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How To Appeal A Travel Insurance Claim

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Contact Allianz Global Assistance

How to Appeal a Health Insurance Decision
  • If you believe the evidence on which we have based our decision is incorrect, or if there is other evidence in relation to your claim that is not known to us, you may appeal your claim. If you decide to do so, please submit your appeal in writing. Please clearly outline why you feel the decision is incorrect along with your supporting documentation. Your appeal will then be reviewed and a response will be provided in writing.
  • If you intend to appeal this decision, we ask that you submit your written appeal to Allianz within 180 days of receiving notice that your claim was denied.
  • Fax: 416-849-4555
  • For products underwritten by all other insurers, please refer to your policy document for more details. After the Ombuds Offices review, you will receive a written response, except in the case where a simple concern can be cleared up over the phone. Most investigations are completed within 30 business days of receiving your complaint and all supporting documentation. If this deadline cannot be met, you will be contacted as to why extra time is required and when you can expect a response. The written response from the Ombuds Office is considered the insurance companys final position. Unless you subsequently present any new and relevant information that was not already previously reviewed, your case will not be reopened.

Check Your Policy Documents

Check the details of your policy to see if the facts fit the reason for the rejection.

Its worth challenging it if you believe it was unfairly rejected. This is because these decisions can sometimes be overturned :

  • Check you gave all the correct details in the beginning.
  • Note down or highlight the exact wording in your policy that says youre covered as youll need it later.
  • If the wording is ambiguous or poorly explained, note that down too. Your insurance company is duty-bound to give you clear information and they must give you a reasonable explanation for refusing to pay your claim.
  • New rules state that an insurance company cant reject your claim if you took reasonable care to answer all their questions honestly and to the best of your knowledge. If your insurer didnt ask for information, they now say you should have voluntarily disclosed, note that down too.
  • Did the insurer ask you for the information that it now says you should have voluntarily disclosed? If it didnt, make a note of this.

Then find any other documentation that relates to your policy.

For example, if you sent your insurance company a letter advising them of a change in your circumstances , try to find a copy of the letter.

Problems With Your Travel Insurance Claim

Travel insurance can give you extra protection if your holiday doesn’t go as planned. This is very important if you are travelling independently because you may find yourself stranded with no way to get home and no rep to rely on to help sort out your holiday problem.

Read this page to find out what you need to do if you have problems making a claim on your travel insurance policy.

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Can I Appeal If My Car Insurance Claim Is Rejected

If you feel that your car insurance claim has been rejected on unfair grounds, then you’re within your rights to appeal it. However, you should run a few checks to see if you’ve got a case before you do:

First, check whether you supplied your insurer any incorrect information, both when you took out your policy and when you put in your claim. If you have, its considered to be non-disclosure of information and the car insurance company is within its rights to reject your claim even if its a mistake. Alternatively, you may have had a claim rejected because your policy doesnt actually cover what youre claiming for. So, before you make an appeal, carefully check your policy documents. Check out our guide on different types of car insurance policy to get an overview of what’s typically covered.

Once youve reviewed your documents, if you still feel the outcome was unfair you can appeal the decision by making a formal complaint to your insurance company using their official process. Contact them by phone or email to get started. Be prepared for this process to involve quite a bit of back-and-forth communication.

Making A Travel Insurance Complaint

Insurance appeal letter sample

If you think you’re covered and your insurer is acting unfairly, you can make a complaint.

The first thing to do is to put your complaint in writing and tell the insurer how you want it resolved.

If you’re not happy with their response, you can make a formal complaint using the company’s internal complaints procedure.

All insurers are covered by the rules of the Financial Conduct Authority and have to deal with complaints in a certain way.

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Do I Need To Send Original Documentation With My Claim

The only original documentation required to support your claim are invoices and receipts. We also suggest that you keep photocopies of every item you send to us. Please note all costs incurred obtaining documentation should be borne by the claimant. This will include any further information such as doctors reports that we may need.

In addition to the claim form you will receive, there is an information checklist that explains the documents that are required for different types of claim.

Can You Make A Claim

If you have a problem with your travel insurance claim, it’s important to check the small print in your policy to make sure that you are covered. An insurer may refuse to pay out some or all of your claim because:

  • you have an excess on your policy. The excess is the amount of the claim that the insurer won’t pay at all. It is typically between £50 and £100
  • you have an exclusion on your policy. Exclusions are things for which you’re not covered and usually found in the small print
  • you’ve been overcharged for what you’re claiming for. An insurer will only refund reasonable costs. If these are too high, you may have to pay for part of them yourself
  • you didn’t take reasonable care. For example, if you left bags unattended or gave them to someone you didn’t know and they go missing, the insurer may refuse to pay out
  • your cover does not replace new for old. Insurers may pay out less than you’re claiming for, to allow for wear and tear of your belongings
  • you left valuables in checked-in luggage
  • you didn’t tell the insurers about a pre-existing medical condition when you bought the insurance.

