March 3, 2023

J. Scott Stanley

March Break is on the horizon. If you are thinking about travelling abroad, it may be helpful to consider what insurance you need. When you purchase travel insurance, you expect to be covered. Unfortunately, when it comes to travel insurance, disputes, errors, and misunderstandings over what is and is not covered occur on a regular basis. Furthermore, denials can happen even when the “right” coverage is purchased. Our earlier blog post covers such a case. The situation involved an Ontario man whose insurance claim was denied after he tested positive for COVID-19 while vacationing, even though he specifically purchased COVID-19 medical coverage. 

In this post, you’ll learn some common reasons why insurance companies deny claims and what you can do if your claim is rejected or you don’t get the compensation you anticipated. 

4 Common Reasons Travel Insurance Claims are Denied — and how to avoid them

Reason 1 – Not understanding your coverage: Reading and understanding your travel insurance policy is your responsibility. However, many travellers do not fully understand the coverage they have purchased. With so many different types of plans available and the fact that most insurance contracts are not written in plain language, it can be challenging to understand what is covered and what is not.

Recommendation: To avoid these mistakes, explain what you need to your insurance broker and tell them your expectations regarding what you think will be covered. Don’t be afraid to ask your insurance broker questions. There may be situations where you can’t get the coverage you want. It’s better to know that BEFORE you go so that you can decide whether the risk is acceptable to you. But don’t stop there. Read the policy carefully to familiarize yourself with the coverage that you have actually purchased. If, after reading the document, you still have questions or there are terms you don’t understand, don’t hesitate to contact your insurance broker for clarification before travelling. It’s their job to help you select the right insurance.

Reason 2 – Mistakes Filling Out Medical Questionnaires: Another common reason for a travel health insurance denial is incorrectly filling out the medical questionnaire. Unfortunately, this is a common error. Insurance contracts require accurate disclosure of past medical conditions and the current state of your health. Withholding or failing to disclose medical information, even if you think it isn’t relevant,  sets you up for a claim denial.

Recommendation: When filling out forms, we advise you to talk to your broker to make sure you disclose any pre-existing conditions and relevant information regarding your health. This also applies if you made any adjustments before travelling. For example, if you started a new treatment before leaving or if your medications were adjusted, review your coverage one more time. Talk to your doctor and contact your insurance broker to confirm any changes do not impact your insurance coverage. 

Note: Recent coverage of a Saskatchewan man’s insurance claim denial underscores the significance of even a minor change in medication. In this case, Mr. Lamothe was vacationing in Arizona when he had a stroke and ended up having to spend 16 days in a US hospital. His insurer denied his claim for medical fees and his travel costs to fly home. Read the full story: This Sask. man had a stroke in Arizona. His family awaits massive bill after insurance claim denied

Related information you may want to review:

Reason 3 – Underestimating the Limits and Exclusions in the Policy: Assuming that your travel insurance will cover everything is a mistake. As with any type of insurance coverage, every plan includes a specific list of events, limitations, and exclusions. Usually, there are limitations on reimbursements for treatment costs and limitations on coverage for injuries resulting from certain activities – or even exclusion for some high-risk activities (i.e., extreme sports). The policy may also contain specific limits on how much your policy will cover for certain types of treatment or events, some of which might not be obvious. There are often disputes over things like reimbursement for transportation back to Canada after an injury, for example.

Recommendation: As explained above, one of the most important things is to carefully read the policy and understand its limits and exclusions. This should be done beforehand and not when filing a claim. A licensed insurance broker or an insurance lawyer can help with this.

Reason 4 – Late or improper claim filing: Another common reason for a rejection is the late reporting of claims. Travel insurance policies have time limits on filing claims that must be met. If you miss the filing deadline, you will most likely be unable to pursue your travel insurance claim. If you think you might have missed a filing deadline, but aren’t sure, ask an insurance lawyer. In some cases, it may be possible to extend the deadline.

Recommendation: If you plan to make a travel claim, do not delay taking action or getting advice. Start the process as soon as possible. Take the time to get familiar with the deadlines and submit all required supporting documents on time to avoid a claim rejection.

Steps to take if your travel insurance claim gets denied 

Step 1: Understand why the claim was denied. As obvious as it may seem, it is critical to review the terms of your travel insurance policy to understand why the insurance company has denied your claim. Many denials occur because people do not understand their coverage and the limitations that apply. 

If something is unclear, ask the insurer for a letter of explanation. This document should explain in detail why your coverage was denied. For example, if your insurance company refuses to cover you because of a “pre-existing condition,” you will want to confirm exactly what they mean. If you plan to challenge a denial (and remember there are time limits to launch a challenge) you will want as much information as possible on why your claim was denied. If you decide to hire an insurance lawyer to help you, they will also need this information to assess your case.

Step 2: Ask for an appeal. Coverage can be denied for a variety of reasons. If you believe the evidence used by the insurance company to make a decision was incorrect, you may file an appeal. It is critical to obtain the necessary documentation to back up your claim. Usually, you can re-submit your claim explaining why you refute the decision within a certain period of time. Again, read your policy carefully to ensure you don’t miss the filing deadline.

Step 3: Talk to a lawyer. Some travel insurance claims can be challenging to process. If you have a denied claim and believe you should be compensated, speak with an experienced insurance lawyer to discuss effective ways to maximize your chances of receiving full coverage. 

Bottom line – Denied Claims Lawyers 

Travel insurance claims are usually rejected for a few specific reasons. Understanding why claims are denied and taking preventative measures can help travellers reduce their risk of having a claim rejected.  

At Murphy Battista LLP, we have over 40 years of experience dealing with BC insurance law and a reputation for effectively investigating and presenting the facts on behalf of our clients. If you are having problems with your insurance company on a claim covered under a travel insurance policy, contact us for a free consultation

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