What to Do if Your Travel Insurance Claim is Denied

You buy travel insurance to protect yourself financially in case of an incident during your trip. Travel insurance helps cover medical emergencies, trip cancellations, and lost baggage. But when you file a claim with your insurer, it gets denied. This is a frustrating scenario to deal with, but don’t worry – there are steps you can take to appeal your claim.

Let’s go over understanding why your travel insurance claim got denied, what to do next, and ways to get your claim approved.

Understanding Why Claims Get Denied

Travel insurance coverage comes in various types, such as comprehensive, trip cancellation, baggage loss, travel medical, and accidental death and dismemberment (AD&D). Depending on your policy and travel insurance provider, expenses eligible for reimbursements will vary.

Here are some of the common reasons for claim denial for travel insurance.

Pre-existing conditions not disclosed

Travel medical insurance may or may not cover pre-existing conditions depending on what policy you choose. You will be asked to disclose pre-existing health conditions prior to purchasing the policy. Some conditions are specifically excluded from travel insurance policies, which can result in your medical expenses during the trip not being covered.

If you believe that you did disclose pre-existing conditions and your emergency medical expenses while traveling should have been covered, a possible issue may be that what travel insurance companies consider to be a pre-existing condition is not intuitive to the average traveler. Travel insurance companies usually consider you to have a pre-existing medical condition if:

• Your condition is new or recently worsened
• You have had recent medical procedures done
• Your medication changed recently
• A physician recommended additional testing
• Medical changes occured during the Look-Back Period (60, 90, or 180 days) right before you purchase the policy

Filing claims outside the coverage period

After you buy your trip protection or travel medical insurance, coverage does not activate until the designated effective date. If your incident takes place before or after the effective coverage period, travel insurance companies will not grant any payouts, even if the expenses would otherwise be covered under the policy.

Once the timely filing limit has passed, you’ve missed to deadline to file the travel insurance claim. Your claim could be denied regardless of incident type if you miss the deadline.

Insufficient documentation or proof

Documentation is critical when it comes to getting your claims covered by any type of insurance. Keep records of your expenses, communications, and documentation related to any incidents during your trip. Keep your receipts, emails, medical records, and other relevant information so you can submit it with your insurance claim.

Without adequate proof, the travel insurance provider may not believe your claim to be legitimate. They will deny your claim or request additional proof.

Routine or preventive care

In general, travel medical insurance policies are short-term and only cover emergencies. This means sudden injuries and illnesses that occur while you’re traveling. Travel insurance is not meant to cover care that you can receive in your home country, where health insurance is expected to cover medical expenses.

Medical tourism

Medical tourism is a popular phenomenon, referring to when people travel to another country for medical or cosmetic care. Millions of Americans travel internationally to obtain facelifts, tummy tucks, and other surgeries. Travel insurance does not cover medical tourism. Only urgent, necessary medical expenses are covered while traveling.

Policy exclusions and limitations

Read your travel insurance plan before going on your trip to find out what services are not eligible for coverage. Common exclusions include:

• Mental health care
• Medical tourism
• Physical therapy
• Routine dental care
• Routine physical exams
• Preventive care
• Physical therapy
• Losses covered by intentional self-harm (including suicide)
• Losses due to civil disorder (e.g. war)

Unreasonable safety measures

A travel insurance company may deny your initial claim if they believe you have not taken reasonable care to avoid the problem.

Not following the proper claims process

Make sure you’ve followed the proper claims process, going through the designated official channels to file a claim with your travel insurer. If your application or claim has any issues, your travel insurance claim may end up being denied.

Review the Insurance Denial Notice

When your travel insurance claim gets denied, the travel insurance provider will send you a denial letter. This letter should cite specific reasons for the denial, such as missing the timely filing deadline or a pre-existing condition is excluded from coverage.

The denial letter will help you understand why your claim has been denied. From then on, you can determine your next step, such as appealing the claim, appealing the claim again, or finding an attorney or insurance broker for counsel.

Steps to Take If Your Claim is Denied

1. Double-Check Your Policy

Review the terms and conditions of your travel insurance policy to see what is covered and what is excluded. Does your claim fall within the coverage parameters? Is there a clearcut exclusion that explains why your claim was rejected?

2. Gather Documentation

Collect all relevant documents. Common supporting evidence for a travel insurance claim include:

• Receipts
• Medical reports and healthcare costs
• Baggage retrieval or replacement costs
• Evidence for trip cancellations
• Travel itineraries
• Photographs

3. File an Appeal

To fight an insurance claim denial, you will need to write an appeal letter. An appeal letter should ideally have:

• Details of the policyholder who is appealing, including policy number and contact info
• Details about the claim denial, included when you received denial notice
• Reason for appealing the denial
• Context to the attached supporting documentation
• Any other details that could be useful for the appeal

On top of sending in the appeal letter through the insurer’s appeal process, you will need to include all the necessary documentation and a clear explanation of the situation. This gives supporting evidence and context, which can help your case.

