to anextent by JAR ops inEurope and Commissionon Accreditation of Air Medical Services (CAAMS) inthe US. But bringing industry standards into line doesraise the question of how to incorporate internationalas well as national standards, and how enforcementwill be monitored. An established air ambulanceoperators forum would also be useful in providinginformation as to where planes are based. This, it wasmentioned, would be extremely useful for assistancecompanies. If assistance companies knew more aboutthe possibilities of wing-to-wing transfers, they wouldbe able to find out how to save money. One further issue on this matter concerned liability inthe case of something going wrong. If there are twolegs to a repatriation journey, at what exact point isthe patient no longer the responsibility of oneoperator and the responsibility of another? This raisesthe possibility of conducting a full examination on apatient before accepting responsibility for them.Overall, it was concluded that if wing-to-wingtransfers allow a quicker response time and providecost containment, these must be selling points. Yes,there are liability issues with this method, but theindustry seems to share common goals and sharesimilar issues with regards to this increasingly popularmethod of repatriation.

International Air Ambulance Directors Forum – MichaelChurchill-Smith, McGill University Hospital and DrMathias Kalina, Flight Ambulance International (FAI)A popular and fast-paced focus group, this discussionopened with a look at the presence of a physician onmedical flight crews. In the US, it is not specified thatsuch crews must contain a physician, but they areprovided if the client requires it. Essentially, this is dueto a matter of cost: medical malpractice cover isexpensive, and flight doctors are expensive in the US.In Europe, the law generally requires medical flightcrews to carry a doctor. This is also a cultural issue: InEurope doctors are in greater supply.The discussion then moved on to this issue ofstandardized reporting. How much do medical crewsneed to document? Should they not think aboutstandardizing medical records and patient safetynotes? Do they have the facilities to do this? One airambulance company present said it collects data

electronically inthe air todeterminepossible outcomesfor the patient.Others also collectdata electronicallyonboard and thendownload theinformation to

computers once on the ground, or use hand-writtennotes and input these onto a computer on theground. Also, some air ambulance companies dohave standardized methods of data collection.Pre-assessment reports should also be standardized, itwas suggested, as these reports are not always verygood or accurate. If you receive a poor version ofsuch a form, do you have enough information totransfer the patient safely? The example was given ofa particular Bahamian hospital, where 97 per cent ofthe patients it released were more critical than thepre-flight assessment forms implied. Also, the stabilityof a patient can change between receiving a pre-flightassessment and the actual flight itself, which might bea few days later. Should it be standard practice,therefore, to receive the pre-flight assessment the daybefore flying? Some air ambulance companies saidthey request such late reports as a matter of course.Generally, most air ambulance companies have theirown internal standards, but there are no Europe-wide(or other) standards for pre-flight assessment. MedicalInformation Forms (MEDIF) are standardized to anextent, but they are increasingly completed by thetreating physician rather than the assistance company.Next on the agenda was the topic of infectious

diseases. Are there any rules yet in place for avian flu?What happens if you get a request to carry an ebolapatient? Are air crews prepared to carry such patientsand does there need to be an agreement betweenthe pilot, nurse and the medical doctor? How do youfind a receiving hospital for such a patient? There isalso the problem of over-flight i.e. getting permissionto carry an infectious patient over certain countriesdue to the possibility of a breakdown and emergencylanding. And what is the proper equipment need tocarry such an infectious patient? Is protective clothingrequired? The authorization of the public healthauthority in the receiving country also needs to besought: especially as air ambulance companies don'twant the responsibility of bringing an infectious diseaseinto a country. It was suggested that a checklist ofequipment, pre-flight processes, and the protocol ofcarrying such a patient be drawn up.This brought us on to the subject of crewimmunization. It was stated that infectious patientsshould be treated on a case-by-case basis, butnecessary precautions need to be considered. Withthe spread of avian flu and access to Tamiflu limited,should all crews be fit tested for masks? Perhaps thereshould be a list of minimum crew vaccination levels,which would include such viruses as Hepititus B.Although some companies do ask that their crewhave such basic immunizations, people cannot legallybe forced to have a vaccination. The question is thenraised of asking the pilot if he is thus prepared to fly,or if indeed he himself is vaccinated, especially giventhat the ventilation in some aircraft means that air iscarried from the cabin into the cockpit. Therepercussions of a non-immunized crew also have tobe considered for public health. There was also general agreement within the groupthat details of nosocomial infections should be enteredon pre-flight assessment forms. There is currently norequirement for this, but it is felt that such infectionsshould be systematically enquired about and rulesdrawn up as to how to transfer such patients.Receiving hospitals would also want to know patientdetails regarding these illnesses.And finally. the issue of the acceptable length ofcrew shifts was discussed. Pilots are governed bylaws relating to this issue, but medical crews arenot. The issue of when a medical crew's shiftactually starts is problematic, but it was suggestedthat wing-to-wing transfers could be the answer tounacceptably long shifts. The advancing of medicalcrews to a destination and carrying more than onedoctor to enable multiple shifts were alsosuggested, along with ensuring appropriate restperiods. Basically, if a company doesn’t take care ofit’s crew, they will look for work elsewhere.

Knowing details such as crewqualifications, can only help to

avoid problems once therepatriation is in progress

With an ageing westernpopulation and older

people ‘behaving like themiddle aged’, more and

more people are travelling

more frequently today. Policies have changed toreflect these trends, said Fotia, with more annualplan options that reflect frequent, short-durationtrips; increased deductible options ($250-$25,000);policies for ‘just US’ and ‘other than US’ travel;penalties for not using recommended networkfacilities or for a delay in contacting the assistancecompany; as well as discounts for loyalty, no claims,and the purchasing of multiple policies. And thedistribution of travel insurance has also evolved toaccommodate changing traveltrends: from 1 July 2005 itbecame mandatory inOntario for travel agents offertravel and out of countrymedical insurance tocustomers; there is greaterflexibility offered by travelagencies. For example, someinsure products purchased elsewhere, such as airlinetickets purchased online. And, says Fotia, travelinsurers could eventually start to disclose theircommissions, but this is not something that hashappened as yet. Changes have also been seen in the underwriting ofpolicies. There has been a definite move towardsmore specific and sophisticated medical underwriting.For example, many plans include medicalunderwriting for those aged over 55; customers arebeing given longer and more detailed medicalquestionnaires; there are stricter eligibility criteria forsome policies; there are more rating categories forolder travellers; and there is generally tighter wordingaround pre-existing conditions and subrogation.

So what do Canadian customers think of thesechanges and what are they demanding from theirtravel insurance policies? Fotia explained that theywant supplier default protection. With the collapse ofso many airlines, customers are looking forprotection in the event of airline or operator failure.They also want ‘flexible’ definitions of family andcouples, he said. Terrorism protection is being askedfor more often, and with it concise wording of whatthis coverage provides. They also want individual

medical underwriting,withoutquestionnaires thatyou need a PhD tocomplete, and theywant clear pre-existing and medicalunderwritingguidelines and more

specific travel advisory wording.

Day two – 10 NovemberDebate:Should travel insurance be compulsory?

As Allan Jones surmised in his introduction to thisdebate, surely all insurers would have travelinsurance made compulsory if they could? Wouldn’tit certainly increase their bottom line? The speakersbelow each made a presentation to the audienceand then debated amongst themselves – with the aidof questions and comments from the floor – on the

issue of whether travel insurance should or could bemade compulsory. A hand count was then takenfrom the audience to find out just which way theindustry would vote…

For: Reg Allatt, CEO – ETFSReg introduced us to his reasoning by declaring thatthe more he’d thought about his ITIC presentation,the more convinced he’d become that travel

insurance should be compulsory. Mandatory travelinsurance, he said, would be of benefit not only tothe industry, but also to the consumer and thehealthcare industry. The customer, he argued, would see reducedpremiums if everybody bought travel insurance. Also,like with other compulsory insurances, if travelinsurance was mandatory, people would be forcedto consider more carefully what they are coveredfor, creating more educated insureds who makecalculated decisions and understand their coverage.

They would, likewise, have enhanced peace of mind,knowing what support they have in case of a medicalemergency abroad. And this could eventually lead tomore niche insurance providers, offering greaterchoice to travellers. So, for example, the elderly andthose with pre-existing conditions would be able tofind better coverage at better prices. The medical profession would benefit, reasonedAllatt, as it would be assured reimbursement for thetreatment of foreign patients, hence lowering thenumber of non-payments due to lack of insurance ormisrepresentation. And for the industry? Compulsory travel insurancewould increase travel insurance payers’ billnegotiating position, which would in turn lead togreater cost stability and lower medical cost inflation.This is especially relevant in the US, where medicalcosts are much higher. Mandatory travel insurance,said Allatt, would also mean less anti-selection. If thepeople not currently purchasing travel insurance arenot doing so because they believe they are veryhealthy, perhaps forcing these people to have suchinsurance would mean less anti-selection, leading toa better class of risk and a larger risk pool. Plusstandards in the industry would have to increase.Insurers must be licensed, but in some countries, thetravel agents – through whom up to 60 per cent oftravel policies are some in some areas – are not.Compulsory travel insurance would force travelagents to increase their product knowledge andresultantly make a better class of sale. And, finally,with more money in the industry, assistancecompanies would also be able to offer a betterservice. With no more issues over whether a client isinsured and no need to investigate denials, energiescould be focuses elsewhere. Increased entrants intothe market would mean more commissions fordistributors, more premiums for insurers, and lowerloss ratios as risk pools improve.

Against: Fiona McDonald, travel underwritingmanager – Europ AssistanceFiona acknowledged the benefits to the individual,third parties and the health and insurance industriesshould travel insurance be compulsory, but, she

asked, what about freedom of choice? If just themedical component of travel insurance was madecompulsory, who would buy baggage andcancellation cover? According to a survey in the UK,most people buy travel insurance for the medicalcover, so providers, argued Fiona, would lose out onthe premium income from other aspects of thepolicy. Also, given the right to self insure, people withmore money might opt to pay for their medical billsshould they arise, or chose between varyingdeductibles. And, despite third party liability motorinsurance being compulsory in some countries, for

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ITICREVIEW24

The distribution of travelinsurance has also

evolved to accommodatechanging travel trends

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ITICREVIEW 25

Focus groupsDefying the myths at Lloyd's – David Sterling, Crispin Speers & PartnersThis was an interesting and informative look at theorigins and workings of the world-famous institutionthat is Lloyd’s. The first mention of the establishmentis to be found in 1688 with a reference to EdwardLloyd’s coffee house in Tower Street. Lloyd’s began asa pool of funds put together by friends to reimburseany one of them if their ship was lost. Today, marineinsurance is still a big part of Lloyd’s business but otherclassestermed non-marine are even larger.The Lloyd's marketplace was put on the internationalmap in 1906 following the San Francisco earthquake,when a claim was met as a result of the disaster. Andanother prominent milestone in its history was thebuilding of the current Lloyd’s building in 1986, whichwas designed by Sir Richard Rogers and opened byHM The Queen. It is still a prominent landmark inthe heart of the city of London, UK.Not long afterwards, following the marking of Lloyd'stercentenary, the marketplace hit hard times, with astring of losses between 1988 and 1992 – such asthe Piper Alpha disaster, Hurricane Hugo, and theExxon Valdex disaster – that threatened Lloyd'sfuture. Various processes were established, however,to enable Lloyd's to regain its strength, including thelaunching of the reinsurance vehicle Equitas in 1992,and admitting corporate capital backers to the marketfor the first time in 1994. A reconstruction andrenewal plan was then put into action in 1996 toprevent further losses to Names (Lloyd'smembers).Today, Lloyd's is the world's leadingspecialist insurance market, insuring some ofthe newest, most complex and difficult risks.It is financially strong and secure, and has agood reputation for paying valid claims. Butinsurers have to respond to an increasinglychallenging risk environment today, saidDavid. There are greater and morefrequent risks, such as terrorism and global warming;urban concentration is increasing risk size; increasinglitigation raises the stakes not just for insurers, but forpolicyholders as well; stock market volatility reducesthe safety net of investment returns; and the speed oftechnological change is also increasing risk.David then gave us an overview of how Lloyd's ismade up of corporate and individual members, whounderwrite in a total of 62 syndicates. Lloyd'sbrokers, in turn, bring business to the market fromclients, other brokers and intermediaries around theworld. In fact, Lloyd's provides specialist insurance inover 200 countries, underwriting directly in 74 ofthese. He also explained the Lloyd's capital base andits 'chain of security' or how it provides funds topolicyholders. This is initially through syndicate levelassets. There are, however, members' funds atLloyd's (additional funds held in trust) and members'other assets (also available to meet claims). And,finally, there are Lloyd's central assets, available at thediscretion of the Council of Lloyd's if the first three

methods fail to meet the claim. David alsotalked us through some insurance industrytrends, some of the unique products thatLloyd's offers, and how to access theLloyd's market. One way is to become aLloyd's broker, but you must have abrokerage license, a strong set of accounts,know how to operate in the marketplace,and be approved on an individual orpersonal basis. You must also be FSAregulated and will be subjected to Lloyd'sinternal monitoring, such as monthlysolvency tests, which all costs money. The group finished the session by looking at howLloyd's operates in the travel insurance market. Davidoffered the group a number of ideas and productsthat can be attractive to the audience. As the creatorsof ransom insurance, Lloyd's is looking at adding onsuch cover to travel policies for those who would likeit. It was stated that this insurance would cover theexpenses involved in dealing with a ransom, ratherthan paying the ransom itself as the ransom has to bekept confidential. It was also mentioned that the massmarket has different travel insurance requirements tothe high-net-worth market, where individuals aremore likely to want cover for episodes such asransom. Some insurers, however, cater only to themass market. And, finally, a doctor in the sessioncommented that it might be an idea for insurers toconsider providing cover for treatment even after apatient has returned home; and, in fact, someinsurers do. Lloyd's, for example, providesphysiotherapy treatment for skiers as an add-on to awinter travel policy.

Setting standards of care in popular tourist resorts– Jon Phillips, BMESFDue to increasing concerns over the standard of careand expertise in medical facilities serving manypopular tourist resorts, and following a request by theFederation of Tour Operators in the UK, the BritishMedical Emergency Services Forum has set out toassess such standards of care in resorts. This focusgroup gave an overview of the work done to dateand the forum's plans for the future, and provided anopportunity for industry members to discuss thepros, cons and concerns of the project. Here aresome of the items that came up:• The creation of Temos (Telemedicine for theMobile Society), which is aiming to standardizehealthcare systems in countries like India, Brazil andthe Middle East. A main goal of this project is to havetelemedicine facilities installed in all member hospitals,which should help with the standardization processand will be reassuring to patients being treated

abroad, especially when in a remote area. Theproject is being run from Germany at the moment,where it is being funded by the University of Aichen.As German travellers venture predominantly toTurkey and Greece, it is hospitals in these countriesthat have mainly signed up so far. It was thensuggested that telemedicine could also be used toassess whether a patient is fit to fly, but this raised theissue of taking decisions away from the assistancecompany. A way around this, it was suggested, is forunderwriters and assistance companies to becomemore involved with the development of Temos.Another concern raised was the issue of how readilyavailable hospital data performance data will be underthe Temos system, but this has yet to be uncovered.• There are other ways in which the industry isworking towards accreditation standards for medicalfacilities. For example, in Holland, certain assistancecompanies are working on setting up accreditationstandards, as are other insurers in other areas. Thereare, of course, also international standards to

consider, such as ISO standards. • A doctor in the group raised the issue ofhow exactly you assess the quality ofmedical care. A report may be carried outon a hospital, but its status may change veryrapidly, so information would have to bekept up to date. And information shouldalso be gleaned from patients, as they see adifferent side to the facilities they are in.Reporting on the standard of facilities and

patient care is a complex issue and the limitations ofsuch reporting must always be taken into account. • An early warning system could be set up,whereby an alarm is triggered when a hospitalreceives a certain amount of complaints. It wasmentioned that this does exist to an extent, but thewill to do something about it is also needed tomake a difference.• Better translation services in hospitals.• Tour reps could be educated by the assistancecompanies as to which facilities to send patients to,but this is problematic, as they may be instructeddifferently by different assistance companies.• The best way to establish a rating system is throughexperience. Most assistance companies have theirown lists of preferred hospitals, built up over timeand through experience. When the standard of carein a hospital can change in a matter of weeks, it is thepeople operating in that area – i.e. the assistancecompanies – who are best placed to make lists ofsuitable hospitals.

• MESF is carrying out its project to helpimprove patient safety and to protectunderwriters.

Q&A law session - PenningtonsSolicitorsThis focus group was an open session,where random questions were put toPenningtons from the attendees. LouiseLydon fielded the questions well andprovided a useful handout regardinginternational claims handling. Here aresome of the matters raised:

• Human rights issues surrounding blood samples. Itwas explained that samples can be taken as long asthe data is not disclosed elsewhere and the test is forthe benefit of the patient only. Even police in the UKneed to get written consent from a patient to gainaccess to test results. It was suggested that consent tohave blood taken where needed could be draftedinto a travel policy, and Penningtons agreed that thiscould legally be done, but that the patient wouldhave the right to retract this when in hospital. • How can an assistance doctor legally use and relyon data given to them verbally by a treating doctor?What information can and cannot be disclosed tounderwriters? How can an underwriter treat data hereceives inadvertently? Penningtons explained that in acourt of law, the question of how medical data wasobtained will undoubtedly come up. Unless you havewritten proof of how you obtained the medicalnotes, it will be the insured's word against theinsurer's. One way to ensure you have proof is torecord telephone calls with clients – so long as youinform them this is happening.• In reality, many of the decisions made by assistancedoctors are based on verbal conversations withunderwriters to determine what the patient iscovered for. • In matters of pre-existing conditions, the courts candemand medical records to use as evidence.• There has been an increase in ski claims, and skiersare beginning to exchange insurance details whensuch collisions occur, just as they do in the case of carcrashes. The facts of these cases are often hard tounravel, however, with detailed diagrams of how thecollision occurred hard to ascertain. • Medical malpractice insurers want to know how airambulance doctors minimise risks to patients. It isautomatically assumed by many that patients do notget the same quality of care on a commercial flight,yet the stress of making the same journey, but havingto take off and land in four separate sections, as youmight in a smaller craft, puts even more stress on apatient. The effects of the weather are also worse onsmall planes.• The hierarchy of precedents determining where anescort company may be sued for malpractice whentransferring a patient. Penningtons explained theconcept of 'forum shopping', which involves lookingfor where the best jurisdiction would be found, i.e.the best geographic area or country in which to bringa claim. A solicitor would also ask where an incidentor accident took place and who was responsible forany negligence.

