Here at TuGo, our goal is to ensure all our customers know what they’re buying, and how to use it, especially if they have a travel insurance claim. Heck, it’s the reason we write this blog! We hope that travellers never have to ask ‘Why was my travel insurance claim denied?’, so here’s some helpful information about the most common reasons for denied travel insurance claims.
There are indeed situations where we must deny claims. Our goal is to inform travellers so you know exactly how travel insurance works, avoiding any surprises! Some good news that many travellers don’t know about is that a claim can be partially approved, or partially refunded. Sometimes an insurer will pay part of a travel insurance claim, but will have to deny some of the expenses.
What’s the difference?
- A partially approved claim, or partial denial, is when the cause of the claim is covered, but the policy doesn’t cover all the expenses (i.e., it’s not in your policy ‘benefits’).
- A fully denied claim is when the policy doesn’t cover the cause of the claim at all. If the cause of the claim isn’t covered, or falls under one of the policy exclusions, your claim won’t be paid.
3 Common examples of partially denied claims
Missing original, itemized receipts
For any claim with prescription drug expenses, you’ll have to submit original pharmacy receipts. A credit card statement or till receipts won’t work. This might be the reason a claim isn’t reimbursed in full, but an easy one to fix!
Tip: Keep ALL receipts and use a camera scanning app to save a copy on your phone for your reference.
Mistake on the Medical Health Questionnaire
Senior travellers will fill out a Medical Health Questionnaire (MHQ) to determine your rate and policy eligibility. If any information is incorrect or missing from the MHQ, an insurer can fully deny your claim, but here at Claims at TuGo, we do things a little differently!
We understand that we’re all human, and sometimes mistakes happen. Depending on the policy you purchased, if you made an honest mistake or omission on your MHQ, TuGo will apply a $15,000 USD deductible instead of denying the full claim. That could save you quite a bit of money, especially if you’re seeking emergency treatment in the US!
Tip: Ask your doctor for help if you’re unsure how to fill out the MHQ.
When it’s no longer an emergency
One of the top reasons claims are partially denied centres around knowing when the emergency phase is over, under the policy terms. Read your policy for the exact definition of a medical emergency, and when it ends.
If you’ve had an accident or illness on your trip and it’s covered by your travel insurance, remember that you’re covered for acute medical care only, and limited follow-up. Tests have to be done at the initial emergency stage. Sometimes it’s best to go home for more tests (if more tests are needed). Knowing what constitutes as a travel medical emergency is helpful.
Remember, travel insurance is not a health plan, it’s an emergency policy. Avoid asking why was my travel insurance claim denied and call your insurer before proceeding with any more tests, procedures or continuing treatment. If you can travel home or wait to have the tests done, and you don’t need additional acute medical attention, you won’t be covered.
Tip: As soon as you’re medically fit to travel, come home if you need more treatment, or call your insurer to consult with them to know if the expenses will be covered or not (and you have to pay the bills yourself).
4 Common examples of fully denied claims
If you’ve submitted a claim due to intoxication or alcohol abuse (for example if records show you had alcohol on your breath), your travel insurance claim will be denied in full. Claims won’t be covered if they result from a history of alcoholism or withdrawal, or even a past alcohol-related illness before your trip (like cirrhosis).
Tip: Imbibe in moderation on your travels, and enjoy responsibly!
Not understanding the travel insurance you bought
It might be the case that travellers assume they bought an array of travel insurance products, when they only purchased one. There are different types of travel insurance plans and policies, and not all are alike.
If you bought travel medical insurance for example, it doesn’t cover trip cancellation or trip interruption. If you bought a baggage insurance plan, that won’t cover Accidental Death and Dismemberment and your travel insurance claim will be denied without the right policy.
Tip: Read your policy, know what you’re getting, ask questions, and if you want full coverage, ask for a package.
You have a pre-existing condition but didn’t get pre-ex coverage
If you have a pre-existing condition, you can get Pre-Existing Condition Coverage. When buying Pre-existing Condition Coverage, you don’t need to identify your condition (no need to disclose that personal info!)
Tip: Ask your broker about pre-existing condition coverage, and get the right coverage for your needs.
Not consulting a doctor when claiming for trip cancellation insurance
Say you need to cancel a trip due to a medical reason before you leave, or interrupt your trip while you’re away. And let’s say you have Trip Cancellation/Trip Interruption or Trip Interruption only insurance. To make a travel insurance claim on a trip cancellation/interruption policy, you must have seen a doctor before you cancel/interrupt your trip, and the doctor has to have advised you to cancel/interrupt the trip, before you do so.
Travellers might often have valid reasons to cancel or interrupt a trip, but you’ll need proof in writing from your doctor, that it was medically necessary.
Tip: Don’t cancel or disrupt your trip on your own. Make sure the trip cancellation or interruption is advised by a doctor! If you’re out of the country, ask for this in writing. It will speed up your claim.
In summary, if you have questions about any travel insurance policy, ask your broker. Your policy is key: read it and ask questions if you don’t understand. Know what you’re buying, what you’re covered for, or not, and know what you can hold your travel insurance company accountable for. At TuGo, we take that very seriously!
Tips if you do have a travel insurance claim:
Let your insurer know right away (don’t wait until you come home!) Claims at TuGo can help guide you through the process so you don’t expose yourself to costs that aren’t covered. Rely on our expertise! You can even start a claim online with a myTuGo account.
Have any other travel insurance claim questions? Leave a comment below!
Happy informed travels,