Common factors for rejection of travel insurance claims

Intoxicated during accident

The top reason for an insurance claim to be rejected by a travel insurer is that the policyholder was intoxicated at the time of the accident or injury occurred. This is why it is very important to fully understand the limitations of a policy before purchase to understand your risk and not get surprised by a rejection.

Participation in adventure sports

The second most common cause for rejection is because the accident occurred while participating in an extreme sport. Some policies do have coverage for some of these activities. It is important to note that some activities, such as motorcycle riding, while may not be considered extreme to most are NOT covered by some policies without some sort of adventure sports rider.

If you are anticipating doing some exciting activity while you travel, be sure to look for a sports rider and furthermore, that the activity you want to do is SPECIFICALLY LISTED on the rider. Some extreme sports, like motocross, are rarely covered, but check out the Diplomat America plan. Other activities, such as bungee jumping or white water rafting can be covered by several plans (Patriot America with rider, Travel Medical Basic with rider, Atlas America no rider needed).

Applicant's pre-existing conditions

The third cause for rejection is because the sickness was due to a pre-existing condition. It is important to note that some policies DO have limited coverage for pre-existing conditions for those policies), but these will have limitations. For example, a person must be stable before a condition could be covered.

if you are still recovering from illness or surgery, this will NOT be covered. Also, some specific pre-existing conditions are NOT covered generally under any circumstances. The most common pre-existing conditions that are excluded are pregnancy, cancer, HIV infection, and chronic illnesses.

Coverage for pregnancy

That leads to the fourth most common cause for rejection by travel insurers: complications of pregnancy. Atlas America (for travel to the USA) or Atlas International (travel anywhere else) covers complications of pregnancy in the first 26 weeks of gestation. NO OTHER policy will cover such complications due to pregnancy, so if this is of special concern, be sure you get the right policy!

In sufficient proof

One of the reason why insurance claims gets rejected could be because the insured /claimant has not provided considerable proof and within the given time frame.

Coverage in restricted areas

The final reason for rejection is because traveler is in a region where they have specifically been advised not to travel. Coverage is not provided in war zones and other places that the US State Department does not recommend travel. If you find yourself in a region where the US State Department advises travelers to vacate, some policies cover and even help coordinate your evacuation from that area.

Some policies cover injuries and losses due to terrorism. If any of these are a possible concern in your voyage, you can consider the Travel Medical Basic policy with specific coverage for terrorist attack.

The only information I would add to a potential client is that it is important, of course, to provide complete and accurate information on your application since this can also be a cause for a rejection later on. Furthermore, you should be aware of the procedure for using your insurance and filing a claim (if necessary). In my experience, insurance companies are more than willing to deal directly with a medical provider to arrange payment (the reverse may not be true).

You and/or the medical provider can give them a call and they should answer 24/7 for any medical emergency situation. It may be necessary to pre-certify medical costs with the company BEFORE they are incurred. These are generally high-cost expenses. For example, you must inform the insurance company within 24 to 48 hours of being in a hospital (if possible).

In this case, I would not rely on the provider to call, but I would advise you to call yourself, if you are able, to let them know what is going on. They will also be able to help you understand the claims process. When in doubt, I would make the easy, toll-free call and keep your mind at ease.

If an event happens before your travel insurance policy officially starts-even by a short period-your claim will not be accepted. It is important to review the exact start date and time of your coverage.

Many claims are denied simply because travelers waited too long to inform their insurance provider of an incident. Promptly reporting any loss, accident, or illness is essential to keep your claim valid.

Insurance companies require clear and complete documentation to process claims. Submitting unclear receipts, incomplete medical records, or missing official reports (such as a police report for theft) can result in your claim being declined.

Every policy has specific limits for various types of coverage. If your expenses go beyond these limits, or if you claim more than the allowed amount for certain items (like electronics), you will not be reimbursed for the excess.

Travel insurance only covers situations specifically listed in your policy. Claims for reasons such as an pre-existing medical ailment, personal change of plans, missed connections not covered by the policy, or incidents involving illegal activity will not be approved.

Travel insurance is there to protect you when things goes wrong but sometimes claim get rejected and this can be frustrating. The good news is by taking a little care you can avoid most common pitfalls. First always make sure your insurance covers your entire trip and that coverage starts before your trip and lasts until you are safely home. If an incident happens outside these dates your claim won’t be accepted. Being honest is important whether it is about your health, your travel plans and what happened during your trip. Leaving out details or exaggerating facts can cause your claim to be denied. If something does go wrong don’t wait to tell your insurance company. The sooner you report the issue the better your chances of a smooth claim process. Along the way, keep all your paperwork for medical bills, receipts, police reports and any other proof organized and keep it ready to submit. Without a clear evidence insurers may have no choice but to reject your claim.

It is also of paramount importance to understand what your policy does not cover. Every plan has its limits and exclusions so knowing these ahead of time helps you avoid surprises. For example, if you plan to try adventure sports or travel to certain destinations double check that your policy includes those activities and locations.

Finally, be truthful and realistic when claiming expenses. Only ask for what you actually spent or lost. Overstating costs can lead to your entire claim being rejected. And don’t forget to file your claim promptly most insurers require claims to be submitted within a certain time frame.

A simple way to stay prepared is to keep a folder whether digital or physical with all your travel documents, receipts and insurance information. Having everything in one place makes filing a claim much easier and faster.

By following these straightforward steps, you’ll give yourself the best chance of having your travel insurance claim approved without any unnecessary headaches.

If your travel insurance claim is denied then start the process by carefully reading the denial letter to understand why. Review your policy to see if the reason matches the coverage terms and gather all related documents like receipts and reports to support your case.

Contact your insurer to ask for clarification and find out if providing more information can help. If you believe the denial was wrong then file a formal appeal with all necessary documents before the deadline.

If needed seek help from an insurance expert or regulator. As a last step, consider mediation or legal action. Keep all communications and paperwork organized throughout the process.

Remember, a denial isn’t always final taking these steps can improve your chances of success.

Create a step-by-step visual guide or timeline. For example:

• List your destinations
• Confirm your travel dates
• Add up your trip costs
• Gather traveler info
• Disclose health conditions
• Read the fine print
• Check claims process
• Buy early for best coverage

Emma was flying to a family reunion when her flight got delayed for hours. She almost missed her connecting flight and had to stay overnight in a hotel. Thankfully, her travel insurance covered the unexpected hotel and meal costs, turning a stressful delay into a minor hiccup.

While exploring Thailand, John suddenly fell ill and had to visit a local hospital. This insurance not only paid for the medical bills but also arranged a later flight home once he was well enough to travel. Without travel insurance, this could have been a huge expense.

Sophia’s expensive camera was stolen during a city tour in Paris. She was upset but relieved that her travel insurance reimbursed her for the loss, allowing her to replace the camera and continue capturing memories.

John was excited for his vacation but had to cancel last minute due to a serious illness. Because he had disclosed his health conditions upfront and bought insurance early, he was able to recover most of his prepaid trip costs.

After landing in New York, Mia found her luggage didn’t arrive with her. She bought clothes and toiletries to get by, and this insurance reimbursed her for these necessary expenses until her bags were returned.