There are greater and morefrequent risks, such as terrorism

and global warming; urbanconcentration is increasing risk size

example in the UK, travel insurance, it was argued,should be classified differently as we should alwaysretain the freedom of choice over personal levels ofcover, rather than being dictated to by a nanny statethat imposes the requirement to protect ourselves. Besides this, there are many questions that ariseregarding the practicalities of making compulsorytravel insurance a reality: Who should we imposetravel insurance upon – the elderly? Students? Shouldwe all have to pay for these travellers, with theyoung subsidising the old, and the healthy subsidisingthe sick? What should we cover under compulsorytravel insurance – baggage? Medical costs? And whoshould provide this cover – a panel of insurers?Single providers? How do we pay for the cover? Dowe make it a tax – a fuel tax or departure tax? Whosets the price of policies – governments? A panel ofunderwriters? Do we want the resultant increase inregulation? And how would compulsory insurance beadministered – would we all require sticker in ourpassports that says we’re covered? Would this delayentry or exiting a country? Increased bureaucracyand extra staff would all lead to greater costs. Butwho really benefits? All of these questions, stated

Fiona, need answering if mandatory insurance wereto be considered. Her concluding comment: “Justsay no.”

For: Laura Hilton, director global health and safety– HTH WorldwideAfter challenging the opposing debating team to aflamenco dance off to decide the winner of thedebate or offering them to admit defeat and be done

with it, Laura got down to business and made asturdy case for making travel insurance compulsory.After asking whether she thought governments

should make laws that require travellers to carrycompulsory medical insurance, Laura declared thatshe thought the answer was obvious: of course theyshould. Increased sales opportunities can only meanincreased revenue for insurers, and even in countrieswhere the market is fairly saturated, there are stillbenefits for the industry. Laura also reinforced RegAllatt’s point about the benefits of having a broadermix in the risk pool. Surely, shesaid, it would be of benefit tobalance out the large number ofsick people buying travelinsurance with more healthypeople purchasing this cover. And for consumers, nightmarescenarios like the uninsured facingcrippling medical bills and foreignhospitals holding patients’passports to ransom would be athing of the past. Laura said it canonly be a bonus for a sicktraveller stuck in a tropicalhospital, or in an unfamiliarhealthcare system, to have thehandholding of an assistancecompany, the buying power of aninsurance company, and the oversight of a medicaldirector.Credible data also backs up the importance ofinsurance in access to care: a 2002 study by theKaiser Family Foundation found that 40 per cent ofuninsureds skipped treatment they thought wasmedicallynecessary;compared to 12per cent ofinsureds. Meanwhile,hospitals wouldbenefit frommandatory travelinsurance, as theyare more likely toget paid.Healthcare systemswould, thus, nolonger beburdened by uninsured travellers and would see areduction in uncompensated care. This is especiallyimportant in small tourist destinations, wheretravellers can sometimes outnumber locals, saidLaura. And billing for international patients would bemore straightforward as there would be no need todetermine whether or not they have cover, whichwould in turn lead to less administrative hassle.Laura then gave examples of where compulsoryhealth insurance is already in place and its use iseffective. International students in the US, she said,are required to have minimum health cover(including elements such as repatriation andevacuation) in order to obtain a visa. Prior to thislegislation, 25 per cent of such students dropped outdue to a medical problem, lack of insurance orinadequate insurance. And many countries, such as inEastern Europe, Latin America and Asia, requiretravellers to have health insurance before obtaining avisa for entry. This idea could be expanded toprotect more travellers and more providers. Travel,surmised Laura, is a risky business – why would younot want insurance to cover it?

Against: Fernando Gomez, deputy developmentmanager – Mapfre AsistenciaFernando’s main concern with the issue ofcompulsory travel insurance is the practicality ofimplementing such a system, and the main questionhe asked was ‘compulsory for whom?’ Firstly,Gomez considered the drawbacks of mandatoryinsurance for outbound travellers. This, he said,

could be seen as a tax, a levyimposed on you for leaving thecountry, which is never going to bepopular amongst the generalpopulation. It would be seen as onemore unwanted departure control,and would also interfere witharrangements made under the E111system in Europe. And what aboutbad risks i.e. the elderly or thosewith pre-existing conditions? Who isgoing to pay for these people, askedGomez. The solutions he foreseesare either price regulations or an‘insurer of last resort’ as exists inSpain, whereby all insurers pay intoa pool to cover uninsured losses.Secondly, Gomez considered the

option of making travel insurance compulsory for theinbound traveller. Again, he said, this could be seenas a tax imposed on you by the foreign government.And what would a country do with uninsuredarrivals? Arrest them at the airport? Policy wording isalso problematic, explained Gomez: with wording

and deductibles differing sowidely around the world,each policy would have tobe scrutinised when a claimis made, and this wouldmake for a verycomplicated process. Next, Fernando used theexamples of Spain and theSchengen countries to lookat how ineffectivemandatory travel insuranceregimes can be. In Spain, itis now stipulated by lawthat all tour operators must

render necessary assistance to travellers. In otherwords, they must buy travel insurance for each oftheir clients. As no minimum standards for coverwere defined, limits are very low, which has had aknock-on effect throughout the country. Accordingly,premiums are very low: it is not uncommon,revealed Gomez, for a tour operator to pay one ortwo euros for a one-week trip. This insurance is notpromoted by the tour operators, so many travellersdon’t even realise they have it: it is seen as a cost tothe tour operator and is not valued by the traveller. Meanwhile, the Schengen requirement is betterdefined, including minimum standards of cover, andstates that all people needing a visa to visit aSchengen country must also have travel insurance.However, as the majority of people visiting theseEuropean countries do so for a vacation, rather thanfor work purposes or for an extended stay, they donot actually need a visa. And, again, insurance fromthe country of origin has produced numerousproblems when a claim arises from a trip abroad. In conclusion, says Gomez, compulsory travelinsurance is difficult to define and to implement; itturns insurance into a commodity; interferes with the

ITICREVIEW26

International Travel Insurance Journal www.itij.co.uk

For consumers, nightmarescenarios like the

uninsured facing cripplingmedical bills and foreign

hospitals holding patients’passports to ransom would

be a thing of the past

free market system; and, based on past examples,does not work satisfactorily.

The arguments put forward in this debate provokedmuch deliberation and altercation from the floor, butwhen it came down to voting either one way or theother, does the industry favour the idea ofcompulsory travel insurance? The answer was aresounding … NO!

Panel session:The serious side of drug and alcohol-relatedincidentsIn the US, 35-50 per cent of all patients in traumacentres are under the influence of alcohol or drugs,Allan Jones told the audience. But, he said, this isn’tjust a problem in the US, and insurers in many areas

of the world end up paying claims they couldrightfully deny. The panellists below each made apresentation to the audience based on the lossesinsurers incur associated with direct and indirectabuse, use and misadventure. They then tookquestions from the floor. Here are the main pointscovered in the presentations:

Steve Wilcox and Joe Valdez – AXAIn this joint presentation, Steve Wilcox, pictured left,who has 30 years’ experience in the travel insuranceindustry, looked at this issue from the view of theunderwriter, and Joe Valdez, pictured below, with 17years’ experience in this industry, gave us the claimsmanager’s perspective. To begin, Steve Wilcox explained that there are twothings underwriters can do that can solve most

problems: increase the price of a policy, or excludecertain cover; and it is on this second option thatSteve concentrated with regards to cover for misuseof alcohol and drugs. Should these things beexcluded from cover, he asked: what is reasonable?A self-confessed amateur dramatics and pantomimelover, Steve soon had everyone on their feet andtook a head count of those admitting to drug andalcohol use. He proved his point, which was thatmost people either do not take recreational drugs,or do not admit to taking these drugs, but mostpeople admit to liking an alcoholic drink, especiallyon holiday. And this is reflected in most policywording. However, the problem is that underwriterscan’t agree on how exactly to word their exclusions.Here are some examples given by Steve fromvarious insurers that show the variety of phrasesused by the industry: ‘Drug addiction, excessivealcohol intake or You being under the influence ofalcohol or drug(s)’; ‘Alcohol or drug relatedincidents’; ‘The influence of effect of alcohol or drugs(other than drugs taken under medical supervisionand not for treating drug addiction)’.It all comes down to intention, said Steve. Insurers’intentions are expressed in different ways, but theirintention is not always clear. The total exclusion ofdrugs may not be what some policies intend, but it iswhat they say. The actual intention is usually not togive cover for recreational drugs. The word ‘abuse’is also a difficult area when it comes to policywording relating to alcohol, as it is hard to define atwhat point someone is abusing alcohol.These exclusions for drugs and alcohol shouldremain, however, concluded Steve, as sometimethey will need to be relied upon. The insurer, hesaid, expects the customer to be reasonable, and ifthey are not, the insurer should have such anexclusion to help him out when necessary.Joe Valdez then looked at the problems insurers facein attempting to prove use or misuse of drugs oralcohol when faced with a claim. With the morehigh-profile and therefore often more costly cases,the first thing loss adjusters and assistance companiesask is ‘was the incident drug or alcohol related?’, butwith other minor incidents, such as a casual fall oranxiety attack, this question is rarely asked. However,one of the major hurdles for insurers is collectingenough evidence to prove an incident occurred as aresult of the abuse ofalcohol or somedrug. Because bloodalcohol tests are notalways carried outwhen the patientarrives at thehospital, insurershave to do extensiveresearch of theirown to establish thereliability of a claim:they predominantlyinterview witnesses,such as hotels, touroperators andambulance crew. Butif a witness testifiesthat he or she smelt alcohol on the breath of theclaimant, does that necessarily mean they were‘under the influence’ of alcohol? And, stated Valdez,there is the eternal problem of lack of co-operationon behalf of the medical providers and doctors, whooften do not declare that the patient/claimant hadbeen intoxicated or smelt of alcohol, as they knowthis could invalidate the person’s claim, whichinevitably means that the hospital possibly won’t getpaid. Perhaps, challenged Valdez, it should be up tothe medical profession to prove that alcohol was notto blame for an incident occurring. This mightalleviate some of the pressure put on insurers andtheir agents to accept liability, which is especially thecase when alcohol or drug use is only suspected.Joe also reflected on how these types of claims causeproblems for the customer, who is often left in limboin a foreign hospital whilst waiting for a decision fromtheir insurer as to whether their medical bills will becovered. If not, the patient then usually facesexpensive treatment and repatriation costs, and insome cases may chose to fight the claim, leadingoccasionally to yet more bad press for insurers. What we need to think about, declared Valdez, iswhether, as an industry, we should reach a

benchmark for the point at which a person’s alcohollevel means the automatic non-payment of a claim;we need to seek greater co-operation with themedical profession, which needs to appreciate theinsurer’s right to refuse payment; and we need toincrease consumer knowledge regarding their policycoverage. Perhaps, suggested Valdez, we couldinitiate a campaign along the lines of ‘alcohol anddrugs can seriously affect your insurance cover’.

Dr Juan Bosco Rodriguez Hurtado – HospitalInternacional, XANITAlcohol use is one of the main causes for concern inthe travel industry today, and it is a trend that is

increasing. Drug use is also common, as Juan Boscopointed out with the aid of graphs showing suchconsumption amongst school-goers. So why, heasked, is it so important for insurers to determinewhether an accident or illness is the result of the useof such stimulants? Because, he reiterated, there aremany people involved in helping a patient when theyare injured abroad: the assistance company, theinsurer, the repatriation crew, and the medical staff ata clinic or hospital, and they all want to be paid.Unfortunately, however, clinics are always caught inthe middle – between the patient who thinks he iscovered by his insurer for medical treatment, and

the insurer whothinks it doesn’t haveto pay for treatmentin drug or alcohol-related cases.Juan Bosco thenwent through someextremely thought-provoking scenarios,illustrating thedilemmas faced byinsurers whenattempting to decideif alcohol was thedeciding factor in thecause of injury.For example, posedJuan Bosco: A 37-

year-old woman who during dinner has drunk twobeers and one glass of wine, and is deemed not tobe drunk, slips on a wet floor and suffers ankle andwrist fractures – is this an alcohol-related case?Problems faced by insurers, therefore, includedetermining the causal factors of an accident orillness and determining permissible alcohol levels.But, to do this the consent of a patient must be givenin order to carry out tests.Even if consent is given to carry out the test, thehospital must still protect the right to intimacy, dignityand privacy of the patient, so how, asked Juan Bosco,can we advise the insurance company of ourfindings? After all, patient confidentiality is protectedby law. So, if alcohol consumption is not going to go away –indeed it is increasing, and is a worldwidephenomenon – how can we limit its negative effects?Education is the key, said Juan Bosco, especially foryoung people. With all-inclusive resorts offeringunlimited free alcohol, and other resorts sellingalcohol very cheaply, we need to encourage andeducate people as to how to drink in a ‘responsible,safe, sensible and healthy way’.

A popular side-line (excuse the pun) at this year's conference was the table footballtournament, which saw teams from all sectors of the travel insurance industry pit their witsagainst their colleagues, and, at times, their competitors. Sponsored by Stones Solictors, theleague was a popular attraction, and the winning team – Irwin Mitchell's Galacticos – wentaway with the winning cheque for the charity of their choice: £520 for The Samaritans.

Table football fever

International Travel Insurance Journal www.itij.co.uk

ITICREVIEW28

Problems faced by insurersinclude determining the

causal factors of an accidentor illness and determiningpermissible alcohol levels.

But, to do this the consent ofa patient must be given in

order to carry out tests

Andrew Eaton-Hart, barrister – Walnut HouseChambersIn the case of drug or alcohol-related incidents, thereare three predominant legal considerations: defining‘accident’ or ‘accidental means’ and ‘intoxication’;

establishing causation i.e. finding a possible linkbetween intoxication and the accident; and providingevidence for a link. Firstly, Andrew considered the definition of accident.If you deliberately drink to get intoxicated, can aresulting injury be classed as an accident? Canintoxication, he asked, therefore result in an incidentfalling outside the definition of accident? There arescales, he told us:for example, at theextreme end,alcoholic poisoningor a drugs overdosewould not beconsidered anaccident. Also,Andrew gave us theexample of a legalprecedent of the case of Dack, whereby the courthad to decide whether an alcohol-related death wasan accident. They ruled that the woman that died,being a nurse, had taken a calculated risk in drinkingto the point of unconsciousness, and was thereforeexcluded from the benefits of her insurance policy. The court basically has to look at such points aswhether a person deliberately followed a course ofconduct that resulted in bodily injury; whether therewas intention in their actions; whether there was acalculated risk; or whether some other causalelement came into affect. When defining an accident,Andrew explained, legal representatives also have toestablish the difference between ‘accidental means’and ‘accidental result’. “Accidental means do notnormally involve deliberate actions by the victim,”said Andrew. Examples of such means includeslipping or tripping. “Accidental result focuses on theend result even there has been deliberate action bythe victim,” he explained. For example, when theend result is not what was intended, one could saythis was an accidental result. In the US and Canada,

the difference between these two definitions is stillblurred, but the UK now has a legal precedent andconsiders these definitions separately.Andrew then considered the definition ofintoxication. After considering some dictionarydefinitions, he said that the point at which alcoholconsumption becomes relevant has to beconsidered. For example, if an accident occurs themorning after alcohol has been consumed, is thatperson still ‘under the influence’? The key fact thatcourts will focus on is ‘impairment of function’ andhow relevant it was to the accident. One final pointAndrew made in this regard was the fact that aslightly different approach has to be taken withalcohol and drug use. Whilst alcohol levels can bemeasured and medical tables exist allowing us tointerpret this data, drugs have a variety of effects onpeople and only a very small amount of empiricaldata exists for us to be able to interpret any findings.Residual drug traces may also show up in a test,which might relate to the much earlier use of a drug,and tests usually just show positive or negativeresults: this area is, therefore, still problematic. Causation was the next area tackled by Andrew.Does a link have to be shown between theintoxication and the accident? If a policy exclusionreads ‘whilst under the influence’, then probably not.But if it reads ‘arising from the effect or influence’,then causation will have to be shown. When anaccident could be attributed to multiple causes, forexample in the case of an intoxicated person thattrips and injures himself, alcohol must be shown to

be the ‘effective dominantcause’ if an exclusion is to beeffective. Lastly, several questionsaround the subject ofevidence need to beconsidered by lawyers weretalked through. Who has toprove or refute intoxication?Andrew maintained that it is

the insurer denying the claim that is responsible inthe first incidence for proving intoxication. What arethe likely sources of evidence of intoxication? Thesecould be police reports, evidence from healthworkers or eyewitnesses in the resort where theaccident happened. What are the problems involvedwith medical evidence? Essentially, stated Andrew, itis the duty of medics to treat patients, not obtainevidence; there are no rules saying patients must bedrugs tested; saying someone smelt of alcoholdoesn’t mean they were intoxicated; the reporting ofalcohol levels as ‘alcohol +’ or ‘alcohol ++’ are notentirely understood; patient reports can be unreliableas they often play down the extent to which theywere drinking. All of these reasons make forsomewhat unreliable evidence. So, what is thequality of evidence required to establish intoxication?Generally, scientific tests such as blood-alcoholconcentration or good evidence of impairment offunction from eyewitnesses are needed. In his closing comments, Andrew concluded that anunintended incident after moderate alcohol

consumption will probably still comewithin the definition of ‘accident’.Meanwhile, the higher the degree ofintoxication, the easier it will be toestablish a causative link with theaccident; and, generally, the more severethe injury, the better quality of evidenceavailable.

Peter Gutelius, senior counsel – RBCInsurance

Although policy wording can beconfusing and hard, at times, to apply,with clinics often caught between a dutyto treat a patient and the worry ofgetting paid by a patient or insurer, mostof us would accept that exclusions foralcohol and drugmisuse are necessary.How do insurers,therefore, build suchan exclusion, askedPeter.He said you can startwith a basic exclusion– something like ‘We

will not pay for losses caused bydrug or alcohol abuse’. Then youhave to think about single eventsversus chronic use andunderstand the differencebetween the two: a single case ofalcohol or drug abuse might beattributed to a particular trip oroccasion, whereas chronic userefers to the long-term orrepeated use of such stimulants.Therefore, said Peter, you canbuild onto your exclusion so itcould read something like: “Wewill not pay for losses caused by your abuse orchronic use of drugs or alcohol.”Secondly, insurers need to specify whether they are

excluding abuse prior to or during a trip – or indeedboth. So, if the insurer’s intent is to exclude ‘chronicuse’ then they need to specify whether this ‘use’must occur on the trip. So, the insurer would buildon the exclusion and it might read something likethis: “We will not pay for losses caused by yourabuse or chronic use, whether prior to or duringyour trip, of drugs or alcohol”, Peter noted.Next, insurers should think about their definition ofdrugs versus medication. Do they mean to includejust illegal drugs? What about prescribed medication?Are you abusing a drug if you fail to take medication,as prescribed? Insurers could cover this in theirexclusion by explaining that they will not cover forsuch non-compliance. And, lastly, insurers couldconsider distinguishing between medical conditionsand injuries: medical conditions being illnesses causedby the drug or alcohol abuse, such as cirrhosis or

pancreatitis; and injuriesbeing somethingsustained as a result ofactivities undertakenwhilst ‘under theinfluence’. In the samemanner, insurers canbuild on their exclusionby saying: “Thisinsurance does notcover any loss, claim orexpense of any kindcaused directly orindirectly by your abuse…”In conclusion, Petergave the example of thecase of Bird versusCanada Life to showhow ‘exclusionarywording will constantlyshift as insurers react tolegal realities while

attempting to balance the competitiveness of theirproducts in the marketplace against their pricing,coverage and claims objectives’.

www.itij.co.uk International Travel Insurance Journal

ITICREVIEW 29

If you deliberately drink toget intoxicated, can a

resulting injury be classedas an accident?

