Travel insurance claim denials are rare: but if the claim is yours, that’s no consolation. What should you do in case of a denial? Your first reaction may be to call in your lawyer. But don’t rush: there’s plenty of time for that. No need to spend that money just yet.
First, demand a letter from your insurer clearly describing the reasons for the denial, referencing the clauses in the policy that you allegedly contravened. For example, if they are denying you for an unstable pre-existing condition, ask them to point out that part of your medical record that substantiates the condition was actually pre-existing, and make sure you also read how the insurer describes the term “pre-existing.” Demand the same evidence of non-disclosure, or any other reason for the denial.
Then sit down and carefully draw up a letter appealing the denial by refuting the evidence, if it is refutable. Do this in writing. Don’t rely on telephone calls. But base your appeal on facts. Use simple. straightforward language. Don’t try to play lawyer, just be clear and honest. Don’t get emotional. Don’t resort to anger or threats. If necessary, get a copy of the your medical record and ask your doctor’s opinion about the denial. If warranted, ask your doctor to write a letter clarifying the record and interceding on your behalf.
If your appeal is denied, ask to take your case to the company ombudsman. This is someone designated by the insurer to objectively review the denial. State your case clearly to the ombudsman—again dealing only with facts—not emotions or appeals for compassion. This is a free service so take advantage of it.
If the company appointed ombudsman upholds the denial and you are still convinced you have not been fairly dealt with, take your case to the Ombudsman for Life and Health Insurance (www.OLHI.CA). This is a national service, set up by the financial services industry to deal with individual grievances just like yours. This too is free, so take advantage of it.
If you have taken all these steps you should have a much clearer picture of the validity of your claim and you can make a better judgement about whether you want to hire a lawyer. None of the above steps will preclude your right to hire a lawyer, and up to this point, you will not have spent any money in advancing your case.
Remember that facts and policy wording determine whether a denial is justified. Travel insurance has limitations and exclusions. It is not a substitute for your provincial health insurance. You need to know your own responsibilities when applying for coverage and the best way to avoid having a claim denied is to have an experienced travel insurance advisor help you with your purchase and answer any questions you may have.