More people with disabilities are travelling than ever before, creating a new set of challenges and opportunities for the travel insurance and medical assistance sectors. Robin Gauldie asks if the travel insurance industry has realised the potential size of the market
In part, there are many more such travellers today because legislation such as the Americans with Disabilities Act of 1990, the UK Disability Discrimination Act of 1995, and similar legislation across the European Union (EU) and most developed countries has made it easier for wheelchair users and those with prostheses and people with impaired vision to travel. Airlines, for example, must carry wheelchairs as checked luggage free of charge for those who are partially mobile, and provide wheelchair lift access to aircraft for wheelchair-dependent travellers. Wheelchair-accessible rooms and bathroom and toilet facilities in hotels, restaurants and visitor attractions are much more widely available than in the recent past. Other factors include technological innovation, such as a new wave of microprocessor-controlled, powered prostheses, and simple demographics. According to the European Network for Accessible Tourism (ENAT), there are already 50 million people with disabilities in Europe. Factor in an ageing population – older people who still want to travel will soon make up 25 per cent of the European population, ENAT claims – and the number of travellers who will need better facilities and services rises to as many as 130 million. “Accessible tourism is not a niche market,” according to ENAT president, Lilian Muller. “It’s a demographic explosion and we will all feel the effects.”
Whatever the factors involved, there’s a strong argument that this vast, growing market it is still overlooked by many who should be reaching out to it – and that may include travel insurance providers.
It’s a safe bet that few overweight desk jockeys could match the performance of Paralympic gold medallists such as South Africa’s Oscar Pistorius, Britain’s Richard Whitehead or the US’s Jessica Long. The 2012 Paralympics reinforced the fact that people with disabilities – either from birth or as the result of accident or illness – are no longer necessarily immobilised. Far from it, in fact. Advances in prosthetic limbs and other mobility aids mean many are almost fully mobile, and related technology is developing very rapidly. Ten years ago, artificial limbs were mechanical devices, using springs and elastic bands as substitute tendons, and controlled by the muscles of the remaining parts of the limb. Now, powered prosthetics such as the Proprio artificial foot, driven by lithium batteries and controlled by microprocessors, are becoming the norm. The BiOM ‘ankle’, developed by US company iWalk, has been hailed as the most significant lower-limb development in the history of prosthetics. California-based Ekso Bionics has introduced a battery-powered exoskeleton, the Ekso™, which will allow paraplegic patients to stand and walk. Earlier this year, disability campaigner Claire Lomas wore a ReWalk ‘suit’, which was developed in Israel, to complete the London Marathon.
Much of the remarkable progress in prosthesis design in recent years has been driven by the needs of the US military. The US government, through organisations including the US Army’s Telemedicine and Advanced Technology Research Centre (TATRC), has invested millions of dollars in research and development in this field since the outbreak of the Afghanistan and Iraq wars. Over the past decade, according to the US Armed Forces Health Surveillance Center, almost 6,000 US service personnel in Afghanistan and Iraq fell victim to incidents leading to traumatic amputations, mostly as a result of insurgent attacks using improvised explosive devices (IEDs). Of those, perhaps as many as 2,000 have undergone major amputations of a hand, foot, or one or more limbs. New-generation prostheses mean that many of them are once again mobile. Most of them are young and – apart from their injuries – fit. They will be travelling for many years to come. Meanwhile, the same equipment is available now to civilian amputees. According to the US Amputee Coalition, there are nearly two million people living with limb loss in the US, and approximately 185,000 amputations occur in the US every year.
The 2012 Paralympics reinforced the fact that people with disabilities ... are no longer necessarily immobilised
Meanwhile, countries such as Brazil, Russia, India and China – the so-called ‘BRIC’ nations – are becoming wealthier and their attitudes towards people with disabilities are becoming more sophisticated. In a recent article (September 8 2012), The Economist magazine noted that just nine countries provided 40 per cent of the athletes at this year’s Paralympics and that ‘disabled sports is still mainly a rich-country affair, reflecting the need for costly prostheses’. The same can be said for disabled travel.
Eventually, though disabled citizens of developing countries too will gain better access to mobility aids of all kinds, thus, many more people with disabilities will be travelling on business or leisure in years to come.