Day three – 11 November

Discrimination, pre-existingconditions and lifestyleunderwriting

The travel insurance industry has had experience indealing with every type of illness, but just how oftendo we consider mental illness, asked ITIC moderatorAllan Jones. With a half to two-thirds of peoplevisiting physicians having an undisclosed psychiatricdisorder, how, as a business, are we prepared todeal with such patients in an emergencyenvironment? In this session, we also considered theconcept of lifestyle underwriting and how to dealwith the often contentious issue of pre-existingconditions.

Mental disability: what does itmean and how might it affecttravel and the purchase of travelinsurance?Leo de Graaf, regional vice president – World Federation for Mental Health

Leo gave an interesting presentation, outlining thevast array of mental illnesses and the range of theircauses and affects. To begin, he gave an overview ofmental disorders, showing that there are many typesof such illness. They include organic disorders, suchas dementias and delirium; behaviour disorders dueto misuse of a drug or alcohol; schizophrenia andother psychoses; mood disorders, such as bipolaraffective disorder; and neurotic and stress-relateddisorders, including anxiety and obsessive compulsivebehaviour. Of specific importance to travel insurers,pointed out de Graaf, are possibly anxiety disorders,which can be enhanced by the thought of travelling,and anti-social personality disorder, as there may bea tendency for the person to commit fraud. There isalso great heterogeneity with mental illness, heexplained. They range in seriousness – from mildnervousness to chronic schizophrenia; influence –from genetics to environmental causal factors;detection – from clearly visible side-effects such astrembling or sweating to being hardly noticeable oronly noticeable under certain conditions, such as

with phobias; accessibility for treatment – somebeing more easy to treat with therapies or drugsthan others; course – some episodes of mentalillness are short and never repeat themselves, othersare longer or cyclical or are sometimes constant,such as is the case with depression; and comorbidity– some illnesses are found to exist alongside otherconcomitant yet unrelated illnesses. De Graaf then considered the epidemiology ofmental illness. A 2001 World Health Organizationstudy showed that: at any one time, 10 per cent ofthe world’s population is suffering from a form ofmental illness; 25 per cent of people around theworld will suffer from a mental health disorder atsome point in their life; and 12.3 per cent of healthylife years were lost to mental health problems in2000. This figure is expected to rise for followingyears. And of the most common forms of disability,the top three are mental health disabilities (unipolardepressive disorder, alcohol use disorders, andschizophrenia).Are there factors that predispose a person towardsmental health disorders, considered de Graaf.Certainly, he said, some illnesses are to a degreehereditary. Gender also predisposes certain people

towards certain illnesses. For example,men around the world suffer morecommonly from alcohol abuse and anti-social behaviour disorders, whereaswomen are more prone to depression.Traumatic life events, such as the loss of achild, and a person’s physical condition canalso trigger a mental illness. For example,heart disease has been linked todepression. And there are two generalconcepts by which these factors expressthemselves: vulnerability and resilience.Vulnerability relates to incidence of anillness showing itself when a person meetscircumstances for which they are unfit,such as drug-induced psychosis. You couldask, said de Graff, whether the psychosiswould have shown itself at some point in

that person’s life anyway, or whether it occurred onlybecause the person was put, or put themselves, in avulnerable position. Resilience relates to the degreeto which a person can handle circumstances thatmight otherwise show up or instigate an illness. With regards to lifestyle, declared de Graaf, there isno clear relationship between mental healthconditions and a specific lifestyle. However, for manyillnesses, undue stress can increase the risk ofdeveloping symptoms, and alcohol and drug abuse isalso a trigger for some mental health disturbances. So, what are the pitfalls in diagnosis? With mentalhealth, there is no x-ray machine or blood test that isgoing to show up physical evidence of a problem, sopatient reports are relied on heavily, which isproblematic in itself. There is also an uncleartransition from normality to pathology. Many yearsago, if a person complained of hearing voices in theirhead, they were declared insane (so would probablynot admit they had the problem), but today it isunderstood that a person complaining of such a thingmay operate completely normally in all other areasof their thinking and behaviour.

In summary, there are several things travel insurersneed to bear in mind, stated de Graaf. Because ofthe heterogeneity of mental disorders, the termmental illness cannot justifiably be used – insurershave to more specific in order to make such wordinguseful. Lookinginto a person’smental healthhistory will be timeconsuming, andinfringes on theprivate world ofthe client more sothan with physicalconditions. Thereis also the high riskof false positivesand false negatives,such as if a persondoes not declare amental illness ordoes not actuallyrealise they haveone. There is,therefore, a high risk of unjustified discrimination.And the stigmatisation that people with mental healthdisorders feel and are subjected to can also backfireon those who are stigmatising, as it could lead to‘denial, dissimulation and the discontinuation oftreatment of people with mental disorders’. Finally,asked de Graff, how would a person with a mentalhealth disorder behave in relation to travelling andpurchasing insurance? His answer was amusing, yetpoignant: “From utterly normal, through a bit queer,up until utterly strange.”

Natalie Salmon, head of access to services andtransport – Disability Rights Commission

The Disability Rights Commission (DRC) in the UK,is an independent body, although established by anAct of Parliament, which aims to eliminatediscrimination towards disabled people and topromote equality of opportunity. Natalie informed usthat part of the job of the DRC is to support disabledpeople in securing their rights under the Disability

Discrimination Act (DDA). The DDA of 1995 is ofparticular interest to UK insurers as much of whatthey do falls under the general service providerduties of the Act, including the provision ofinformation – such as in leaflets or on websites,

which should beaccessible todisabled users;public premises,which must beuser-friendly fordisabledcustomers;telephoneinformation andhelplines, whereinformationspecific todisabledcustomers needsto be available;and staff, whoneed to be ableto give relevant

information and advice. Under the DDA, disabled people cannot bediscriminated against by being refused service oroffered service on worse terms than for an able-bodied person, for example making a disabledperson wait. They also cannot be offered service of alower standard or in a worse manner. By law,reasonable adjustments must also be made to enabledisabled persons to use a service, unless theadjustment is deemed to be impossible orunreasonably difficult to implement. For example, aplace of business might have to offer a wheelchairramp, unless it would interfere with health and safetylaws. While these rules are relevant to insurers, butare rather general, the Act does consider insurersspecifically. It recognises that disability can be relevantto insurance applications and claims, and that insurersmight be justified, in certain circumstances, in treatinga disabled person less favourably, but only if they canaffirm all of the following: it is in connection withproviding insurance, not a service; it is based oninformation relevant to the assessment of the risk tobe insured; information used to form an opinion isfrom a reliable source; and the less-favourabletreatment is reasonable considering the relied uponinformation. Such information can, of course, be medical reports,said Salmon, but they must be up-to-date, as medicaladvances – as well as social attitudes – are constantlyevolving. Other sources of information must betested and not based on stereotypes orgeneralisations. Generally, is important to remember,she stated, that blanket assumptions should beavoided; insurers should take into account individualcircumstances; and that it is for the insurer to provethere is a genuine risk in providing insurance cover.Best practice should, therefore, be maintained bymaking information available to disabled persons in avariety of relevant formats, such as Braille or largeprint. Insurers should also be up-front and honestabout policies and wording relevant to disabledpeople, such as pre-existing conditions; and should

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ITICREVIEW30

There is a high risk of unjustifieddiscrimination. And the

stigmatisation that people withmental health disorders are

subjected to can also backfireon those who are stigmatising,

as it could lead to ‘denial,dissimulation and the

discontinuation of treatment

offer staff disability awareness training or at leastmake general staff training of a high enough standardto deal with the specialised needs of some disabledcustomers. Regarding policies, information on varioushealth conditions and impairments should be kept upto date and should once again be reliable andrelevant. This is especially important whenconsidering a pre-existing condition and its relevanceto the insurance being sought. And when it comes tostrategy, staff training is again the key. From theprocessing of policy applications to dealing withclaims, staff should have the knowledge of how todeal with any pre-existing condition or disabledperson’s request. One case the DRC dealt withconcerned a person that had declared a case ofglaucoma: the price quoted for their policy wasdouble that of a normal policy, but when the insurerwas contacted and the conditions of glaucomaexplained, the policy price was halved. If the personhandling the original call does not have the specificknowledge to be able to handle a policy applicationeffectively, then they should at least know where togo or who to turn to for more advice or information. In her closing comments, Natalie reinforced the factthat transport is becoming more affordable andaccessible – and this means to disabled people too.The population is also ageing, so more and morevulnerable people will be seeking travel insurance.We don’t want, as an industry, ‘to be the remainingbarrier in an increasingly accessible and inclusivetourist industry’, she concluded.

Lifestyle underwriting: a newway of looking at travel risksGary Andrews, senior vice president, InsuranceServices – ETFS Inc. CanadaGary started by asking the audience to be open-minded in looking at how lifestyle underwriting can

be used. We have a tendency, as an industry, to seethings in a black and white manner, and in reality, hesaid, the products and services that we put togetherhaven’t moved on a great deal in the last 10 to 20years. It’s about time things started to move on andinsurers got smart. According to Gary, we are in asexy industry – as part of the travel industry – and ifwe can understand where we’re going, we canmake our products more attractive. One more thingto realise is that our industry is niche and very

incestuous and we can’t just keep slashing rates tooutdo our competitors: We need to realise that theimportant thing is continuing to make a profit in thismarginal market, so practices need to change. Today, said Andrews, it’s all about gut underwriting.Gone are the days of finalising deals on the back ofcheque books or cigarette packets; regulation haschanged the way we do business and times havemoved on. Today, a gut underwriter is ‘anexperienced underwriter, who has a good knowledgeof the leisure industry, has a good understanding andinterpretation ofmanagementinformation, and,more importantly,understands wherethe industry isgoing’. Theavailability of suchunderwriters,however, saidAndrews, is quitelimited. We havegood underwriters and the ability to interpret data,but the management information available could beinferior. What is important for a good underwriter tounderstand is not just past trends, but current worldtrends and the impact of future events, such asmedical inflation or when the World Cup ishappening (which affects travelling patterns). Often,the problem that occurs when actuaries underwriteinsurance, he said, is that they tend to rely on pasttrends and figures, rather than looking at the nature ofthe business and where it’s going. “Lifestyle underwriting is where we’ve got to be,”declared Andrews. We need to get sophisticated andreally understand what it means to be client-focussed. Lifestyle underwriting is not a new concept

and we can learn from other industries where it isalready applied. In fact, direct writers in the early1990s were once accused of cherry picking, byonly going after lines of business that showedmore of a profit, but today this is moreacceptable, so we need to get on with trying toachieve the same result. In the early 1990s, insurers also began taking intoaccount lifestyle factors. Direct Line, for example,would only accept payment via a credit card – amethod that made use of prior vetting of the clientby the credit card issuer. A person with a creditcard had been credit checked and, therefore,deemed credit worthy, eliminating some elementof risk. Also, in the motor insurance industry, thereare usually in excess of 30 underwriting variablesthat are considered when assessing the risk of apotential client. And men generally pay more fortheir motor premiums than women, as they areperceived as a higher risk. With regards to homeinsurance, underwriters likewise began to

determine key factors they could use to control risk.For example, they began by looking at postcodes todetermine not just whether the customer lived in atheft-prone area, but to look at building up a lifestylepicture of the client: looking at the type of housethey might live in, and how many bedrooms it mighthave, and whether that might mean they have afamily, or whether they would drive a family car asopposed to a sports car. Insurers, said Andrews,began to get smart.

So what are the key features of lifestyle underwriting?It is about people, what they do, how they do it,where they do it, and their perception of risk. Whenlooking at travel, we all know that when people areon holiday, they seek pleasures that invariablyincrease their risk. However, the perception of thisincreased risk is limited or unknown. We can,nevertheless, look at data that reveals correlationsbetween age and gender and create a better riskprofile of an individual. Andrews gave statisticsshowing that claims costs for males between 18 and

35 were much higherthan those for similaraged women. The dataalso showed that claimscosts came down whenlooking at data for thoseaged 46 and over.Talking aboutunderwritingperceptions, a familybeach holiday will beperceived as a safer risk;

an older couple, whose children have left home,taking a cruise holiday for example, are alsoperceived as a safe risk. However, as Andrewsreminded us, older people are getting a lot moreadventurous and taking more and more risks whenthey venture abroad. What are some of the other lifestyle factors –besides age, gender and postcode – thatunderwriters can take into account? Well, they alsolook at occupation and weight. Professions such asteaching, whilst deemed to attract ‘middle of theroad’ types of individual, do give employees plenty oftime off in which tovacation, and likewisehigh-flying executivesalso tend to travel agreat deal –meaning anincreased risk. Weightand other lifestyle factorssuch as smoking areoften considered duringthe medical screeningprocess.Next, Andrewsconsidered how lifestyleunderwriting can controlrisk. The basic answer isthrough technology.Technology coupled withsmart data, throughlinking a back-endprocess that candetermine likely claims types and costs with a front-end system that can identify the nature of premiumsaccording to customer profiles, means we can getsmart with our underwriting. This, in turn, means wecan determine overall loss ratio and loss ratio byprofile. Lifestyle underwriting, explained Gary, meansyou can segment the book of business in a smarterway, targeting risk areas and applying predeterminedmultipliers, rather than taking a blanket approach torisk. Smart technology and smart data also mean youcan constantly evaluate your business, rather thanrelying on annual reports. Overall, however, it meansyou can give clients exactly what they need and, atthe same time, maximise your profit.

Panel session:Medical screening

In the last of the ITIC panel sessions, the participantslooked at what insurers are doing about medicalscreening in different regional markets, issues forsellers and distributors, and what approaches aretaken when client answers at the point of sale arenot truthful

Dr Ron Mayer, CEO – World Travel ProtectionRon Mayer gave an enlightening presentation on howmedical screening is provided in Canada. Heexamined the pitfalls that can be encountered whendeveloping or adopting a screening application, andprovided a framework for an effective screeningprogramme. As mentioned by Franz Fotia (Day1)Canada has a unique snowbird population of oldertravellers who journey south to warmer climates inthe freezing winter months, so medical screening wasdeveloped to test the health of these riskier travellers.Market demand also called for more inclusiveunderwriting: it was felt that too many people werebeing left out of insurance due to their pre-existingconditions. Medical screening, therefore, helped toextend the scope of insurance to more individuals. A system was, therefore, developed that was simplefor customers to use or simple to administer overthe telephone at the time of buying insurance. Thismeant a system that was quick to use – even forcustomers with multiple conditions. And indeveloping the system, WTP looked at whether itwas necessary to have agents with specialist medicalknowledge or that were underwriters; and also it

determined the value of thespecific questions asked tocustomers with regards tohow well they would allowyou to determine anindividual’s overall risk.Next, Mayer looked at thedifferent types of medicalscreening applicationsavailable. Paper-basedproducts, he said, are stilllike life insuranceapplications and aregenerally filled out inconjunction with yourphysician. However, hedoesn’t believe these workvery well in the context oftravel insurance as theytend to focus more on

long-term mortality rather than a morbid event in ashort or specified period of time. Generally, Mayerbelieves that most of the paper or electronicapplications that are physician-based are not the bestanswer to developing the right kind of medicalscreening for travellers. They tend to ask out-datedquestions that hold little predictive value for thetravel industry: asking whether a person has had aheart bypass in the last 10 years does not necessarilydetermine the likelihood of them still suffering a heartattack at any time and it doesn’t look at details likehow many vessels were bypassed. Such questionsare also be used to eliminate conditions thatshouldn’t be eliminated, as is the case with asking if a

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ITICREVIEW32

What is important for a goodunderwriter to understand is

not just past trends, butcurrent world trends and the

impact of future events

person has taken steroids, when such a treatment isused for asthma. With paper-based evaluations,questions and conditions also get bundled in order tokeep the questionnaire simple and shorter; whichdoes not enable insurers to properly target thespecific area of risk. As a result, you can end up withabsolute or condition ineligibility, where customersare not covered based on how they’ve answeredthe questions. Otherwise, insurers will change thepre-existing conditions clause to cover different timelimits since a condition occurred, or they will changethe rate charged for the policy, or both. However,warned Mayer, if an insurer just adds a long pre-exclause into a policy, it’s not going to be a popularpolicy and won’t sell well.The other form ofscreening is, of course,the lifestylequestionnaire, whichlooks at a person’s dailyhabits and how they mayaffect health – such assmoking, diet, weight,and exercise. In Mayer’sexperience, whencomparing smoking, diet,weight and BMI againstclaims data, in theabsence of a condition,there is no correlationbetween claims andshort trips. However, ifanother condition is present in conjunction with ahigh body mass index (BMI), there is a link. Suchquestionnaires may not be able to predict when alikely condition or emergency event will occur in aperson, but in terms of looking at a person’simpulsivity and assessing their risk, they have a veryuseful predictive value. You do, however, need agreat deal of claims experience to make yourquestions truly effective at gauging the level of risk anindividual poses. Without properly understanding therisk, said Ron, you will probably be losing out onrevenue potential, but with experience you can writepolicies that will cover ‘high-risk’ individuals thatother insurers may well not touch.How do you, therefore, calculate a premium thatincludes pre-existing conditions? WTP receives abase or ‘healthy’ premium from their underwriterand then costs in any risk factors for variousconditions for each individual. Problems arise,however, because people forget to divulge certaininformation, they make mistakes, bend the truth, orout and out lie. How can insurers deal with this? Bysending out clear and concise coverage confirmationfor each policy sold, detailing exactly what is coveredand listing any pre-existing conditions. It should statethat any conditions not declared may invalidate thepolicy and that any amendments can be madeimmediately or if a person’s condition changes. And, finally, Ron considered underwriters’ responsesto non-disclosure, which has been variable, and attimes guarded. There have been denials for non-disclosure and there have been settlements in spiteof non-disclosure; and in some cases the underwriterhas offered to pay the claim if the client pays thepremium shortfall for the illness they didn’t declare.They have also asked whether conversations withclients are recorded so that evidence can be relied

on in court if necessary, and they have also askedwho filled out the questionnaire, as in places likeCanada there are language issues, so a form mayhave been filled in by a relative.

