How to file a travel insurance claim and what to do if you’re turned down

Editor’s note: This the last in a series of posts about travel insurance sponsored by Access America. Here’s part one, part two, part three and part four.

Elliott Advocacy is underwritten by Generali Global Assistance. Generali Global Assistance has been a leading provider of travel insurance and other assistance services for more than 25 years. We offer a full suite of innovative, vertically integrated travel insurance and emergency services. Generali Global Assistance is part of The Europ Assistance (EA) Group, who pioneered the travel assistance industry in 1963 and continues to be the leader in providing real-time assistance anywhere in the world, delivering on our motto – You Live, We Care.

First, the good news: Nine out of ten travel insurance claims are honored according to the US Travel Insurance Association. So if you’re thinking of filing a claim on your policy, it will probably be honored.

Now the bad news: If you’re among the 10 percent who have been rejected, you could face a long and ultimately unsuccessful struggle to have your claim paid.

You don’t want to end up there.

How to avoid it? Make sure your initial claim does everything it should.

Call your insurance company before you file a claim. Ask what it needs from you, and if there are any restrictions in your policy that might make a claim unsuccessful (for example, some policies that cover medical problems require that you seek treatment within 24 hours of an incident).

Read your policy. You should have done this before buying the insurance. Now you have to read the fine print with an eye toward answering this question: Will my claim be honored?

Keep all receipts. In fact, you’ll want to retain every scrap of paperwork that could even remotely relate to a claim. Don’t throw anything away. Ask for everything in writing – bills, invoices, receipts, hotel folios. You can never have enough documentation.

Get the cause of delay in writing, if possible. A lot of claims are rejected because travelers can’t prove a cause of delay. So if you’re held up, be certain to document the cause, preferably in writing. Finding out the reason long after your trip can be difficult – if not impossible.

Filing and waiting

Your travel insurance company will tell you how to file a claim. Claims typically take between two and four weeks to process, but some complicated claims that require more extensive research by an adjuster can take longer. Expect to receive a form acknowledgment of your claim, with a final decision within roughly a month, but no more than two months.

If you’ve waited longer than six weeks, contact your travel insurance company to find out about the status of your claim. You may need to refile. (It’s rare for paperwork to get lost, but it can happen.)

A good portion of the inquiries about travel insurance that I get involve the sometimes lengthy wait for a claim to be processed. There are two main reasons for a delay: First, a large natural disaster that triggers thousands of claims. And second, a special circumstance that requires additional research on the part of the adjuster, or requires you to send additional information.

Most claims are denied because of a pre-existing medical condition. As I mentioned in an earlier section, you should try to find a policy that covers pre-existing conditions. Also, make sure the policy covers your traveling companion and be sure your companion’s family members are included in the definition of “family.” Some policies don’t.

A rejection isn’t the insurance company’s final word. It only means that based on the information it has in your claim, it isn’t going to honor it. A brief, polite, written appeal with any new information that you believe is relevant to your case is the first step in getting the company to reverse its decision.

Appeals are taken seriously by most insurance companies, and are typically reviewed by several adjusters at a more senior level. Their goal is to make sure nothing was overlooked by the first adjuster. This process can take as long as the initial claim, so stay patient. In my experience, however, appeals are answered faster than the first claim.

More than half of appeals are successful. But roughly 4 in 10 are not – the “no” is a final answer – and you’re left with another decision: Do you accept their decision or take your appeal to the next level?

Often, a hard look at your claim by an independent third party will reveal that you don’t have a case. (I’m sometimes that person.) Maybe the event you’re making a claim for isn’t a covered reason, or maybe you don’t have the receipt to back your claim. But now is a good time to take another look at your claim and appeal and to decide whether it’s worth going on.

A small percentage of those cases should be appealed, and here’s how:

Send a brief, polite email to your insurance agent or travel agent, notifying one of them of your rejection. Agents often can and do act as intermediaries when something goes wrong with a policy. Remember, they took a commission on your policy, and they have to be licensed to sell the policy, so they have some skin in the game.

Contact your state insurance commissioner. Your insurance commissioner may be able to help if your claim was rejected without cause. Here’s how to find your insurance commissioner. Many travelers have reported that their claims were honored simply by copying the state insurance commissioner on their appeal.

Contact your Better Business Bureau. You’ll want to include your agent and insurance company in your report. The BBB is known to investigate claims of this nature, but it has little sway over the final outcome of your appeal.

Take the agent or your insurance company to small claims court. You don’t need an attorney to go to small claims court, but there’s a limit on the claim amount. So be sure to do some homework before filing a complaint. Typically, this is your last resort. If your agent or insurance company prevails in small claims court, you are normally out of options.

I’d like to thank Access America for sponsoring this independently written and researched project and to the sponsors of this site — particularly those in the travel insurance industry — for their support.

(Photo: Image Editor/Flickr Creative Commons)