Airport security personnel who have not been adequately trained to recognise them are frequently baffled when first encountering these high-tech prostheses with their sophisticated electronics, according to many prosthetic users. This leads to long delays when boarding, even for high-profile paralympians.
“Just like the many passengers with a disability who fly on a daily basis, our athletes regularly experience unnecessary problems travelling through airports and with airlines,” says Xavier Gonzalez, chief executive officer of the International Paralympic Committee, organisers of the Paralympic Games. If obstructive security procedures are a frequent obstacle for travellers enabled by a prosthesis or wheelchair, but otherwise fit, they are an even more contentious issue for assistance providers transferring disabled patients who are also ill or injured. All too often, security personnel consider unfamiliar items and unfamiliar behaviour as suspicious and therefore dangerous, according to Dr Peter Felkai, of assistance company SOS Hungary.
“Professionals in the travel business have bitter experience of international ignorance in this field, including the level of knowledge of security clerks,” Felkai says. “The question is always swept under the carpet, just sometimes bobbing to the surface in news and media.” Felkai points out that there are no clear guidelines for dealing with patients with disabilities, ranging from people with mental disorders to people with impaired hearing and vision.
Travellers with psychiatric or psychological problems may, he says, experience even greater problems than those with more highly visible physical disabilities. “Can you imagine the behaviour of a security guard towards, for example, a child with autism, or the fear and dread such a person might feel during the ‘security procedure’?”
Felkai claims that two out of three travel insurance companies exclude patients with mental disabilities from their policies. Moreover, he says, many policies use vague descriptions that exclude ‘disturbed behaviour’ or any phenomena connected to the insured’s mental status. “On this basis, even patients suffering from, for example, diabetic coma or altitude illness would be excluded from the travel insurance coverage,” Felkai points out. “Some stubborn doctors and professionals fight against this ‘legal racism’, but scientific arguments seem to be useless against bureaucracy.” In some cases, medical escort teams have been forced to ‘smuggle’ patients past security ‘with the help of able-bodied people at the airport’, he claims.
Transport and accommodation providers have also been slow to recognise that they need to cater to the needs of people with disabilities. In general, they have done so only when pushed into it by legislation, which in turn has generally only been introduced by governments after years of intense lobbying by groups representing people with disabilities.
As a result of rules introduced by the European Commission and national governments in Europe and beyond, hotels as well as airlines and other transport operators in most EU countries, North America and the rest of the ‘developed’ world now provide at least a minimum of access for travellers with disabilities. Elsewhere, accommodation providers in destinations that do big business with EU package tour operators have also been pressured by holiday companies to comply with EU standards of access provision.
Wheelchair users have been the biggest beneficiaries of such action, perhaps because they are the most high-profile group of ‘disabled’ people and perhaps because it is easier for non-disabled people to empathise with them – a small but significant number of ‘fit’ people may be long-term wheelchair users in later life, or become temporary or life-long wheelchair users as a result of illness or accident. But there have been a string of well-publicised incidents in which wheelchair-using travellers have been shabbily treated. Last year, Swiss International Airlines refused boarding to Shuaib Chalklen, rapporteur on disability at the United Nations, who is a wheelchair user. In May this year, BBC journalist Frank Gardner, partially paralysed after being shot by terrorists in 2004, was denied boarding by Kenya Airways on his way from London Heathrow to Nairobi. These high-profile cases are just the tip of the iceberg, according to the European Disability Forum (EDF), with complaints against airlines being received almost daily. The EDF has campaigned for tougher enforcement of passenger rights by governments and at an EU level, and European transport commissioner Siim Kallas says the European Commission will bring in new guidelines on the issue by the end of 2012. “It is not enough for people to have rights on paper if they don’t work on the ground,” Kallas said.