Try to avoid flooding the appeal letter with irrelevant information.

4. Seek Assistance

A travel insurance agent or broker can help you better understand your travel insurance policy claim and reasons for denial.

It is also a good idea to consider legal assistance. An attorney with experience in dealing with denied insurance claims can help you file an appeal. In serious cases of denied coverage, an attorney can also help you understand your other options, such as legally disputing the insurance claim when it has been wrongfully denied.

Preventive Measures to Avoid Claim Denials

To avoid future travel insurance claim denials, it’s important to thoroughly review the insurance policy before purchase. Buy travel insurance early rather than later so that you can plan for the coverage to be active throughout your travel destination. Make sure that you opt for a suitable travel insurance coverage type and limit that aligns with your needs.

When filing your initial insurance claim, you should double-check that your details are accurate and complete. Attach receipts, medical records, lost baggage details, and other supporting documentation relevant to your incident.

Understanding Your Policy

Understanding the policy before purchasing

If you’re reading this guide, it may already be too late and you can skip to the next step. However, if this is a part of your research before committing to a travel insurance policy, it’s the best time to pull out your prospective insurance policy. Read the policy’s details and ask an insurance agent for clarification if you are confused by anything.

Knowing the coverage limits, exclusions, and requirements

Insurance can be difficult to understand with so much jargon in the policy details. Here are common travel insurance terms you should understand.

Coverage limit: This is the maximum travel insurance payout for your covered trip. International travelers are generally advised to obtain $50,000 in emergency medical coverage and $100,000 for special trips (e.g. if you’re going to a remote area or on a cruise).

Exclusions: Travel insurance policies usually provide you with a list of exclusions that are not covered. For example, your policy might not cover areas with political unrest, medical tourism, and pre-existing conditions.

Requirements: Your travel insurance policy may come with certain requirements. For example, insurance policies typically require you to start and finish in the same country.

Add-ons: Many travelers find it beneficial to obtain travel insurance add-ons such as the ability to cancel for any reason, pet travel insurance, and adventure sports coverage. If you have any unique needs or goals when traveling, check to see if you can customize your travel insurance coverage.

Policy cost: Travel insurance typically costs between 4% and 10% of the entire nonrefundable, prepaid trip. If your risks are higher or you’ve chosen a more comprehensive plan, the cost of travel insurance can nearly double. Policy cost is also influenced by age and add-ons.

Documenting Everything

Having documentation with clear dates and timelines can help you get a claim approved. Make sure to keep detailed records of all travel-related expenses and incidents, such as physician reports, receipts, and communications with the hospital or travel agency. When filing or appealing a claim, supporting proof for your claim can greatly boost your chances of a successful appeal.

Timely Filing of Claims

After a stressful and dangerous incident occurs, it’s natural to need time to recover. It’s important to remember to file your insurance claims as soon as possible once you get the chance, since there may be a deadline you need to meet.

Most travel insurance policies require you to file claims within 90 days of the incident. This is known as the timely filing limit. If you file a travel insurance claim after the deadline, your claim is likely to be denied.

Disclosing All Relevant Information

When purchasing travel insurance, it’s important to be upfront about pre-existing conditions and other risk factors. If the travel insurance provider discovers that you have an excluded pre-existing condition or that you fail to meet the requirements, coverage may be immediately revoked (along with any payout you already received).

In addition, your information when purchasing the insurance policy needs to be complete and accurate. Discrepancies and errors can not only cause delays in claim approval, but also claim denials.

Case Studies and Real-Life Examples

Faye and other top travel insurance providers strive to help travelers gain the most out of their trip without worrying about coverage gaps. Travelers who have their claim denied will receive clear denial letters that detail why their initial claim was denied.

After a claim has been denied, customers can file an appeal by following the appeal process. Updates will be delivered via mobile app, email, or other manner depending on your insurance provider.

Conclusion

If a travel insurance claim has been denied, here are important steps to take:

Review the claim denial letter Understand what is covered by your policy Gather evidence to support your claim Ask questions to clarify why your claim was denied Seek assistance from insurance agents or legal advisors File an appeal with your travel insurer

By taking time to understand your travel insurance policy and being proactive, you can greatly increase your chances of getting a travel insurance claim accepted, even if it was initially denied. Keep detailed records of incidents that arise during your trip to act as supporting documentation. Act promptly if a claim is denied so you don’t miss any deadlines.

At the very least, filing an appeal could help you gain more insight into what went wrong so that it doesn’t happen again the next time you travel.

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