Dr Paul Beven, director – Healix International

Paul Beven divided his presentation into twosections: where we are with medical screening in theUK at the present time, and what we should bedoing about inaccurate declarations. He began bylooking at past medical screening methods, went onto look at where we are with medical screeningtoday, and talked about where it might go in thefuture. In the past, the starting point was exclusion

wordings, which were usedto deny claims deemedunpayable, and rating wascarried out largely on acommunity basis. Travelagencies and touroperators were thedominant distributors oftravel insurance, and as aresult, product pricing waskept simple, withdestination, duration andage being the main policyguidelines. A number offactors combined to bringabout change in the wayinsurers dealt with the issue

of medical screening, however. Payouts for medicalexpenses increased dramatically as medical inflationoutstripped general inflation around the world.Distribution methods changed and the travel agentbegan to be used less and less as the source fromwhich to buy travel policies, which led insurers toconsider the feasibility of carrying out medical andrisk rating processes elsewhere. Demographics andtravel patterns changed: ‘more people of an olderage group are travelling further and for longer’. Withthe Ombudsman in the UK and other regulatoryauthorities, it is becoming more difficult to rely solelyon exclusion wording: there is increasing expectationfor insurers to ascertain risk at the point of sale andprovide the customer with an effectivelycommunicated decision as to whether they will begranted cover. And, said Beven, evidence of thebenefit of screening is becoming increasinglyapparent.So, where has this led us to in the UK today? Someform of medical risk rating or screening is applied tomost travel insurance polices, irrespective of themethod of sale, whether this is through thepreferred method of a process integral to the saleitself, or whether through a third party at a differenttime. And policies are increasingly available forindividuals presenting substantial risks – such asadvanced age or illness – that are not covered understandard policies. So, what about the future? Beven believes thatmedical risk rating is here to stay. Online self-screening will become more popular and insurerswill develop more accurate matching of pre-existingconditions to claims made, which will in turn provideus with better data to be able to practice moreaccurate risk underwriting. This, he said, will formpart of a further move away from community risk

rating towards more individual underwriting, allowingan expansion in the number and scope of policiesavailable for those riskier travellers. But what about inaccurate declarations? Beven saidhe endorses a lot of what Dr Ron Mayer said in hispresentation on this issue. And, in the UK at least,when claims are disputed, said Beven, they will bearbitrated by the Ombudsman on a case-by-casebasis, with the emphasis firmly on fairness to thecustomer. Insurersneed also tocomply withexisting legislation,such as FinancialServices Authorityregulations and theDisabilityDiscrimination Actin the UK. Forinsurers to givethemselves the best chance of being able to declinean invalid claim, however, they need to operate bestpractice at the point of sale, or when the screeningoccurs. This means providing clear warranty wordingcapturing all relevant conditions; offering a clearquestioning process that reflects the warrantywording; explaining to a client the impact of givingfalse or incomplete information regarding pre-existingconditions; providing a clear statement ofendorsement; allowing customers the opportunity toamend a declaration; and recording calls andproviding a good degree of staff training.

Ole Aerthoj, director – Gouda Insurance

Ole Aerthoj provided us with a Europeanperspective to medical screening, and began hispresentation by answering the question of whatmedical screening can do for underwriters. “It givesus the ability to categorise risk”, he said, and totherefore differentiatepremiums. It also givesunderwriters the ability todeny risk, which is of benefitto the client as well as theinsurer. It is not fair, saidAerthoj, to endorse anindividual’s trip abroad if it islikely that they will developmedical difficulties, even iftheir GP has told them that aholiday to recuperate will dothem good. And screeningarms insurers with recordedmedical data, which is readilyavailable when a claim arises.This information can also beuseful for a treating physician when an accidentoccurs. However, screening entails a cost; it takestime to administer – which is especially problematicfor travel agents; and with the regulations governinginsurers and other businesses today, issues of dataprotection and discretion must be observed, which isagain problematic for travel agents when askingpersonal questions at a counter. Aerthoj then produced a chart showing how differentlevels of screening can affect the sales process bytaking up different amounts of time. Althoughcustomers don’t like the purchase of insurance to

take very long, the more time spent in addressing anindividual’s health at the point of sale, the moresecurity there is for the insurer in case of a laterdispute. Better medical information essentially allowsa patient to be treated more effectively in case of anemergency and hopefully allows the insurer to avoida court case.“What other measures are being taken todifferentiate risk?” was the next question posed by

Aerthoj. Henoted thatscreening is aprocess almostsolely carriedout in the UK.However, inDenmark,there are acouple ofspecialist

insurers that ask all insurance applicants over the ageof 70 to submit written information about theirmedical condition. Elsewhere, for example in the USand Germany, medical insurers are providing travelinsurance, which reduces the issue of medicalscreening. Age, he said, is a commonly used factor todifferentiate risk, and premiums are also often loadedfor long-term travel, as there is, of course, morechance of getting sick the longer you are away.Different rates are also commonly applied todifferent travel destinations, and, in Germany, genderis used as a category for determining risk.And what do we do with these higher risk clients? Asmost of us know, an additional premium can beadded to a policy, or a higher excess can be offeredfor a higher risk – although this is often deemed toocumbersome to collect; travel, perhaps just to certaindestinations, can be denied under the terms of thepolicy, and named illnesses can be excluded. A goodindustry solution to the treatment of higher risk

clients, however, would bethe requirement for themajority of insurers tofollow the same rules toallow standardizedregulation.And, lastly, Aerthojconsidered the future oftravel insurance in Europe.The cost of large medicalclaims is increasing and weneed to find ways ofregulating this. With morepeople crossing borders toreceive medical treatment,due often to long waitinglists in their own country,

the travel insurance industry has to be aware of suchmotivations for travel and the risks it exposes. Theincrease in the use of the Internet for purchasinginsurance will be of great benefit to medicalscreening, said Aerthoj: It allows a confidentialdialogue between the client and the insurer anddoesn’t take up the precious time of the agent.Overall, he concluded, the winners in the market willbe those companies that can find the right balancebetween the time it takes to capture data from andexplain your product to a client and the cost of therisk they are protecting themselves against.

www.itij.co.uk International Travel Insurance Journal

ITICREVIEW 33

Online self-screening willbecome more popular andinsurers will develop more

accurate matching of pre-existingconditions to claims made

Welcome Function – Hygeia Corporation

Conference Bags – Funeralcare International

Delegate Badges – MedSave USA

Pre-Conference Coffee Break – Aetna Global Benefits

Lunch Drinks – Avus International Loss Adjusters

Table Football Tournament – Stones Solicitors

Message Board – IMG Europe

Gala Evening – ITIJ

Post-it notes – WTP Assist

Thank you to the ITIC Sponsors

The opulent surroundings of the Alfonso XIII

made for a most enjoyable gala dinner

location. Entertainment was provided by

skilled Spanish guitarists, as the excellent food

was enjoyed and the wine flowed. The ITIJ Awards

ceremony recognised those companies voted as the

leaders in their field this year, and the evening was

rounded off in style with a captivating flamenco [no, it’s not

flamingo Allan – editor] performance. The dancers wore

traditional costumes for a spirited, passionate, and very

personal performance. We hope that those of you that

were in Seville enjoyed it as much as we at Voyageur

enjoyed hosting the event. We hope to see you again

next year, and to those of you that have not been able to

make it to an ITIC conference thus far, we hope to meet

you at one of our events in the future.

International Travel Insurance Journal www.itij.co.uk

ITICREVIEW34

The gala dinner

Above: The table football champions, Manuel Montenegro and Mark

Lee, receive their charity cheque from ITIC chairman Ian Cameron, far

left, and Stones Solicitors’ Bronwen Courtenay-Stamp and Sam

Pucci. Below: Music and dancing was provided by the exotic

flamenco troupe. Top right: Paul Golder holds court on the TAI table.

Inset: The delightful Laura Hilton gets up close and personal with

suave moderator Allan Jones.

Above: Despite being as sick as a parrot, Joe Valdes

attempts to laugh off losing the final of the table football

with Julie Remmington. Below: Aetna Global Benefit’s

Mark Jardin and his lovely wife, Cara, are joined by the

equally lovely Sharon Welsh. Bottom: A flamenco dancer

leaves the male delegates open-mouthed as she turns on

the style. Left: An enthusiastic Jeff McIntosh celebrates

his victory in the Air Ambulance award category . Bottom

left: The ITIC girls, Adele Brown, Denise Clements and

Helen Watts, looking radiant.

www.itij.co.uk International Travel Insurance Journal

ITICREVIEW 35

Top: The Air Ambulance contingent strike a pose while

enjoying a drink… or two. Above: Charlie Easmon

swaps amusing anecdotes with Sue Knight and a sleek

Reid Cawston. Below: It’s murder on the dance floor.

Right: ITIJ’s advertising hotshot David Fitzpatrick

hosts an array of industry talent on the ITIJ table.

Above left: A pair of hip-thrusting delegates take their turn

performing the flamenco. Above: Hungry delegates wait in

anticipation for their scrumptious five-course meal. Left: Roger

Waddington has an animated conversation with Kalyan Sachdev as

the Russian delegation cuddle in the corner. Bottom: An animated

Scott Roberts maintains a fixed grin as the rest of the UKUL table

swap ‘exciting’ insurance stories.

Right: A delighted Suzanne Cunningham trips the light

fantastic with her snake-hipped admirer. Far right: The Air

Ambulance Professionals Franziska Hollenstein and Gerardo

Leguisamo smile sweetly for the camera. Below: The tables

begin to fill up as the gala dinner gets into full swing and the

wine starts to flow.

All conference photos by Sidz www.thefloatingsidz.com

International Travel Insurance Journal www.itij.co.uk

ITIJAWARDS36

INDUSTRY AWARDS 2005We are delighted to present the winners of this year’sITIJ Awards. The winner of each category received theiraward at the annual ceremony at Hotel Alfonso X111,Seville on Friday 11 November 2005. Here they givetheir reaction to receiving this prestigious award

Medi Travelcover LtdCompleted by Dr Krish Shastri, director

1: Why did you want to win the award?

To receive top honours in the Insurer of the yearcategory at this year’s international conference inSeville is a very special achievement for a nichecompany. Medi Travelcover is the UK’s onlyspecialist provider of travel insurance forholidaymakers with a diagnosis of cancer.

2: Why do you feel you deserved to win?

In February 2005 Medi Travelcover introduced itslatest product development initiative aimed at thosewith a diagnosis of lung cancer. Of all the cancers,lung cancer is characteristically aggressive and mostindividuals inevitably receive a terminal prognosis ofless than twelve months. The scheme is based onindividual case underwriting using underwritingcriteria and methodology developed by a projectteam working with a panel of consultants and hasbeen welcomed by patients, cancer charities andsupport groups as a key service.

3: How do you feel about winning?

To be ranked alongside the good and the great andto receive such a prestigious award is an honour fora small niche player like Medi Travelcover. We takegreat pride in the knowledge that our professionalpeers have voted for us in recognition of ourcontribution to a challenging niche market.

4: How do you think the award will affect yourbusiness?

The prestige of this award will enable us to turn theattention of our colleagues in the industry to thisdeserving but neglected sector of our community.

Churchill TravelCompleted by Geoff Carter,commercial director

1: Why did you want to win theaward?

The Churchill Travel team worked hard to develop aninnovative new travel insurance product and we areproud of its success. Winning an award from the highlyrespected International Travel Insurance Journal meansrecognition for our achievement within the travelindustry, which is important to us.

2: Why do you feel you deserved to win?

Churchill put a lot of time and resources intoreinventing the travel insurance product this year. Weinvolved staff, customers and trade body Best Practicein the process. The policy wording was completelyrewritten and we developed a groundbreaking new ITsystem, which offers new options to our customers.We believe that the result – flexible travel insurancecover – caters to the needs of the modern traveller,and its success has been reflected in the 164 per centincrease in sales since the product first launched in June 2005.

3: How do you feel about winning?

We were pleased to be finalists, and then of coursedelighted to find out that we were winners, especiallyas there were so many strong entries and we weren’texpecting to win. It’s a great end to a fantastic year andvery rewarding for everyone involved.

4: How do you think the award will affect yourbusiness?

We’ll benefit from the publicity within ITIJ, of course.We’re also planning to feature the ITIJ award logo inour marketing communication, website and travelpolicy documents to demonstrate the quality of ourinsurance cover. The win has also been communicatedinternally, as it’s great news and will encourageeveryone towards greater success in 2006.

Medi Travelcover Ltd.

Joint insurers of the year

The proud winners: (left-right) Joanna Saddeh, Krish Shastri, Andy Juggins, Sarah Lee (ITIJ editor), RafaelSenen Garaa, Ian Cameron (ITIC Chairman), Jeff McIntosh, Mark Lee (winner of the table football

Medical & Cost ContainmentCompany of the year

Global Medical ManagementCompleted by Soraia Arroya, director of clientaccounts, and Joanna Saadeh, director of clientaccounts and marketing

1: Why did you want to win the award?

GMMI is honoured that our status as the industryleader in international cost containment has beenofficially recognised by an independent revieworganisation.

2: Why do you feel you deserved to win?

We understand the award to be designed to recogniseexcellence within the travel insurance industry. GlobalMedical Management delivers value and excellence toour clients. We offer complete cost containment fromthe inception of the medical episode to the very end.Our concept of cost containment goes beyond theapplication of network discounts. We contain costs bymeans of cost prevention (i.e. reduced length of stay)and by offering state of the art IT solutions to ourclients that significantly decrease their administration.Further, we have always believed in deliveringoutstanding and personalized service to our clients.

3: How do you feel about winning?

GMMI’s team and management are thrilled with theITIJ award. It compliments our team’ s dedication andcommitment in our efforts to ensure we always remainthe leaders in this industry; constantly evolving to meetand surpass our client’s needs in the market. We aregrateful for the recognition and thankful to our clientswho have trusted us with their cost containment needsfor 13 years and counting!

4: How do you think the award will affect yourbusiness?

We think that the award and the prestige of the ITIJrecognition will provide us with continued positivemarket exposure. The ITIJ award will be a part of ourmarketing campaign in 2006.

Assistance or Claims Handlerof the yearMapfre Asistencia

Completed by Rafael Senén, general manager

1: Why did you want to win this award?

Being as it is the most important award in theinternational assistance sector, winning this prize is,naturally, an important goal for any company in thismarket. In the case of Mapfre Asistencia, our companyhas repeatedly seen its good work recognised with a

nomination that, every year, reaffirmed our position atthe top of the international assistance organisations(among the first five). Moreover, the InternationalTravel Insurance Conference award entails duerecognition of the excellent work performed by thewinning company, in this case Mapfre Asistencia, by itspeers in the assistance sector, given that the winner ischosen by a team of professionals of recognisedprestige within our market.

2: Why do you feel your company deserved thisaward?

Essentially for the excellent work that MapfreAsistencia has carried out ever since it was formed in1989 and which, in just 15 years, has turned it intoone of the most important assistance companies inthe world. Way back in 1989, when we initiated this

professional endeavour, westarted from a premise that hasremained unalterable since then:offer the best service, thanks to acomprehensive range of our ownproducts and innovativetechnology, in order to satisfy theexpectations of our customers.Throughout this time – andthanks to the dedication and effortof over 3,200 professionals thatgo to make up Mapfre Asistenciaall over the world – ouroverriding goal has become areality and this is what has madeus deserving of this award, whichrecognises us as the very bestassistance company in 2005.

www.itij.co.uk International Travel Insurance Journal

ITIJAWARDS 37

Ian and Sarah with Air Ambulance of the yearwinners Canadian Global Air Ambulance

Ian and Sarah congratulate Mapfre Asistencia on their triumph

3: How do you feel about winning?

Satisfied, because there is nothing more gratifying thanthe acknowledgement of a job well done and this prizeserves to ratify our work. This is what encourages usto continue working in the same fashion, with one soleobjective: to turn our company into the number onefor our customers and the benchmark company withinour sector.

4: What will this award mean for your business?

Receiving this award is obviously already having a

highly positive effect on our work. Our currentcustomers and providers are feeling the satisfactionof collaborating with a top-ranking company – acompany whose business strategy and managementare advancing along the right path, ever catering fortheir demands. For our potential clients, this marksthe confirmation that Mapfre Asistencia is what itappeared to be, a great company well able torespond to their expectations. Undoubtedly, thisaward will translate into new business for MapfreAsistencia, mainly in the English-speaking world,where we shall continue striving to demonstrate thequality of our work.

Air Ambulance of the yearCanadian Global AirCompleted by JeffMcIntosh, president

1: Why did you want towin the award?

Our employees, oftenreferred to as globalers,have worked very hardover the past few yearsto grow the company, never losing sight of the valuesand keys to success that were set out from day one.Many globalers had no previous experience ininternational air ambulanceoperations prior to joiningCanadian Global. The learningcurve for most of them wasoverwhelming. Ultimatelythey/we have all succeeded inlearning the business, learninghow to do things better – dayin, day out – and crafted aformula towards providingconsistent, quality customercare. The award is the rewardfor our employee'scontributions. It’s made thework seem so worthwhile.

2: Why do you feel youdeserved to win?

We feel we have had arespectable and sustainablelevel of growth over the past

year, and met reasonable levels of excellence in thecriteria set out for our category. However, knowingthe finalists in this category, I'm sure the judgingwasn't easy.

3: How do you feel about winning?

Fantastic! It’s still a surreal feeling for all of us.

4: How do you think the award will affect yourbusiness?

First, it will inspire and give confidence to theemployees – hard work does pay off. Secondly, wethink the award will add credibility and increase ourvisibility. We will take advantage of the award byusing it in future marketing efforts.