Stig Langvad, chairman of the Danish Council of Organisations of Disabled People and a member of the European Disability Forum, has been wheelchair-enabled since 1973 as the result of a vehicle accident. He is a frequent traveller and says the biggest problem encountered by travellers with disabilities is lack of training and insensitive treatment. He also points out that insuring his wheelchair is itself an issue. With a replacement cost of €30,000, it is insured as luggage, and is covered for loss or damage only up to €1,000. Langvad’s wheelchair has previously been damaged in transit, with a repair cost of €5,000. As a Danish citizen, he is protected by state disability cover. Others are less fortunate. Typically, even insurers offering specialist policies for people with disabilities offer mobility equipment cover of only between £4,000 and £5,000. The Ossur Flex-Foot Cheetah blades used by most Paralympic runners cost around US$22,500. The iWalk Powerfoot BiOM costs more than $50,000, and the Ekso carries a $150,000 price tag. Finding a travel insurer that will cover such expensive items against loss, theft or damage can be a challenge and as most such devices are made to measure, replacing them in an emergency is often impractical. With their complex electronics, these new prosthetics may be vulnerable to damage, for example by water or by abrasive dust or sand, a factor that insurers bear in mind when calculating premiums.
“We can and do cover a wide range of mobility aids, some highly sophisticated and expensive,” says Warren Dickson, managing director of Fish Insurance, a British company that specialises in providing cover for people with disabilities, with more than 70,000 clients. “However, we advise that if someone is spending so much on a device upon which they are so dependent, that they insure it in its own right and take travel cover to protect against other risks.”
Travel insurers are already quite sophisticated in how they define disability. For example, an older client who has lost both legs as a result of diabetes will probably also suffer from an array of other related medical conditions. A younger person whose amputation was caused by a vehicle crash, an industrial accident or military action may well be otherwise quite fit.
“There is a clear difference between someone with a disability such as an amputation caused by an individual trauma and someone with an going medical condition and insurers do treat those [groups] differently,” says Graeme Trudgill, head of corporate affairs at the British Insurance Brokers’ Association. Trudgill says insurers are prevented from discriminating against disabled people by law and that it is unlikely that a disabled person would have problems obtaining insurance protection.
However, insurance premiums for travellers with disabilities are typically much higher than the cost of a standard policy. “Premiums are, as ever, proportionate to risk and the range of disabilities, and the risk they represent, varies immensely,” says Warren Dickson. “But clearly premiums for people in disabilities tend to be bigger, in factors of multiples, than a standard, commoditised policy that costs a few pounds or so. It’s complex because there are such a wide range of disabilities to be considered.” Some disabilities, he points out, such as paraplegia, can be associated with secondary conditions that raise risk.
“One issue that creates indiscriminate discrimination against disabled people, and acts as a market disincentive, is that they get hit much harder by insurance premium tax simply because their premiums tend to be significantly higher. There are a lot of people who claim to serve the market, but genuine specialists are few and far between. This is a specialist market requiring both specialist cover and service. We’ve invested in systems and training to ensure we can deliver what we say we will for disabled people because they’re not just core to the business, they are the business.”
Fish’s assistance provider, Healix, is ‘particularly well equipped’ to handle all manner of medical emergencies, with clinical and support staff experienced in caring for people with a range of disabilities, Dickson says.
Finding a travel insurer that will cover such expensive items against loss, theft or damage can be a challenge, and ... replacing them in an emergency is often impractical
In conclusion, with relatively few true specialists in this growing sector, there does seem to be room in the market for a greater range of specialist or tailor-made policies to provide for the needs of travellers with a wide range of disabilities. As Warren Dickson points out: “It’s not just about the cover, but the entire process, from product development through quoting, customer service and claims. If you do not understand the market, cannot empathise with the customer, then your proposition will fail. We know disabled travellers have gone without cover rather than put up with the mainstream insurers’ insensitivity and high premiums. Specific benefits that we offer include cover for the emergency replacement of a carer, wheelchairs, mobility aids and prescription medicines.” Dickson remains unconvinced that mainstream providers are interested in what remains an expert niche, or are equipped to serve it.
“It’s not just a matter of bolting on to existing standard policies. That doesn’t mean an offering is suddenly fit for purpose. Advisors need to be well trained in the issues, not just the product. Disabled people want to be treated equally, which means they want good, appropriate service which is understanding and sensitive, but not patronising.”
Insurance and assistance providers that embrace the realities of a challenging but potentially rewarding and growing market sector, and that adapt their policies and services to meet the widely varying needs of travellers with disabilities, will be well positioned to reap the benefits in terms of new business. Those which fail to do so will miss out, and may even lose the loyalty of existing clients.