My claim has been denied; can I fight it?
Vacations are supposed to be exciting and enjoyable, but what do you do when the unexpected happens? Whether it’s lost baggage or an accident that lands you in a foreign hospital, you may end up out of pocket. Luckily, if you have taken out a decent travel insurance policy, then you should be covered if you file a claim. So you can imagine it’s a headache when you receive word from your insurer to say that your travel insurance claim has been denied-what next?
Contact your insurer straight away
The first and foremost thing you must do is contact your insurer to garner more information on why they have said no. It could be as simple as a piece of missing paperwork or that they need more evidence, or it could be that you misread the terms and conditions of your policy. Ask for a detailed, written report that you can look over. It’s also a good idea to acquire exact definitions of the terms they use-things such as “eligibility”, “pre-existing condition” and “stable” are some of the most common. While you may think you know what these words mean, in legal terms they could take on a whole new meaning.
Keep copies of evidence and resubmit
Although your insurer might have denied your claim initially, it could simply be because some evidence or documentation was missing. Make sure that you keep copies of everything to do with your claim-from receipts to paperwork documenting your hospital stay. It is useful to make an itinerary of all the possessions you take with you, especially any expensive jewellery or electronics, incase they are lost or stolen. Often an insurer might ask for photographic evidence, especially when it comes to injuries. Do what you can to provide them with enough information to fully understand your claim.
You are more than entitled to re-submit your claim for a second assessment, you never know, you may strike lucky.
Make sure you understand the details of your policy
One very common mistake people make when taking out a policy is that they don’t understand the terms and conditions of their policy, and they don’t realise this until it is too late. It is important that you have adequate coverage, especially if you have special circumstances such as a pre-existing medical condition. Instead of trying to go for the quick, cheap option up front, consider opting for more throughout, specialist coverage if special circumstances apply to you. If you are caught short further down the line without proper coverage, it could cost you far more than your vacation was worth.
Dispute your denied claim
If speaking to your insurer hasn’t cleared things up for you, or you still feel you didn’t get a fair outcome, then ask for a review by the insurer's designated ombudsman. All insurance companies in Canada should have a resource, so go there first. If you still feel you were treated unfairly according to the terms of your policy, you can take your case to the OmbudService for Life and Health Insurance or the Canadian Life and Health Insurance Association.
Some provinces have their own specific dispute resolution services. In Ontario this is the Financial Services Commission of Ontario (FSCO).