YOUR TRAVEL INSURANCE > FAQS > DENIED CLAIMS

How to avoid Denied Claims

Insurance companies include clauses in their policies to limit their risk of claims. As a traveller, it is important to be familiar with the most commonly used reasons for the denial of a claim.

Incorrect Medical Questionnaire - The answers on this form determine your rate category and assign a pre-existing condition clause (explained below) to your policy.

Approximately 85% of snowbirds over 55 must complete this form in order to purchase travel insurance.

The answers in your medical questionnaire must match information in the medical file kept by your physician. If they do not, the insurance company will consider your entire policy null and void. This will leave you without coverage for ANYTHING—even if your health issue is unrelated to the question answered incorrectly.

Pre-existing medical condition exclusion - This exclusion demands that any current medical condition that requires medication must meet certain criteria before the insurance company will agree to cover it.

If the definition uses the term “treated”, any current medical condition that required treatment (in any way, including but not limited to medication or surgery) in the time period specified in the policy, will NOT be eligible for coverage.

If the definition uses the term “stable”, any current medical condition that required treatment (with either medication or surgery) in the time period specified in the policy, will be covered provided that condition meets the criteria set out in the policy's definition of “stable”.

Most “stable” definitions require that there be no new symptoms or the development of more severe symptoms, or that there are no medication changes during the time period specified. Even decreases in medication are not allowed in most policies. Some even specify that you cannot be referred to a specialist during the stability period.

If you do not meet the pre-existing medical condition exclusion, the insurance company will disallow any claim that is made relating to that particular medical condition only.

Eligibility Criteria - These criteria are either found in the medical questionnaire or hidden deep in the policy wording. If the applicant does not meet the eligibility criteria, the insurance company will not cover any claim for ANY medical emergency for that applicant.

Some insurance companies will not provide coverage for applicants who have had heart surgery a certain number of years ago, have taken certain medications in the recent past, have recently used home oxygen or have had a change to their heart medication in the last 6 months to 1 year. These are only examples of what can be found in policies. You must read your insurance policy to understand exactly what applies in any policy you consider purchasing.

To avoid hassles and to protect yourself against denial of your travel insurance claim, we suggest the following:

• Know your medical conditions, medical background and understand your medications, why you take them and when the dosage was last modified.
  
• Use a qualified travel insurance specialist, like Snowbird Medi-Quote, who understands the details of these policies. This will save you time and money and give you peace of mind knowing that you have purchased the right medical insurance.