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ITIJAWARDS38

Ian and Sarah with GMMI – Medical and Cost Containment Company of the year

Ian and Sarah with joint insurers of the year Churchill and Medi Travelcover

Fidel Castro may some years ago havedescribed tourism as ‘a necessary evil’ but hesagely added: “We cannot live in a glass case.We have to withstand the inconvenience that

tourism brings in its wake and focus on the manypositive benefits.”Chief amongst those for Castro’s Cuba has been thecreation of more than a quarter of a million jobs andan enormous contribution to the national budget.Growth within the tourism industry has beenphenomenal. Back in 1991, the Caribbean islandattracted half-a-million visitors, generating an incomeof US$387 million. By 1997 that had mushroomedto one million tourists and an income of US$1.7billion and by 2000 to 2.5 million people with agross spend of close on US$4 billion. “Tourism hasbecome one of the pillar industries of Cuba, alongwith cigar and sugar manufacture,” says SamuelSavariego Capuana, who heads up Cubanacan,Cuba’s biggest tourism group.As Cuba’s large and lavishly presented stand at therecent World Travel Market exhibition in London,UK, reflected, tourism has fast become Cuba’smost reliable means of attracting not only valuableinward foreign investment in the infrastructure butthe hard cash that visitors spend while on theirholidays in the sun.

Global interestThe Italians have led the way in visitor numbers,followed by the Canadians. Other key markets havebeen Spain – not surprisingly, considering thelanguage affinity – plus Germany, France, Mexico,Brazil and, increasingly, the UK. Chinese visitor numbers have been expandingrapidly in recent years and there is likely to soon bea direct air link between the two countries, whileChinese investment helped create Havana’s first five-star hotel.There are also, much to the chagrin of PresidentBush’s government, considerable numbers ofAmericans, who, not qualifying for officiallysanctioned visits, break their own nation’s law byslipping in through the backdoor, usually via eitherCanada or Mexico – risking potential heavy fines andeven imprisonment for doing so.The vast majority of foreign visitors are on usuallykeenly priced package holidays with the major touroperators and a number of specialist companies, butin recent times there has been a steady increase of

individual travellers who wish to explore on theirown. To quote the official Prensa Latina press agency:“To arrive in Cuba without having bought a packageholiday can be compared to undertaking Homer’sOdyssey, but exploring this fascinating island by busand train, or even on a bicycle, staying at simplepensions or with families in their own homes, is amagical adventure.”The train journey from Cuba’s capital Havana toSantiago, travelling the length of the island, takes 14.5hours according to the timetable, but US sanctionsmean lack of spare parts for the ancient locomotivesand rolling stock, and so breakdowns are frequent.Not so with the many vintage US- and UK-made

automobiles to be seen on the island’s roads andespecially in Havana – the Cubans have turned theirmaintenance into an art form and lovingly cared forvenerable old Chevrolet, Hudson, Packard,Oldsmobile, Studebaker, Hillman and Humbermodels have become a tourist attraction in their ownright.Cuba has one of thebest social medicinesystems on theplanet. Its doctorsand surgeons are inthe avant-gardeamong healthprofessionals. Buttravel insurance is avital requirement foranyone visiting anisland which still hassome ratherpernicious tropicaldiseases and whose roads are not always in the beststate of repair.The most westerly of the Greater Antilles group ofCaribbean islands, sub-tropical Cuba covers some110,860 square kilometres (42,803 square miles)and is set approximately 145 kilometres south of theFlorida Keys. Besides the main island, which is longand narrow, there’s Isla de Juventud – still popularlyknown as The Island of Pines – as well as more than1,500 small coral cays and islets.The closest neighbour, besides the scowling US, isthe island of Hispaniola, which is shared by theDominican Republic and Haiti, and Jamaica.Some 11.3 million people inhabit the country, withSpanish their language and Roman Catholicism thekey religion. Having been ruled over by the Spanishthen dominated by the Americans, they are – Castro

supporters and opponents alike – fiercely proud oftheir independence.

An established infrastructureA life-expectancy of 76 for men and 79 for womenreflects the high standards of healthcare in what

remains a largelyimpoverishednation. Cuba hasone doctor forevery 200 citizens,compared to oneper 405 in the US.A child fromHavana is twice aslikely to survive toadulthood as a childfrom WashingtonDC. Healthcare isfree to Cubannationals while

charges to foreigners are modest.The Cubans are a highly educated people, with animpressive literacy rate of 96 per cent – which isconsiderably higher than that prevailing in the US andmost of the western world.Sugar, tobacco, shellfish, medical products, citrusfruits, cement, coffee and, of course, tourism, arethe main earners of foreign currency. Internally,there’s both a barter system and a black market thataccount for much of the commercial and privateactivity, circumventing the official tax system and thusdamaging government finances. Until a new law waspassed on 8 November 2004, US dollars wereaccepted in retail outlets but today the peso is theisland’s universal currency and dollars will need to beexchanged into local currency at a 10 per centcommission rate. Currently, a peso is worth slightly

Cuba LibreCuba Libre Castro’s Caribbean islandis increasingly open for

business despite USsanction, as Roger St

Pierre discovers

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WORLDMARKETS40

less than a dollar. A $US20 tip paid to a dentistmoonlighting as a tour guide is equivalent to what hewould earn in a week of pulling teeth!With a growth rate running at around five per cent,purchasing power parity stands at an estimatedUS$22 billion a year, equating to just US$1,700 perannum per head, a fact which, as much as politicalconsiderations, accounts for the continuing problemof people trying to leave the country and enter theUS. These days, most who flee can be consideredeconomic rather than political refugees.

American antipathyMany Cubans would argue that their nation’s relativepoverty is due more to US sanctions than to anyfailings of the socialistpolitical system in itselfbut detachedobservers wouldprobably contest that,in reality, both theseare key factors.Whatever, the systemremains in place andFidel Castro continuesas the world’s longestserving political leader.The spiritual presenceof such other revolutionaries as José Martí and CheGuevara can be sensed everywhere, with aprofusion of posters, T-shirts and other memorabiliaalways on display. Despite the collapse of the SovietUnion, long Cuba’s key friend and trading partner(and a donor of between US$4-5 billion a year inannual subsidies), despite continuing internalproblems and despite the demise of otherCommunist states, modern Cuba seems to have anamazing survival instinct. Largely through catering toincoming tourism, the country has been dipping itstoes in the waters of capitalism whilst resisting thetemptation to dive in at the deep end.The Spanish, Germans and other European nationshave been investing heavily and most of the latestand best hotels are now under European orCanadian management if not ownership. China hasinvested prolifically in the nickel industry, while oil-rich Venezuela supplies cheap fuel.The case against American sanctions continues to be

argued long and hard. A 20-page State Departmentdocument issued in August 2002 statedunequivocally: “Americans who travel abroad (toCuba) can have significant foreign policy and nationalsecurity implications and can damage the nationalinterest.”The paper argued that: “Tourism props up theCuban government. Virtually every tourist booking isunder government control and most tourists areeffectively confined to a few tourist ghettos.” Rathermischievously adding, despite the reality that visitorsare perfectly free to explore the country if they wish:“If US tourists could stay where they liked and havereal contact with average Cubans it might bedifferent.”

President Bushreiterated thecontinuing USstance by telling arally in Miami ofexiled Cubans andtheir supporters:“Trade with Cubawould do nothingbut line thepockets of FidelCastro and hiscronies.”

The counter argument is that while tourism doesprovide considerable revenue to state enterprises,the Cuban regime has never been anywhere closeto the point of collapse, even during the massiveeconomic crisis that followed the withdrawal ofSoviet backing in 1992. In truth, its continuingsurvival is down to other factors, not least the folkmemory of how much worse things were for thevast majority of the population under the previousBatista dictatorship.American antagonism remains. Under current USregulations, Stateside-based underwriters, brokers,agents, primary insurers, reinsurers and US citizensworking for foreign companies operating in theinsurance industry are specifically prohibited fromengaging in any business dealing that involvescompanies located within Cuba, or which is carriedout by companies controlled from Cuba, or to dealwith Cuban citizens wherever they are located,unless they are legally resident within the US.

Legislation by the US further regards all assets ofsuch entities or individuals, including insurancecontracts, as being frozen.Consequently, US insurers must take particular care– especially in the complex maze of reinsurancematters – that, even indirectly, they have no dealingswith Cuba or Cuban entities unless sanctioned bythe Office of Foreign Asset Control. For those westerners who do invest in Cuba, life canbe as full of frustrations as of rewards. Red tapeabounds. At present only joint venture partnershipoperations are allowed and your partner will be agovernment that is hide-bound with bureaucracy.However, that does not mean profits cannot bemade and one major Spanish hotel chain reckons toget its investment back on each new hotel withinfour years.

Travel insurance potentialThere is growing scope within the insurance sectorin general and travel insurance in particular. Atpresent, planes into and out of Cuba are packed withforeign tourists and, increasingly, business people,rather than Cuban nationals – who are only allowedto leave the country with special permission andwho often forego insurance cover for domestic tripsbecause they feel the umbrella of the free state

health system suffices. But as things slowly improveand liberalise the Cubans will travel increasinglybeyond their own borders and that means they willneed appropriate insurance cover.For now, business travel is the key element as Cubaseeks new markets for its own goods and sources ofsupply for its needs. Bail bond coverage is a vitalelement of any travel insurance policy because theCuban Court of Justice usually requires a bail bondfrom anyone facing a criminal liability claim as a resultof an accident.Setting up shop in Cuba might require lots of patientnegotiation but is not expensive. Property prices,even in the heart of Havana’s business district, arelow; so too are labour costs, with salaries runningbetween 150 and 300 Cuban pesos a month(US$150-US$324). Workers must be employedthrough one of the government’s official employmentagencies, which will charge for its registered worker’sservices as well as imposing a 25 per cent socialsecurity and wage tax. After deductions, theemployee is then paid direct by the agency.Effectively, all workers – save the slowly growingnumber of self-employed – are governmentemployees. As such they at present pay no incometax. The potential for business is definitely there, it isjust a case of persevering through the red tape.

www.itij.co.uk International Travel Insurance Journal

WORLDMARKETS 41

Tourism props up the Cubangovernment. Virtually every

tourist booking is undergovernment control and mosttourists are effectively confined

to a few tourist ghettos

International Travel Insurance Journal www.itij.co.uk

FEATURE42

In the first part of ourthree-part series on whoseadvice is best followed whentreating patients abroad, DrFrank Gillingham, MedicalDirector, HTH Worldwide,puts forth the hospitaldoctor’s point of viewOne of the many valuable lessons I learned duringresidency training some 28 years ago was that oneshould always assume that a referring practitionerknows at least as much, or perhaps more, than youdo. I can remember listening to numerousderogatory comments about older physicians,whom many of my young colleagues regarded asbeing out of touch, after referring patients to ourteaching hospital. We believed that since ourattending doctors were the experts, those wholooked to us for help simply lacked our clinicalcompetency.As the years have gone by, I have come to realisethat many of those physicians were referringpatients to us because they did not have theequipment, or the specialty training, to take care ofcomplex cases. And as we would soon discover,many of those same referring physicians had a muchbetter understanding of their patient’s pathologythan we could ever hope for. So as I began mycareer as the medical director of a company who

insures expatriates, students and leisure travellersacross the globe, I had to remind myself of the

same lesson – those who are treating my clientsknow and understand at least as much, andprobably more, than I do about them.

Cases in handA few months ago, a young woman on a studyabroad assignment from the US fell and broke herhip in Capri, Italy. She was transported to a smalllocal hospital in Sicily. Unfortunately, it was lateFriday afternoon, so by the time her family and ourstaff heard of theaccident, theattendingorthopedist hadleft for theweekend. It wasvery difficult toget anyinformation, butwe were assuredthat the youngstudent was notin need ofemergencysurgery.Meanwhile, a USorthopedist andfriend of the patient’s familyconvinced the parents that thepatient needed immediatemedical evacuation back to theUS, and that if she did not havesurgery within 48 hours, shecould lose her hip. Of course,the US orthopedist assumedthat the young lady had adisplaced fracture of the neckof her femur, and he wascorrect in asserting that if thatwere the case, she would needimmediate repair to save thecirculation to her hipbone. However, he was wrong inassuming that the treatingphysician in Italy would not beaware of this danger and worseyet, that he had abandoned his patient for theweekend. As it turns out, the fracture was notdisplaced, and there was little threat that postponing

surgery would put her hip at risk. When we werefinally able to contact the Italian orthopedist, he wasinsulted that we assumed our patient was being‘mistreated in a third world country’.Another case involved a missionary who was shot inthe chest trying to defend his parishioners fromthieves. During his sermon, two young menentered his church and held his worshipers atgunpoint while cleaning out their pockets andpurses. The brave, if not ill advised, priest decided

that he had enough,and attacked one ofthe two thugs. Thesecond planted asingle shot into hisleft chest, and thetwo fled with onlyhalf the loot. Ourclient was rushed tothe local clinic.Although his vitalsigns were stable, itwas determined thatthe bullet hadricochet off a rib,penetrating thediaphragm and

lodged itself in the capsule of thespleen. In the US, insertion of achest tube followed by immediatesurgical exploration of the abdomenwould have been the standard ofcare. In Africa, where ourmissionary was stationed, prudentobservation is often the norm intrauma care. In this case, a chesttube was inserted to drain the smallamount of blood in his chest cavity,antibiotics and intravenous fluidswere administered, and the patientwas monitored for sudden bloodloss, fever and severe abdominalpain. Those of us who wereinvolved in this case wanted thepatient airlifted to a centre withmore sophisticated trauma

capabilities, but the attending surgeon insisted thatthe patient could be safely observed in his facility.The patient recovered without incident, and was

Whose opinion should prevail?

Part one: the hospital doctor

To obtain definitive care,patients must be educated that

evacuations are fraught withdangers of their own. Not only

can a patient’s conditiondeteriorate during transport, butalso the transportation vehicle

itself may present high risk

discharged in good condition having never neededexploratory surgery for his abdominal injury.

To fight or to flyPatients themselves must be considered in thedecision paradigm aboutmoving from onetreatment facility toanother. Although it isoften a knee jerk reflex towant to go home, or to amore sophisticated‘Centre of Excellence’, toobtain definitive care,patients must beeducated that evacuationsare fraught with dangersof their own. Not onlycan a patient’s conditiondeteriorate duringtransport, but also thetransportation vehicleitself may present highrisk. In the 25 years that Ihave been involved in theemergency medical system in Los Angeles, US, therehave been at least a dozen paramedic helicoptercrashes resulting in serious injury or death topatients. Severalwere beingtransported forrelatively minorinjuries orillnesses. Oneparticularly tragicincident involveda Los AngelesCountyparamedicsearching for alost stretcherwho leaned ona helicopter pontoon without being properlytethered. He plunged almost 100 feet to his death. It is not to say that those of us who participate indecisions about evacuating patients should not becautious and circumspect, but being the patient’sadvocate does not always mean insisting on anevacuation when local care is adequate. Although wewould all like to see guidelines for the medicalevacuation of patients, they are not practical.Guidelines fall into the same category as treatmentalgorithms – they may be useful for some, butcannot be used in all situations. Anyone who haspracticed medicine knows that algorithms havelimited value. In California, US, where I practice emergency

medicine, the responsibility for the patient stays withthe treating physician until the patient is received atthe next hospital. We are reluctant to allow patientsto leave our facilities until we are comfortable thatthe benefits of transfer outweigh the risks. Our laws

require that we documentthe advantages of transfer inthe medical record. So themedico-legal burden formoving a patient is with thetransferring, and not thereceiving physician. Even inplaces where the laws arenot so stringent, mostphysicians would not allow apatient to be transferredsimply because another, non-treating physician wantedthem to do so. Finally, we occasionally comeacross a patient seen by alocal physician who is neitherhappy with the local care, norwilling to be evacuatedhome. This is the patient who

never seems satisfied, no matter what options areavailable. They present unique challenges toeveryone involved: the treating physician, the

medical director ofthe assistance/insurance company,and the privatephysician back home.Our company wasinvolved in a casewith a middle agedman in Moldavia, inEastern Europe, whohad a variety ofsymptoms, includingvisual blurring, doublevision, unilateral

headache, intermittent fevers and a non productivecough with shortness of breath. Among others, hewas evaluated by a local neurologist, who felt thatthere were significant enough neurological findings towarrant a more in-depth evaluation. Nonetheless,the patient decided to forego any additional work-upin favour of waiting it out. At the same time, hewanted to be reassured by us that his condition wasnot serious, and that a delay in his evaluation wouldnot be detrimental. He was not in favor of returningto the local providers, as he was unhappy with thephysical facility and lacked confidence in thephysicians who had examined him. His game planwas to wait a week or two to see if his conditionimproved, and to return home to the US if it did

not. In this case, the patient was unwilling to agree tothe two most viable options: returning to the localhospital to complete his work-up, or be evacuatedto the US immediately to have his conditionevaluated by his own physicians. Since there was noway that our medical team could provide thereassurance that a delay in his evaluation would notbe detrimental, we continued to insist that he obtaincare as soon as possible. Ultimately, the patientagreed to return home to the US when hedeveloped a rash after a few days of waiting it out.

Primary carer knows bestSo who is the best one to make a decision aboutmedical evacuation? Although guidelines might be

useful for those of us requesting evacuations, there islittle doubt the opinion of those with primaryresponsibility for the patient should prevail. Mostpractitioners are aware of their own limitations andthose of their facilities. It is the rare physician, fromany part of the world, who does not ask for helpwhen there is an obvious need to do so. It is important not to be quick to judge theinadequacies of others, and making decisions forfinancial considerations can backfire. Equally it isnecessary to listen carefully to the patients and theirfamilies. But to me it seems it is the opinion of theproviders who are caring for your patients thatshould be the final word in most cases.

Next issue: The assistance doctor’s opinion

www.itij.co.uk International Travel Insurance Journal

FEATURE 43

Although guidelines might beuseful for those of us

requesting evacuations, there islittle doubt the opinion of thosewith primary responsibility for

the patient should prevail

PROFILE44

International Travel Insurance Journal www.itij.co.uk

Over the past eleven years, Michael Starko hasbuilt successful alliances with numeroushealthcare networks within the US and around theworld. He is responsible for OneWorld Assist’sclaims administration, international emergencyassistance and cost containment units. Prior tobecoming managing director, Michael initiated anddeveloped OneWorld Assist’s current costmanagement system

Full name: Michael Starko

Job title: Managing director

Company: OneWorld Assist

Where were you born? Edmonton, Canada

Where do you live? Vancouver, Canada

Where were you educated? I received my Bachelorof Arts degree in economics from GonzagaUniversity in Spokane, Washington, US.

What was your first job and what was your worstjob? My first job was pressing sheets at my family’sdry cleaning plant. That would also qualify as myworst job. The heat from the presses combined withthe chemicals from the dry cleaning solution madefor pretty hideous conditions.

How did you find yourself in the assistanceindustry? I had been working in propertymanagement where a primary responsibility wasnegotiating leases. It was this negotiating experience

that led to my first job at OneWorld Assist. I washired to negotiate prompt payment discounts on thecompany’s hospital bills – the extent of costcontainment 15 years ago.

