YOU ASK:

What can I do when the travel insurance company denies a claim?

WE ANSWER:

Insurance companies have valid reasons as to why they denied a claim:

  • It may be that the claim is related to something that is not covered by the policy.
  • Also, if you get sick because of a pre-existing medical condition, you might have failed to tell the insurance company. In this case, the insurance company reserves the right to deny your claim.
  • It may also be that you as the claimant have not provided sufficient information to warrant the claim as being payable.
  • and many other possible reasons.

Now, if your travel insurance company denies your claim, the first thing you should do is to calm down.

Of course, the natural tendency when you receive the notice that your claim has been rejected is to go ballistic and threaten to sue the insurance company. However, nothing can be gained when you do this. Not only will this cost you (probably more than what you're claiming for), insurance companies are also armed with lawyers that are used to defending the company against such lawsuits. The best thing to do is to aim for a win-win situation.

What you should do is request for full disclosure as to the reasons why the claim is denied.

When the reasons are given and you still feel that your claim is valid, you can file an appeal on the denied claim. When you do, provide all the documents (such as doctor's notes) needed to prove that a valid reason existed for the claim and that the insurance company should pay the claim. When you make the appeal, include the copy that explains the benefits that should be provided by the policy. Remember that there is usually a time-limit or time-frame as to when you can make your appeal.

Every time you make contact with the insurance company, take down notes. Record the time and date of your call, the company representative who talked to you and what was the gist of your conversation. If your claim is still rejected, you should try to reach the next higher level of authority in the company and make your appeal there.

You can also look into arbitration. You can approach the State Insurance Commission for your complaint. Your last resort will be to sue, but this should only be after you have exhausted all means to convince the insurance company to pay the claim.

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