Tell us a little bit about your company. Since 1979,OneWorld Assist has provided internationalassistance to millions of travellers, and claimsmanagement and cost containment services todiverse organisations. We focus on building strongclient relations, whether we are servicing a specialtyinsurer or a traveller facing a medical emergency. Each year we handle approximately 20,000 claims,many from US-bound travellers. We’ve grown ournetwork of US healthcare providers to 3,500hospitals and 150,000 medical professionals. Ourexpertise navigating the public and private healthcaresystems in the US gives us a competitive advantage.Our proprietary database BestCare Direct adds tothis knowledge base by providing quantifiablestatistics on every US hospital, which we use tobenefit our clients.

How is your new BestCare Direct productinnovative and how is it being received in theindustry? Our proprietary BestCare Direct databaseoffers statistics on all US hospitals and will help uslead the charge into more proactive costcontainment practices. With BestCare Direct, theOneWorld Assist team evaluates and refers hospitalsbased not only on lower retail rates, but also oncomplication and mortality quality outcomes onspecific procedures, length of stay and number ofprocedures performed each year. This provides ourclients with unsurpassed service, as well as a whole

new level of cost containment because we aredriving clients to providers who have a lower initialcost of care. This results in a lower net cost of carewhen combined with our repricing capabilities.BestCare Direct information is sourced from USFederal Government data as well as 20 stateagencies including Florida, Arizona and California.We’ve presented BestCare Direct at severaltradeshows and it has been very well received.

In your opinion, how and why has the wayinsurers view cost containment changed? The costcontainment sector faces challenges in the wayinsurers view the industry. There seems to be a lackof credibility whenworking in the UShealthcare system andconjecture about theextent to which costcontainmentcompanies work withUS care providers.Building a costcontainment solutionthat providesincentives solely bysavings rate createsmore skepticismabout our industry.Transparency in ourbusiness practices willbe important for ourcontinued success.

In your opinion,what factors willchange travelinsurance in thefuture and how doyou see the industryadapting? Travel insurance will see a growth fromthe snowbird market (seniors travel) as ourpopulation ages. According to Statistics Canada, thenumber of people aged 55 and older made up 22per cent of the population in 2001. It is forecast thissegment will become 33 per cent of the populationby 2026. Other opportunities will be created fromconsolidations in the financial services industry inCanada, and from those who deal directly withtravellers such as travel agencies/tour operators andthose with established customer databases.Continued upward pressure on overall healthcarecosts will make it imperative that insurers partnerwith innovative cost containment providers who usetechnology and experience to provide sustainableprogrammes to their clients. We will have to be prepared with a competitiveproduct and services to ensure we balance theservices and the costs of handling different markets.

There have been prominent calls in Canadarecently for a privately-funded healthcare systemto co-exist alongside medicare, and the countryhas also seen a ban on private health insurancestruck down in Quebec. How close is the countryto fully embracing a private healthcare sector and,in your opinion, what would this mean for medicalproviders and insurers in the country? Privatehealthcare providers already exist today, offeringspecialty treatment such as day surgery andlaboratory services. With many Canadians facinglengthy waiting times for treatments and surgeries,the need for private healthcare options will put morepressure on our federal government to allow thesector to flourish. The recent Supreme Court of Canada decision set aprecedent by stating people in the province ofQuebec can now access private health insurance fortreatment that does not occur in a reasonable time.This opens up an avenue for medical providers andinsurers that was never officially endorsed before.

There will always be a strong desire by Canadians tokeep the public healthcare system intact. However,many ordinary Canadians as well as medicalproviders are seeking alternatives that complementthe public system so that service delivery can beimproved.

What has been your greatest achievement(career/personal)? Career – My biggestachievement was developing OneWorld Assist’s costcontainment capabilities. When I started 15 yearsago, cost containment was simply ensuring promptpayment discounts. It’s since grown to thecomplexity of providing contracting, network

relationships andtechnological advancementslike BestCare Direct.Personal – Sports have alwaysplayed a large part in my life.In 2000, after a number ofyears trying, I qualified for andcompleted the BostonMarathon. To accomplish thisgoal after years of failing tomeet the standard wasextremely rewarding.

What motivates you? I am acompetitive person and Ithink this motivates me tosucceed. In most cases this isan attribute that is positive;however, sometimes I haveto remember to reign it in,such as during our companypicnics!

How do you prioritize yourtime? It is very challenginggiven how busy life is. It is

very important to have balance in your life and I trymy best to ensure that my family, my career and myhealth are not compromised.

Can you tell us about your family? I have beenhappily married to Kathy for more than 12 years. Wehave 10-year-old twins (girl/boy) and an 8-year-olddaughter. Our job as parents consists of the threeCs…Cooking, Cleaning and Chauffeuring!!!

What are your future career/personal/life plans?My plans are to continue to develop leading-edgeproducts and services for OneWorld Assist. I believethat our organization’s future is very bright and I wantto be there to see and share in its continued success.Personally, I hope to continue to be healthy enoughto lead an active lifestyle and to be an activeparticipant in the lives of our kids.

What do you do when you are not working?Family is my highest priority. When I am notparticipating in the three Cs (see above), you can findme swimming, biking and running. I have completedover 100 triathlons, including four Ironmancompetitions.

What is you favorite holiday destination?Anywhere that I can enjoy the sun, the sand, the surfand the scuba diving. Barbados would be mynumber one choice.

If you could be in any other profession, whatwould it be? I would like to be an architect. I reallyenjoy drafting and design. I think it would be veryrewarding to see your drawings take shape frompaper to reality.

Who do you most admire? My mom is my heroinefor her courageous battle with emphysema. Up untilher very last breath, she handled her disease withstrength, dignity and a positive disposition eventhough she had to fight for every breath she took.

The ironman of cost containment

It is easy to sympathize with callers arrested abroadfor carrying legitimate, prescribed medications.Sometimes, foreign law enforcement authorities acton the belief that a particular prescription drug hasbeen illegally obtained. This can easily occur when thedrugs are not carried in their original prescription vial.It is recommended keeping pills and capsules in theirpharmacy issued containers and carrying a copy of theprescription, including the generic name of the drugfor added safety, since customs and police officials maynot be familiar with brand names.Other problems occur when travellers return fromforeign destinations unwittingly transportingcontraband. I received a call about just this sort ofproblem as I started to write this column. A middle-aged engineer had spent the week working at hercompany’s facility in a Mexican border town. ThisSunday school teacher, and mother of two grownchildren, with an impeccable background crossed theborder into Texas, dropped off her rental car andattempted to board a plane at the McAllen Airport forher flight home. She was stopped at the securitycheckpoint when the hand-carved cane she hadpurchased in Mexico was placed in the X-raymachine. Inspection of the cane revealed a daggerhidden inside, and the befuddled woman wasarrested for felony possession of a prohibited weaponin a secured area.Following her company’s procedures, she used hersingle telephone call to contact her assistancecompany, which immediately called our hotline.Within 45 minutes, our attorney colleague visited herat the police station, calmed her down and assuredher that he would obtain her release on bail. Thenew client tearfully insisted that she had no idea thatan illegal weapon was concealed in the cane. A felonyconviction would have a devastating effect on her lifeand career. We are working with local counsel toavoid this. The US Transportation Security Administration(TSA) reports that more than seven millionprohibited items were confiscated at US airports in2004. Approximately 14,000 of these incidentsresulted in fines ranging from US$250 toUS$10,000. We are unable to determine thenumber of arrests. Other calls have involved travellers who purchased a

souvenir in Turkey and were then arrested and jailedfor violating Turkey’s antiquity protection laws. Amiddle-aged professional woman spent more than amonth in an Izmir prison prior to being released onbail after customs officials had confiscated aninexpensive mask she had purchased at a market anddeclared it to be an antiquity. To avoid an arrest,holiday and business travellers should closely followthe foreign export regulations of the countries theyvisit – many countries post these procedures online.While Turkey has recently modernized its criminallaws and procedures to meet European Unionstandards, its antiquity protection laws remain ineffect. As is the case in many countries, these lawszealously guard against the removal of artifactsconsidered to be part of the national heritage.More frequently, shopping abroad leads callers tocomplain about being defrauded after they returnhome and determine that an artifact they purchasedabroad is fake or does not meet their expectations.On occasion, our recommended local counsel hasprovided effective assistance, but often, the sellereither cannot be located or denies responsibility.Other calls come from travellers to foreign countrieswho arrange with shopkeepers the shipment of theirpurchases and then receive nothing. Those who usea credit card for their transaction may have aneffective remedy since credit card companies, subjectto time limits, can cancel the charge if the goods donot arrive or if they arrive defective.Facing the most draconian penalty is the womantraveller who is victimized by a drug smuggler whoconceals heroin in his victim’s suitcase anddisappears if she is arrested. These unfortunatewomen are not covered by travel insurance’s legalcover benefit and no one pays for their defence. Atone point, several years ago, seven women, allvictims of such scams from the UK, Canada andUS, wrote to us from a Bangkok prison. Theirletters begged for assistance in transferring fromThailand to their home country’s prison systems.There was nothing anyone could do until they hadcompleted eight years of their life sentences.Travellers who learn about these potential holidaypitfalls are at least alerted to be careful.Most, but not all of these disastrous legalpredicaments are avoidable.

As customs crack down on what people can carry

into and out of a particular country, travellers need

to be aware of what is legal and, more importantly,

what they should not carry across borders. Dick

Atkins sorts out right from wrong souvenirs

Beware of what you carry

After the earthquake:Hope for India and PakistanWithin days of the tremendous 7.6-magnitudeearthquake that struck Pakistan on 8 October, manyobservers wondered if the shared tragedy wouldfeed an easing of tensions between India andPakistan. iJet Risk Management analyses theaftermath of the quake

The quake, which was centered approximately 95kilometres (60 miles) north-northeast of Islamabad,was also felt in Afghanistan and India, but most of thedestruction occurred in northern Pakistan. Latestnumbers indicate that the death toll from the quakehas exceeded 53,000 in Pakistan alone. In India-controlled Kashmir, almost1,500 people died. Thehardest-hit area was thecapital of Pakistan-controlled Kashmir,Muzaffarabad. Inneighboring North WestFrontier Province, thedeath toll is at 9,000.Within hours of the quake,India began pledging andrushing aid to Pakistan.Indian authorities announced the airlift ofapproximately 25 tonnes of supplies to Pakistan – thefirst such effort in almost two decades. The epicentreof the quake was in Pakistan-controlled Kashmir, ahighly disputed area. Both India and Pakistan lay claimto Kashmir – the Line of Control that separates India-controlled Kashmir from Pakistan remains a heavilymilitarised zone.Thus, even the effusive goodwill of the quakeresponse effort did not dampen all historicalanimosities. Some Pakistani officials expressedfrustration that Kashmir-based Indian forces could notenter Pakistan to help with quake relief. Kashmir is aflashpoint issue between India and Pakistan as bothcountries’ leaders contend that free crossings wouldcompromise military intelligence and security.The Pakistani government faces internal and externalcriticism for not allowing Indian helicopter sorties tohelp with relief efforts in Kashmir; Indian-basedchoppers would take less time to reach quake-struckareas than would those based on the Pakistani side ofthe border. The Pakistani government asked for theuse of Indian helicopters without crew, almostassuring that India would refuse the request.Indian officials were somewhat surprised – and slightlysuspicious – when, on 18 October, Pakistan offeredto ‘open up’ the Line of Control. That offer came asIndian authorities also agreed to open free phonelinks for Kashmiris on the Indian side of the border tocontact relatives in Pakistan. Tens of thousands ofKashmiris on both sides of the line have relatives onthe other side, cut off by a lack of basic phone links.Four telephone centres were opened on 19 Octoberfor relatives to call each other.

Potential for peaceThe Indian army announced on 24 October that ithad set up two camps along the Line of Control (inthe Poonch and Tangdar districts) to treat victims fromthe Pakistan side of the line – a third relief centre wasbeing planned in the Uri district. However, Indian andPakistani authorities were unable to come to anyresolution with regards to movement of civiliansacross the border.Hopes for cessation of militant activity sank furtherwhen suspected Islamists assassinated Jammu andKashmir State Minister for Education Ghulam NabiLone. Mohammad Yusuf Tarigami, a legislator and a

vocal critic of Islamist extremism in Kashmir, wastargeted in a separate assassination attempt on thesame day.There have also been several reports of militantinfiltrations and shootouts along the Line of Control.On 26 October, a car bomb exploded in Srinagar, thecapital of Indian-held Kashmir, killing dozens of Indiansecurity personnel. The Kashmiri militant group Hizb-ul Mujahideen claimed responsibility for the attack.Despite several reports of damage to jihadist camps inPakistan-controlled Kashmir, these groups have longshown a sadly consistent ability to resume violenceafter apparent setbacks. Witness the 29 October

coordinated detonation of threebombs in New Delhi – asophisticated attack that killed at least60 people in the crowded areas ofPahargunj, Sarojini Nagar andGovindpuri. Most of those killedwere holiday shoppers preparing forthe upcoming Diwali and Eid al-Fitrcelebrations. An obscure Islamistgroup – Islami Inqilabi Mahaz – saidit was responsible. The bombingsare the most severe in the capital

since the December 2001 attack on the parliamentbuilding by Lashkar-e-Toiba (LeT) militants.

Bottom lineGiven years of regional instability and the continued,mutual suspicions over quake-related overtures, it isunlikely India or Pakistan will make huge advances onpeace in the short term. The terrorist attacks willfurther stymie any potentially warming peace talksbetween the two neighbours. India will blamePakistan for being unable to control terrorist groupsbased out of Pakistan-operated Kashmir. Pakistan willdeny all allegations and accuse India of mud-slinging. Itis also uncertain how long authorities on both sideswill allow the line to remain open to civilian traffic.Though earthquake relief operations may createadded goodwill between India and Pakistan, thetragedy is unlikely to end any impasse over theKashmir issue or to otherwise fuel a meaningfulwarming in Indo-Pakistani relations.

www.itij.co.uk International Travel Insurance Journal

DICK’SHOTLINE / HOTSPOTS 45

International Travel Insurance Journal www.itij.co.uk

SERVICEDIRECTORY 46 To have your company listed in the Service Directory email: dave@itij.co.uk

DRF German Air Rescue Frank Spirgatis – Director, Fixed Wing

Raiffeisenstr 32 frank.spirgatis@drf.de70794 Filderstadt www.german-air-rescue.deGERMANY Tel (24hr): +49 711701070

Fax: +49 711701071

Euro-flite Air Ambulance Juani Missonen – Coordinator

Helsinki International Airport juhani.missonen@jetflite.fiPO Box 187 Tel: +358 20510 1900FIN-01531 Fax: +358 20510 1901VantaaFINLAND

FAI – rent-a-jet AG Volke Lemke – Director Sales & Marketing

Flughafenstrasse 100 lemke@fai-ag.deD-90268 Nuremberg www.rent-a-jet.deGERMANY Tel: +49 911 36009 31

Fax: +49 911 36009 59

Global Medical Support Otto Karud – Marketing Director

Ullevaal University Hospital gms@snla.no0407 Oslo www.globalmedicalsupport.comNORWAY Tel: +47 22 96 50 50

Telfax: +47 22 96 50 51

IFRA Bernhard Fantner – Assistant to Director

Bahnhofplatz 13/5 office@ifra.atPOB 160 www.ifra.at3500 Krems Tel: +43 2732 825 610AUSTRIA Fax: +43 2732 851 01

Jet Executive International Charter Gunter Krahe – Ground Ops Manager

Mundelheimer Weg 50 sales@jetexecutive.comD-40472 www.jetexecutive.comDusseldorf Tel: +49 211 602 7775GERMANY Fax: +49 211 602 77766

Luxembourg Air Ambulance Andy Breeden – Operations

175A, rue de Cessange info@air-ambulance.luL-1321 www.air-ambulance.luLUXEMBOURG Tel (24 hr): +352 420 440 1

Fax: +352 420 440 366

Med Call GmbH Michael Diefenbach – CEO

Bahnhofstrasse 22 info@medcallgmbh.com65185 www.medcallgmbh.comWiesbaden Tel: +49 611 9310 310GERMANY Fax: +49 611 9310 311

Medic’Air International Dr Herve Raffin – General Manager

35 Rue Jules Ferry operations@medic-air.com93170 Bagnolet www.medic-air.comParis Tel: +33 1 4172 1414FRANCE Fax: +331 4857 1010

Medical Jet Services & Partner W DichtlRadetzkystr 19 office@medicaljetservice.comVienna www.medicaljetservice.com1030 Tel: +43 1 713 2799AUSTRIA Fax: +43 1 713 2799-19

Red Star Aviation Mustafa Atac – CEO

Sabiha Gokcen Int Airport redstar@redstar-aviation.comJ Blok Kurtkoy 34912 www.redstar-aviation.comIstanbul Tel: +90 216 588 0216TURKEY Fax: +90 216 588 0225

Swiss Air Ambulance/REGA Walter Stunzi – PR/Marketing Mgr

PO Box 1414 ops@rega.chZurich Airport www.rega.chCH-8058 Tel: +41 333 333 333SWITZERLAND Fax: +41 44 654 3590

Tyrol Air Ambulance Jakob Ringler – Managing Director

PO Box 81 taa@taa.atA-6026 www.taa.atInnsbruck Airport Tel: +43 512 224 220AUSTRIA Fax: +43 512 288 888

AIR AMBULANCE cont.AIR AMBULANCE

AFRICA

AMREF Flying Doctor Service Dr Bettina Vadera – Medical Director

Wilson Airport emergency@flydoc.orgLangataRoad www.amref.orgPO Box 18617 Tel: +254 20 600 090Nairobi Fax: +254 20 344 170KENYA

Netcare 911 Aeromedical Shane MaraisNetcare 911 House flight@traumalink.co.za49 New Road www.netcare911.co.zaHalfway House Tel: +27 11 254 1392Midrand 1685 Fax: +27 11 254 1405SOUTH AFRICA

AUSTRALASIA

Asia Assistance Partners Siriporn Wongurai – Int Ops Director

184/235 Forum Tower aapartners@anet.net.th36th Flr Ratchadapisek Rd www.aapartners.netHuaykwang Tel: +662 645 3733-5Bangkok 10320 Fax: +662 645 3732THAILAND

Asia Medical Assistance Abhijeet Sachdev – Vice President

DLF City-ll asiamedassist@vsnl.netM.G Road www.privathealthcaregroup.comNew Delhi Tel: +91 9899 198 198Gurgaon 122002 Fax: +91 1242 235 2527INDIA

CareFlight International Colin Robshaw – Co-ordinator

Westmead Hospital Campus crobshaw@bigpond.net.auPO Box 159 www.careflight.orgWestmead Tel: +61 2 9891 1644NSW 2145 Fax: +61 2 9891 1284AUSTRALIA

Medical Wings Jarin Kiatfuengfoo – Director

222 Room 3602 m.w@medicalwings.comBangkok Int Airport www.medicalwings.comViphavadeo-Rangsit Rd Tel: +662 247 3392Sikan, Donmuang Fax: +662 535 4355Bangkok 10210, THAILAND

Mediflight Debra O’Brien – Operations Manager

Royal Adelaide Hospital info@mediflight.com.auNorth Terrace www.mediflight.com.auAdelaide Tel: +61 8 8223 6618SA 5000 Fax: +61 8 8223 6340AUSTRALIA

South Pacific Air Ambulance Scotty Watson – Managing Director

NEW ZEALAND ops@spaanz.co.nzAUSTRALIA Tel: +649 256 9000SINGAPORE Fax: +649 256 9111

EUROPE

Aeromed 365 Ltd Alida Benton – Managing Director

Worth Corner Business Cntr info@aeromed365.comTurnershill Road www.aeromed365.comPound Hill, Crawley Tel: +44 8707 596 999W Sussex RH10 7SL Fax: +44 8707 559 599UK

Alba Consulting Ltd. Andrew McGill – Managing Director

14 Belvedere Gardens enquiries@albaconsulting.orgCrowborough www.albaconsulting.orgEast Sussex Tel: +44 1892 610 560TN6 2LR Fax: +44 1892 652 620UK

Air Augsburg Roland Schoberth – Director

Roseggerstr 17 info@ambulanzflugdienst.deD-86368 www.ambulanzflugdienst.deGersthofen Tel: +49 821 299 1020GERMANY Tel: +49 821 299 2030

Ambulance-Assistance Tour Eiffel Dr Kollenbach – Medical Director

5 Place de Rungis contact@ambulance-assistance.org75013 www.ambulance-assistance.orgParis Tel: +33 141 2409 09FRANCE Tel: +33 141 2407 55

www.itij.co.uk International Travel Insurance Journal

SERVICEDIRECTORY 47call +44 (0) 117 925 5151 To make an alteration to a listing email: dave@itij.co.uk

ASSISTANCE COMPANIES cont.NORTH AMERICA

Aerojet Stuart Hayman – President

4631 NW 31st Ave #220 info@aero-jet.comFt Lauderdale www.aero-jet.comFL 33309 Tel: +1 954 730 9300USA Fax: +1 954 485 6564

Air Ambulance Professionals, Inc. Brian L. Weisz – President

Ft. Lauderdale Executive Airport sales@airambulanceprof.com1535 South Perimeter Rd www.airambulanceprof.comHangar 36B Ft. Lauderdale Tel: +1 954 491 0555Florida 33309 Fax: +1 954 491 6114USA

Air Ambulance Specialists, Inc. Donald Jones – President

8001 S.Interport Blvd. info@airaasi.comSuite 250 www.airaasi.comEnglewood Toll Free: +1 800 424 7060CO 80111 Tel: +1 720 875 9182USA Fax: +1 720 875 9183

Air Ambulance Worldwide Inc. Mark Jones – President

35246 US Hwy 19 North mjones31@tampabay.rr.com#210 www.airambulanceworldwide.comPalm Harbor Tel: +1 727 781 1198Florida 34684 Fax: +1 727 786 0897USA

Air Trek Air Ambulance David Bump – Vice President

28000 A-5 Airport Road airtrek@sunline.netPunta Gorda www.medjets.comFL 33982 Toll free: +1 800 633 5387USA Tel: +1 941 639 7855

American Care Air Ambulance Joel Reynolds – General Manager

8775 Aero Drive americancareair@aol.comSuite 120 www.americancareairambulance.comSan Diego Tel: +1 858 627 0515CA 92123 Fax: +1 858 627 0534USA

Canadian Global Air Ambulance Jeff McIntosh – President

Toronto jmcintosh@canadianglobalair.caWinnipeg www.canadianglobalair.caVancouver Toll Free: +1 800 563 3822CANADA Tel: +1 204 888 5555

Fax: +1 204 888 9111

Global Air Response Carlos Elcoro – Int. Programme Director

7355 S Peoria Street tcox@airresponse.netA3/ Suite 209 www.airresponse.netEnglewood Tel: +1 800 631 6565CO 80112 Fax: +1 888 631 6565USA

JetWest Shawn Crocker16644 Roscoe Blvd operations@jetwest.comVan Nuys www.jetwest.comCalifornia 91406 Tel: +1 818 787 910091406 Fax: +1 818 787 4473USA

National Air Ambulance George Martinez– Mgr Flight Co-ordination

3495 SW 9th Ave enquiry@nationalairambulance.comFort Lauderdale www.nationalairambulance.comFL 33315 Tel: +1 954 359 9900USA Fax: +1 954 359 9500

Skyservice Air Ambulance David Ewing – VP Int. Market Development

YUL/Trudeau Int Airport skyservicemiami@aol.com9785 Avenue Ryan www.skyservice.comMontreal (Quebec) Tel: +1 514 497 7000H9P 1A2 Fax: +1 514 636 0096CANADA

ASSISTANCE COMPANIES

AFRICA

AMREF Flying Doctor Service Dr Bettina Vadera – Medical Director

Wilson Airport emergency@flydoc.orgLangata Road www.amref.orgPO Box 18617 Tel: +254 20 600 090Nairobi Fax: +254 20 344 170KENYA

Connex Assistance Egypt Lara Helmi – Int Network Director

Office II info@connexassistance.comIst Floor www.connexassistance.com6 Sad El Aali Street Tel (24hr): +2 02 336 0005Dokki, Cairo Fax (24hr): +2 02 762 0003EGYPT

AUSTRALASIA

Asia Assistance Partners Siriporn Wongurai – Int Ops Director

184/235 Forum Tower aapartners@anet.net.th36th Flr Ratchadapisek Rd www.aapartners.netHuaykwang Tel: +662 645 3733-5Bangkok 10320 Fax: +662 645 3732THAILAND

Asia Medical Assistance Abhijeet Sachdev – Vice President

DLF City-ll asiamedassist@vsnl.netM.G Road www.privathealthcaregroup.comNew Delhi Tel: +91 9899 198 198Gurgaon 122002 Fax: +91 1242 235 2527INDIA

Blue Dot Assistance Dr Faustinus Wirasadi– President Director

Blue Dot Center bluedot.assistance@idn.co.idBlok K, L, M www.idn.co.idJl Gelong Baru Utara 5-8 Tel: +62 21 5696 2399Tomang, Jakarta Barat 1440 Fax: +62 21 5696 2499INDONESIA

Customer Care Pty Ltd Janine Benson – Operations Manager

Level 3 janineb@customercare.com.au60 Miller Street www.customercare.com.auNorth Sydney 2060 Tel: +612 9202 8222NSW Fax: +612 9202 8220AUSTRALIA

First Assistance Mary-Jo McDonald – Sales & Marketing Mgr

PO Box 17-310 rescue@firstassistance.co.nzGreenlane www.firstassistance.co.nzAuckland Tel: +64 9 356 1650NEW ZEALAND Fax: +64 9 525 1278

Global Assistance & Healthcare Mario Babin – Chief Executive Officer

Jalan Pattimura global@global-assistance.net15 Kebayoran Baru www.global-assistance.netJakaita Tel: +62 21 725 811512110 Fax: +62 21 725 7961INDONESIA

Medical Wings Jarin Kiatfuengfoo – Director

222 Room 3602 m.w@medicalwings.comBangkok Int Airport www.medicalwings.comViphavadeo-Rangsit Rd Tel: +662 247 3392Sikan, Donmuang Fax: +662 535 4355Bangkok 10210 THAILAND

South Pacific Air Ambulance Scotty Watson – Managing Director

NEW ZEALAND ops@spaanz.co.nzAUSTRALIA Tel: +649 256 9000SINGAPORE Fax: +649 256 9111

EUROPE & THE MED

Antalya Assistance Murat Arslanoglu – Network Manager

Muratpasa Mah. info@fempatr.comAdnan Menderes Bulvari 19 www.fempatr.comGazihan K:4 D:21 Tel: +90 242 243 6219Antalya Fax: +90 242 248 7724TURKEY

ARC Transistance Hans Biekmann – Network Director

11 Avenue Pleiades hans.biekmann@arctransistance.comB-1200 Brussels www.arctransistance.comBELGIUM Tel: +32 2 776 04 70

Fax: +32 2 776 04 99

Atlantic Assist Adriano Gouveia – Operations Manager

Rua da Alfandega 10-2.D info@atlanticassist.comPO Box 750 www.atlanticassist.com9000-056 Funchal Tel: +351 291 214 200Madeira Fax: +351 291 214 202PORTUGAL

AIR AMBULANCE cont.

International Travel Insurance Journal www.itij.co.uk

SERVICEDIRECTORY 48 To have your company listed in the Service Directory email: dave@itij.co.uk

Global Voyager Assistance Costas Danilenko – CEO

PO Box II cdanilenko@gvassistance.com125124 www.gvassistance.comMoscow Tel: +7 095 775 0999RUSSIA Fax: +7 095 775 0998

Life Assistance Igor A Striganov – General Director

House 3/7 24h@lifeassist.ru5th Passage of Marinoi Roshi www.lifeassist.ru129594, Moscow Tel: +7 095 755 5678RUSSIA Fax: +7 095 631 0465

Marm Assistance Jill Atac – CEO

Sabiha Gokcen Int Airport marm@redstar-aviation.comJ Blok Kurtkoy 34912 www.redstar-aviation.comIstanbul Tel: +90 216 588 0588TURKEY Fax: +90 216 588 0602

MK International Emergency Services Minas Kaloumenos – General Manager

95, Ioanninon Street mkassist@hol.gr10444 Athens Tel: +30 210 5154600GREECE Fax: +30 210 5131660

Monitor International Helen Lishmund – General Manager

Monitor House info@monitorinternational.com2a Belmont Road www.monitorinternational.comSutton, Surrey Tel: +44 208 770 2778SM2 6DW Fax: +44 208 770 2756UK

SER Assistance Ltd. Dr S Zareceansky – Gen Mgr & Director

50/2206 Dizengoff Street serasist@netvision.net.ilDizengoff Tower Tel: +972 544 370 00264332 Tel-Aviv Fax: +972 362 919 91ISRAEL

SOS International Helle Drager – Marketing Manager

Nitivej 6 soshungary@invitel.huDK-2000 www.sos.dkFrederiksberg Tel: +45 7010 5050Copenhagen Fax: +45 7010 5056DENMARK

TBS Team 24 d.o.o Edvard Hojnik – General Manager

Ljubljanska Ulica 42 info@tbs-team24.com2000 Maribor www.tbs-team24.comSLOVENIJA Tel: +386 2618 2301(Croatia, Bosnia, Macedonia, Fax: +386 2618 5800Kosovo, Herzegovina & Serbia)

NORTH & CENTRAL AMERICA

Assured Assistance Inc. Martha Turnbull – Director of Operations

6880 Financial Drive martha.turnbull@rbc.comMississauga Tel: +1 905 816 2495Ontario Fax: +1 905 813 4719L5N 7Y5CANADA

CMN Inc. Peter Lozier – Vice President

140 Renfrew Drive plozier@canmednet.comSuite 103 Markham www.canmednet.comOntario Tel: +1 905 669 4333L3R 6B3 Fax: +1 905 669 2221CANADA

Global Excel Management Brian Allatt – CEO

73 Queen Street corpinfo@globalexcel.caLennoxville, Quebec www.globalexcel.caJIM IJ3, CANADA Tel: +1 866 566 11304242 Cranmore Court Fax: +1 819 566 8335Belle Isle, Fl 32812, USA

Medex Assistance Corporation Linda McGee – SVP of Sales

8501 LaSalle Road info@medexassist.comSuite 200 www.medexassist.comBaltimore Tel: +1 410 453 6300MD 21286 Fax: +1 410 453 6301USA

TMCA Margaret Whartom – Ops Manager

217 Broadway margaret@tmcatravel.comSuite 600 www.tmcatravel.comNYC Tel: +1 212 964 8580NY 10007 Fax: +1 212 406 1520USA

World Travel Protection Canada Inc. Dr Ron Mayer – President & Chf Med Officer

400 University Avenue ron.mayer@wtp.ca15th Floor www.wtp.caToronto Tel: +1 416 977 3565Ontario M5G IS7 Fax: +1 416 205 4676CANADA

AIR AMBULANCE INTERIOR

Air Ambulance Technology Egon Kuntner – President

A-5282 aat@airambulancetechnology.comRanshofen www.airambulancetechnology.comAUSTRIA Tel: +43 7722 85051

Fax: +43 7722 85051-22

COST CONTAINMENT

EUROPE

ChargeCare International Philip Marshall – Director of Operations

PO Box 18 admin@chargecare.co.ukHolsworthy www.chargecare.co.ukEX22 7WB Tel: +44 1409 261 368UK Fax: +44 1409 261 633

M & V Administrators GmbH Jennifer Venables – Corp. Ops Director

Obergütschstrasse 33 jennifervenables@mv-administrators.comPostfach 7622 www.mv-administrators.comCH-6003 Luzern Tel: +41 41 210 6040SWITZERLAND Fax: +41 41 210 6039

Marm Assistance Jill Atac – CEO

Sabiha Gokcen Int Airport marm@redstar-aviation.comJ Blok Kurtkoy 34912 www.redstar-aviation.comIstanbul Tel: +90 216 588 0588TURKEY Fax: +90 216 588 0602

NORTH AMERICA

CMN Inc. Peter Lozier – Vice President

140 Renfrew Drive plozier@canmednet.comSuite 103 Markham www.canmednet.comOntario Tel: +1 905 669 4333L3R 6B3 Fax: +1 905 669 2221CANADA

Global Excel Management Brian Allatt – CEO

73 Queen Street, Lennoxville corpinfo@globalexcel.caQuebec, JIM 1J3, CANADA www.globalexcel.ca4242 Cranmore Court Tel: +1 866 566 1130Belle Isle, FL 32812 Fax: +1 819 566 8335USA

Global Medical Management Raija Itzchaki – Assistant VP Marketing

7901 SW 36th Street contact@gmmusa.comSuite 100 www.gmmusa.comDavie Tel: +1 954 370 6404FL 33328 Fax: +1 954 370 8613USA

Health Systems International Peggy Novotny – VP / Gen Mng. Int Bus.

5975 Castle Creek Parkway pnovotny@us-hsi.comSuite 100 www.us-hsi.comIndianapolis Tel: +1 317 806 2000IN 46250 Fax: +1 317 806 2033USA

Hygeia Corporation Joe Radigan – Chief Operating Officer

15500 New Barn Road j.radigan@hygeia.netSuite 200 www.hygeia.netMiami Lakes Tel: +1 305 594 9291FL 33014 Fax: +1 305 594 9201USA

ASSISTANCE COMPANIES cont. ASSISTANCE COMPANIES cont.

Rowland Brothers International Melanie Walkling

299-305 Whitehorse Road info@rowlandbrothersinternational.co.ukWest Croydon www.rowlandbrothersinternational.co.ukSurrey Tel: +44 20 8684 2324CR0 2HR Fax: +44 20 8684 8000UK

Servilusa Vanda Castro – Manager Int Dept

Agencias Funerarias SA internacional@servilusa.ptInternational Dept. www.servilusa.ptRua do Entreposto Industrial Tel: +35 121 470 63008-2 Esq, 2610-135 Amadora Fax: +35 121 470 6499PORTUGAL

NORTH AMERICA

Bergen Funeral Sevice Scott Nimmo – Funeral Director

129 E 7th St. scott@bergenfuneral.comNew York www.bergenfuneral.comNY 10009 Tel: +1 212 254 2864USA Fax: +1 201 288 5694“Servicing all of the USA, Canada, South & Central America”

HEALTHCARE CLINICS

LuzDoc International Medical Serv. Ltd Dr Maria Alice Silva – Medical Director

Medical & Assistance Services luzdoc@mail.telepac.ptRua 25 de Abril, 12 www.luzdoc.comVilla da Luz Tel: +351 282 780 7008600-174, LUZ LGS Fax: +351 282 780 709PORTUGAL

Number One Health Group Dr Charlie Easmon – Director

1 Harley Street charlie@travelscreening.co.ukLondon www.executivescreen.comW1G 9QD Tel: +44 207 307 8756UK Fax: +447092 196 169

Privat Travel Clinics Abhijeet Sachdev – Vice President

DLF City-ll sos@privathealthcaregroup.comM.G Road www.privathealthcaregroup.comNew Delhi Tel: +91 9899 198 198Gurgaon 122002 Fax: +91 124 235 3794INDIA

HOSPITALS

ASIA

Bangkok General Hospital Jane Bailey – Int Marketing Executive

International Medical Center jane@bgh.co.th2, Soi Soonvijai 7 www.bangkokhospital.comNew Petchburi Road Tel: +66 2310 3460Bangkok 10320 Fax: +66 2310 3367THAILAND

Privat Hospital Abhijeet Sachdev – Vice President

DLF City-ll sos@privathealthcaregroup.comM.G Road www.privathealthcaregroup.comNew Delhi Tel: +91 9899 198 198Gurgaon 122002 Fax: +91 124 235 3794INDIA

EUROPE

Hospital Clinica Benidorm Ana DaPaz Brown – Medical Director

Avenida Alfonso Purchades 8 anapaz@clinicabenidorm.com03500 Benidorm www.clinicabenidorm.comAlicante Tel: +34 96 585 3850SPAIN Fax: +34 96 586 4345

Xanit Hospital de Benalmadena Dr. Juan Bosco Rodriguez Hurtado – Director

Camino de Gilabert s/n xanit@xanit.netBenalmadena www.xanit.net29630 Tel: +34 952 44 3119/0032Malaga Fax: +34 952 57 6661SPAIN

Medsave USA Donald Moyle – Chief Marketing Officer

1400 Old Country Road dmoyle@medsaveusa.comSuite 109 www.medsaveusa.comWestbury Tel: +1 516 622 1700NY 11590 Fax: +1 516 622 1733USA

OneWorld Assist Calvin Ball – Business Development Manager

10th Floor info@oneworldassist.com6081 No. 3 Road www.oneworldassist.comRichmond, BC Tel: +1 604 278 4108V6Y 2B2 Fax: +1 604 303 2142CANADA

TMCA Margaret Whartom – Ops Manager

217 Broadway margaret@tmcatravel.comSuite 600 www.tmcatravel.comNYC Tel: +1 212 964 8580NY 10007 Fax: +1 212 406 1520USA

CLAIMS MANAGEMENT

Global Assistance & Healthcare Nathan Hannah – TPA Mgr Asia/Pac

Jalan Pattimura nathan.hannah@global-assistance.net15 Kebayoran Baru www.global-assistance.netJakaita Tel: +62 21 725 811512110 Fax: +62 21 725 8951INDONESIA

Global Excel Management Brian Allatt – CEO

73 Queen Street, Lennoxville corpinfo@globalexcel.caQuebec, JIM 1J3, CANADA www.globalexcel.ca4242 Cranmore Court Tel: +1 866 566 1130Belle Isle, FL 32812 Fax: +1 819 566 8335USA

CRITICAL CARE PATIENT TRANSPORT

EUROPE

Lufthansa German Airlines Doris Ehring – Product & Process Management

FRA SQ/B doris.ehring@DLH.deFrankfurt Airport Tel: +49 172 367 7929D-60546 Fax: +49 69 690 58147GERMANY

Defin Funeral Services Murat Arslanoglu – Network Manager

Muratpasa Mah. info@fempatr.comAdnan Menderes Bulvari 19 www.fempatr.comGazihan K:4 D:21 Tel: +90 242 248 8389Antalya Fax: +90 242 248 7724TURKEY

Funeraria Officia Roberto Zega Cristina Zega – General Manager

Via Clelia 26-28 cristina@zega.itRoma www.zega.itITALY Tel: +39 067 840 300

Fax: +39 067 802 488

Funeralcare International Roger Waddington221 Upper Richmond Road funeralcare.international@letsco-operate.comPutney Tel: +44 20 8788 5303London SW15 6SQ Fax: +44 20 8788 2525UK

Global Networks Funeral Assistance Cristina Almudi – Managing Director

23 Blindmans Lane info@gnfa.infoCheshunt www.gnfa.infoHertfordshire, EN8 9DR Tel: +44 1992 640 066UK Fax: +44 1992 785 030

MK Funeral & Transportation Services Minas Kaloumenos – General Manager

95, Ioanninon Street mkassist@hol.gr10444 Athens Tel: +30 210 5154600GREECE Fax: +30 210 5131660

CRITICAL CARE PATIENT TRANSPORT cont.COST CONTAINMENT cont.

www.itij.co.uk International Travel Insurance Journal

SERVICEDIRECTORY 49call +44 (0) 117 925 5151 To make an alteration to a listing email: dave@itij.co.uk

SERVICEDIRECTORY50

Smile cornerCorporate Lesson 4:A crow was sitting on a tree, doingnothing all day.A rabbit asked him: “Can I also sitlike you and do nothing all daylong?”The crow answered: “Sure, why

not.” So, the rabbit sat on theground below the crow, andrested. A fox jumped on the rabbitand ate it.Moral of the story: To be sittingand doing nothing, you must besitting very high up.

NORTH AMERICA

AmeriMed American Hosp & Med. Cnt. Mark R Engelman – MD

4340 E Indian School Road mengelman@amerimed-hospitals.comSTE 21, PMB 564, www.amerimed-hospitals.comPhx, Az 85018 Tel: +1 602 952 0405USA Fax: +1 602 952 1668

Baptist Health International Center of Miami Yohandra Fuentes – Finance Manager

8940 North Kendall Drive international@baptisthealth.netSuite 601-E www.baptisthealth.net/internationalMiami, Fl 33176 Tel: +1 786 596 2373USA Fax: +1 786 596 5979

MEDICAL ESCORT ON COMMERCIAL AIRLINES

AFRICA

AMREF Flying Doctor Service Dr Bettina Vadera – Medical Director

Wilson Airport emergency@flydoc.orgLangata Road www.amref.orgPO Box 18617 Tel: +254 20 600 090Nairobi Fax: +254 20 344 170KENYA

AUSTRALASIA

CareFlight International Colin Robshaw – Co-ordinator

Westmead Hospital Campus crobshaw@bigpond.net.auPO Box 159 www.careflight.orgWestmead Tel: +61 2 9891 1644NSW 2145 Fax: +61 2 9891 1284AUSTRALIA

Medical Wings Jarin Kiatfuengfoo – Director

222 Room 3602 m.w@medicalwings.comBangkok Int Airport www.medicalwings.comViphavadeo-Rangsit Rd Tel: +662 247 3392Sikan, Donmuang Fax: +662 535 4355Bangkok 10210 THAILAND

Mediflight Debra O’Brien – Operations Manager

Royal Adelaide Hospital info@mediflight.com.auNorth Terrace www.mediflight.com.auAdelaide Tel: +61 8 8223 6618SA 5000 Fax: +61 8 8223 6340AUSTRALIA

EUROPE

Medic’Air International Dr Herve Raffin – General Manager

35 Rue Jules Ferry operations@medic-air.com93170 Bagnolet www.medic-air.comParis Tel: +33 1 4172 1414FRANCE Fax: +33 1 4857 1010

NORTH AMERICA

Air Ambulance Worldwide Inc. Mark Jones – President

35246 US Hwy 19 North mjones31@tampabay.rr.com#210 www.airambulanceworldwide.comPalm Harbor Tel: +1 727 781 1198Florida 34684 Fax: +1 727 786 0897USA

American Care Air Ambulance Joel Reynolds – General Manager

8775 Aero Drive americancareair@aol.comSuite 120 www.americancareairambulance.comSan Diego Tel: +1 858 627 0515CA 92123 Fax: +1 858 627 0534USA

Global Air Response Carlos Elcoro – Int. Programme Director

7355 S Peoria Street tcox@airresponse.netA3/ Suite 209 www.airresponse.netEnglewood Tel: +1 800 631 6565CO 80112 Fax: +1 888 631 6565USA

International Travel Insurance Journal www.itij.co.uk

HOSPITALS cont.

Ambulance-Assistance Tour Eiffel Dr Kollenbach – Medical Director

5 Place de Rungis contact@ambulance-assistance.org75013 www.ambulance-assistance.orgParis Tel: +33 141 2409 09FRANCE Tel: +33 141 2407 55

AMREF Flying Doctor Service Dr Bettina Vadera – Medical Director

Wilson Airport emergency@flydoc.orgLangata Road www.amref.orgPO Box 18617 Tel: +254 20 600 090Nairobi Fax: +254 20 344 170KENYA

Atlantic Assist Adriano Gouveia – Operations Manager

Rua da Alfandega 10-2.D info@atlanticassist.comPO Box 750 www.atlanticassist.com9000-056 Funchal Tel: +351 291 214 200Madeira Fax: +351 291 214 202PORTUGAL

SOS – Hungary Assistance Dr Peter Felkai – Medical Director

Szentendrei Street 301 soshungary@invitel.huBudapest www.soshungary.huH-1039 Tel: +36 1240 0475HUNGARY Fax: +36 1439 1440

MEDICAL SCREENING

Risck Solutions Ltd Ian Findlay – Commercial Director

The Medical Centre admin@risck.co.uk238 Broomhill Road www.risck.co.ukBrislington Tel: +44 117 300 7007Bristol BS4 5RG Fax: +44 117 300 7003UK

The Medical Screening Company Glenda Cardenas – Accounts Manager

Monitor House info@monitorinternational.com2a Belmont Road www.monitorinternational.comSutton, Surrey Tel: +44 208 770 2778SM2 6DW Fax: +44 208 770 2756UK

Travel & Medical Insurance Services Michael J Turner – MD

1st Flr Suite, West House sales@travelandmedical.net46 High Street www.travelandmedical.netOrpington, Kent Tel: +44 845 058 8000BR6 0JQ Fax: +44 845 053 3000UK

RE-INSURANCE

Crispin Speers & Partners ltd David Stirling – Marketing Manager

St Clare House david.stirling@cspinsurance.com30-33 Minories www.cspinsurance.comLondon EC3N 1PE Tel: +44 20 7977 5700UK Fax: +44 20 7702 9276

TRAVEL AGENTS

Voyageur Aeromedical Travel Marc Lucus – General Manager

Voyageur Buildings marc@voyageur.co.uk43 Colston Street www.voyageur.co.ukBristol BS1 5AX Tel: +44 (0)117 927 3554UK Fax: +44 (0)117 925 5940

MEDICAL PROVIDER

CONTRIBUTORS

Published on behalf of Voyageur Publishing & Events Ltd,Voyageur Buildings, 43 Colston Street, Bristol BS15AX, UK

The information contained in this publication has been publishedin good faith and every effort has been made to ensure itsaccuracy. Neither the publisher nor Voyageur Ltd can accept anyresponsibility for any error or misinterpretation. All liability forloss, disappointment, negligence or other damage caused byreliance on the information contained in this publication, or in theevent of bankruptcy or liquidation or cessation of the trade ofany company, individual or firm mentioned, is hereby excluded.

Printed by Pensord Press Ltd

Copyright © Voyageur Publishing 2004. Materials in this publicationmay not be reproduced in any form without permission.

INTERNATIONAL TRAVEL INSURANCE JOURNAL ISSN 1743-1522

Dick Atkins is chief counsel for InternationalRecoveries, Philadelphia, which provides globallegal assistance to the travel insurance industry.He is in charge of International Recoveries’ legalhotline and has been involved in handlinginternational legal incidents for the past 20 years.He can be reached via email ondickatkins@aol.com

Barbara Casassus is a Paris-based freelancejournalist. She contributes to the American weeklymagazine ‘Science’, the daily newspapers ChicagoTribune and ‘Baltimore Sun’, and to specialistmagazines and newsletters on economics, law,tourism and publishing in France. She wrote for theFinancial Times, the Times Educational Supplementand a number of periodicals while living in theMiddle East and Japan.

Miles Clarke is a Sydney-based freelance journalistwith more than two decades’ experience innewspapers, radio and trade press. As a businessand travel writer, his work takes him throughout thePacific, Southeast and East Asia, Australia and NewZealand.

Robin Gauldie is a freelance journalist specialising intravel, aviation and related sectors. A former editor ofthe pan-European travel industry newspaper TTGEuropa, he has also edited Destination ASEAN; ABTAMagazine; and Travel Agent International. Hecontributes to the Times, the Sunday Telegraph, theScotsman, the Sunday Mirror, and to numerousspecalist magazines and is the author of more than 20travel guidebooks.

Frank Gillingham is Senior Medical Director ofHTHWorldwide’s international business developmentefforts in Europe and Canada and has been aguest speaker at international businessconferences. Frank is a Board-Certified Internistand Emergency Medicine Specialist. He is also aprivate emergency physician in SouthernCalifornia and a former emergency departmentdirector and member of the UCLA emergencydepartment staff. He currently is the assistantdirector at the Valley Presbyterian Hospital in LosAngeles. Frank completed residency training atLos Angeles County/USC Medical Center, receivedhis M.D. from Albert Einstein College of Medicineand his B.A. from the University of Pennsylvania.Frank can be reached atfgillingham@hthworldwide.com

iJET Travel Intelligence (www.ijet.com), the travel riskmanagement company, provides real-time travelintelligence information through its award-winningWorldcue (copyright) technology platform for trackingand communicating with travellers. iJET services arebacked by regional and category specialists from thefields of intelligence, security, travel, and health whostaff an around-the-clock operations centre inAnnapolis, MD.

Milan Korcok is an award-winning freelance healthpolicy and economics writer who covers travelinsurance, public health, and medical educationissues in Canada and the United States. He has beenwriting about health financing and policy issues inthese countries since the 1960s and is a frequentcontributor to leading North American professionaljournals and consumer media. He lives in FortLauderdale, Florida.

Roger St Pierre is one of the UK’s most experiencedtravel, music and motoring writers and has visited 111countries on five continents. His insights appear in awide range of consumer and trade publications.Roger’s 33 published books include a history ofMcDonald’s, guides to such destinations as Orlando,Moscow, Edinburgh and the Costa del Sol, biographiesof Marilyn Monroe, James Dean, Bob Marley and JimiHendrix and a range of cycling books, the latest ofwhich is A Bike Is For Life.

Ian Youngman is a specialist freelance insurancewriter and researcher who writes for a wide range ofpublications. As well as researching and publishingspecialist management reports on insurance, he is aghostwriter for various companies andorganisations.He previously had extensive industryexperience with insurers and brokers.

www.itij.co.uk International Travel Insurance Journal

ONTHEMOVE 51

Diary dates12 - 13 DecPricing and Rate Making in PlainEnglish Seminar

Marriott Suites Old Town, Scottsdale, USwww.dormanconsulting.com

12 DecemberHow to be certain in an Uncertain World

Cobham, Surrey, UK

13 December How to be certain in an Uncertain World

Margaretting, Essex, UK

14 December How to be certain in an Uncertain World

Wakefield, West Yorks, UK

15 December How to be certain in an Uncertain World The Fitness First Stadium, Bournemouth, UK

14 December How to Charge Fees the Right Way

Leeds, UK

15 DecemberA Step-by-Step Process to Transformyour Practice

The Great Hall, London, UK

15 December Sales success in a Competitive world

East Midlands Airport, Derby, UKwww.cii.co.uk

Westfield appointskey staffWestfield Insurance in Ohio, US, has been busymaking a number of appointments. Scott Jurek hasbeen named senior executive, claims field operations,Western division. In this capacity, he will help set andexecute the claims strategy for Westfield Insurancewhile working collaboratively with business partners incommercial lines, personal lines and agribusiness tobring value to customers.Michael Prandi has been named senior executive,complex claims and litigation. He is responsible for thelitigation management of all claims as well as allsubrogation recoveries.Terry McClaskey has been named executive, personallines underwriting practices. In this capacity, heprimarily oversees business planning, education andcompliance in the personal lines department.Mary Christian has been named executive, claims staffoperations. In this capacity, she provides strategicdirection and leadership for claims activities including,but not limited to, enterprise-wide projects focusedon achieving corporate goals and key businessobjectives that drive positive financial results.Finally, Robert Testa has been named executive,personal lines sales, overseeing employees in fivestates responsible for new personal lines business.

Lopez appointedZurich CEO SpainZurich FinancialServices Group(Zurich) hasannounced theappointment of JulianLopez, pictured, tochief executive officerof its Spanish businesseffective 1 April 2006.José Cela, CEO Spainsince 1994, will retireat that date. Lopez willreport to DieterWemmer, CEO Europe General Insurance, and bepart of the European General Insurance ExecutiveCommittee. Lopez joined Zurich in 1998 as head ofpersonal lines in Spain. Meanwhile, Dan Loris has joined Zurich’s technicalcentre as director of its property line of business(LOB) in North America. In this role as property LOBdirector, Loris will work closely with the organisation’sproperty leaders to implement Zurich’s NorthAmerica commercial underwriting strategy, He willalso oversee Zurich’s technical centre LOB staff andlead its property network.

MMC names newappointmentsMichael Cherkasky, president and chief executiveofficer of Marsh & McLennan Companies, Inc.(MMC), has announced that Brian Storms has beennamed chairman and chief executive officer of MarshInc., its risk and insurance services subsidiary, and thatE. Michael Caulfield has been appointed president ofMercer Human Resource Consulting, effectiveimmediately. As chief operating officer of Mercer Human ResourceConsulting, Mr Caulfield was responsible for co-ordinating and globalising core-operating processesand for compliance, finance, human resources,information technology, and legal functions. MrCaulfield has more than 30 years’ experience infinancial services, including as executive vice presidentfinance management, of the Prudential InsuranceCompany of America and chief executive officer ofPrudential Investments.Mr Storms, who served most recently as presidentand chief executive officer of Mercer HumanResource Consulting, succeeds Mr Cherkasky, whocontinues as president and chief executive officer ofMMC. Mr Caulfield, formerly chief operating officer ofMercer Human Resource Consulting, succeeds MrStorms as president of the firm.

Mallett and Stumpfboost RBSThe Royal Bank of Scotland has appointed JohnMallett as head of insurance in the UK, and RolandStumpf as relationship director of insurance. Mallett has built a wealth of insurance experiencesince joining the London insurance market in thelate 1980s with Coutts, before moving to Natwest.He managed his own portfolio of corporate clientsand was involved in Lloyds’ most recent capitalraising exercise. In his new role, Mallett will beensuring the team delivers first-class solutions insupport of clients’ strategic goals, allied to strongcustomer service. Stumpf, meanwhile, joins fromChubb Insurance, where he worked as a seniorunderwriter for over four years. Prior to that heworked in the corporate banking arm of BarclaysBanks in a variety of relationship roles.

Enoizi moves toCNACNA Financial Corporation has named Julian Enoizi asmanaging director of its European businesses, subjectto regulatory approval. Mr Enoizi will succeed KeithDavies who held the position from 2001. Mr Enoizi joined CNA in 2002, and currently servesas general manager and Legal Counsel for ContinentalEurope. He is a lawyer who has been instrumental inestablishing and developing the company’sContinental business. “Keith has led our European businesses to a muchstronger position, financially and operationally, and weappreciate his contributions,” said James R. Lewis,president and chief executive officer of CNA Propertyand Casualty Operations. “Julian’s experience andleadership make him an ideal successor. We lookforward to building on our momentum, and seeingour European business become an even biggercontributor to CNA’s success.” “I have really enjoyed myself at CNA,” said KeithDavies. “I am proud of what the CNA team inEurope has achieved in the past four years. Now Ilook forward to developing some of my otherinterests, knowing that there is a firm foundation onwhich Julian can build.”

Willis in IndiaWillis Group Holdings Ltd. has named a chiefexecutive for its operations in India. Ashok Dhawan,who will be based in Mumbai, previously was chiefoperating officer of Intelenet, a joint venture ofBarclays Bank PLC UK and the HousingDevelopment Finance Corp. Ltd, an Indianmortgage bank.

New MD for EuropAssistanceCharles Walckenaer,pictured, has beenappointed managingdirector of EuropAssistance UK andIreland. He started hisprofessional career in1968 with the GANGroup, where hecreated the InternationalAudit Department. From1981–86, he took onnew responsibilities atGAN North America, before being appointedmanaging director of the Phenix Soleil Group (Rome). In 1990, Walckenaer joined the Axa Group asinternational director and was later appointedchairman and CEO of Axa Global Risks. In 2003, hejoined the Generali Group in France. In his latest rolewith Europe Assistance, Walckenaer will reportdirectly to CEO Martin Vial.

Mondial geared upfor trainingIn itscommitment tostaff training,Mondial UKhas appointedCarolynneHenshaw astrainingmanager,corporate andtravel. She willbe overseeingthe trainingstrategy for thetravel insurancesales,emergency assistance and claims teams, whileincorporating FSA regulation. She will also deliverboth internal and external training courses ontechnical and customer service skills.Prior to joining Mondial, Carolynne worked on theclient development team at Mercury International,managing travel and private health insuranceaccounts. Before this, she lived in Spain, Mexico andJapan, teaching English. With 10 years’ experience inthe travel and insurance market, combined with fiveyears as a teacher, Carolynne is ideally positionedfor this training and development role.