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How An Insurer Must Deal With Your Claim

Although there is some paperwork involved in making a claim, you should remember that under the Central Banks Consumer Protection Code regulated companies are required to:

  • Have a written procedure in place for dealing with claims.
  • Help you if you need to make a claim and let you know about new developments which affect the outcome of your claim within 10 business days of knowing about them.
  • Let you know their decision on your claim within 10 business days of making the decision. When a claim is not settled in your favour, they should explain the reasons why in writing, and provide you with details of how you can appeal the decision.

Illegal Or Reckless Behaviour

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Any claim made that arises from illegal, fraudulent or dishonest behaviour will not be covered by travel insurance. Travel insurance companies share information on such claims as an industry wide fraud prevention and detection measure. Similarly, claims arising as a result of reckless behaviour such as the unauthorised use of swimming pools, going to restricted locations, are also not covered by travel insurance. You must abide by all relevant rules and regulations during travel and at your chosen location.

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Excessive Alcohol Or Drug Use

Injury or accident arising from excessive alcohol, will not be covered by travel insurance. You are not expected to be teetotal, however, you must always drink responsibly and not use any prohibited drugs, or medication unless prescribed by a physician. If you have an accident or are injured while drunk, any medical, repatriation or associated costs – such as missed original flights – will not be paid by your travel insurance.

Laws and customs around alcohol consumption vary in certain countries so know the rules in your chosen location before you get there.

Whats The Difference Between Named Perils And Cancel For Any Reason Travel Insurance

There are two basic types of travel insurance policies. The more common is the named peril policy, which allows you to cancel or interrupt your trip if you experience a covered reason. Your policy will include a list of covered reasons for cancellation or interruption and will pay you 100 percent of your non-refundable trip costs when you cancel for one of those reasons. These can include an injury to or illness of a close family member or a traveling companion.

The other type of policy is often called cancel for any reason, which allows you to cancel a trip for almost any reason and will pay you a percentage of your non-refundable trip costs. Cancel for any reason coverage is generally more expensive than a named perils policy.

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Travel Insurance Claim Rejected Here Are 9 Common Reasons Why

17 Jul 2018

If something goes wrong with your holiday plans either before your travel, or during your trip, and you need to make a claim on your travel insurance, you want the process to be as stress free and straightforward as possible. The last thing you need is unnecessary hassle and a holiday insurance claim denied at the end of it.

UK Travel Insurers pay out a whopping £345 million a year in claims payments, but not all claims are paid, so weve prepared some of the most common reasons why travel insurance claims get rejected, to help you avoid this happening to you, your friends and family. Read on and find out how.

Travel Insurance Claims Centre

Doctor

Whether you need medical attention while away on a trip, or plans change while on your trip due to an unexpected covered cause, TD Insurance is ready to help. Thats why our claims process is easily accessible by offering 24/7 customer support and a step-by-step guide on how to submit your claim.If something does happen while youre away, its important to contact our administrator. In a medical emergency, call our administrator immediately, or as soon as is reasonably possible. A delay could limit the maximum benefit payable under the policy to 80% of eligible medical emergency expenses, to a maximum of $30,000.Please read our instructions below to submit your claim, to appeal a decision and for more information about our TD Travel Insurance Plans.

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Should I Write To My Insurance Company Or Call

Most travelers feel that picking up the phone is more convenient, but thats an instinct you should resist. It may be easier, but having an answer in writingusually by emailis far more useful. It also creates a necessary paper trail that you can refer to if you should ever have to make a claim. If you must call, be sure to get the name of the person you spoke with. Make a note of the time and date.

How about your travel agent or insurance agent? Theyre not off the hook after youve purchased your policy. Many states require insurance agents and travel agents who sell insurance to be licensed, and if an agent has sold you a policy with promises of coverage, and the insurance didnt cover you, then you need to connect quickly with the agent.

While a travel agent or insurance agent can act as an advocate when your claim has been denied bear in mind, though, that there may be some privacy restrictions that limit your agents involvement you should never rely on them for authoritative information about coverage. In fact, a good agent will insist that you review your policy for yourself before buying.

Always direct your communications to the primary source: your insurance company. In the event of a dispute, its the insurance companys coverage promises not those of your agentthat matter.

Buying travel insurance is as important as your selection of an airline, cruise line, car rental company, or hotel. Becoming a power user of your policy is just as important.

How To Make Travel Insurance Claims

So the thing about travel insurance is that people only remember it when something unpleasant messes up our travel plans. Then, we panic and scramble when the insurer asks for things like the purchase receipt of a DSLR bought 6 years ago.

Sound familiar? If yes, heres a pro-tip be familiar with what you can and cant claim for, and make sure you have a rough idea of the supporting documents needed.

Its good practice to have a copy of your insurance policy on your phone, so you can always check it as and when you need, even on the go. Some travellers also have a habit of snapping photos of their luggage and belongings before the trip, just in case anything gets lost, delayed or damaged.

The exact claim procedure will depend on your insurance provider, but generally, the process goes like this:

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Things To Consider Before Making A Claim

  • Before making a claim, check the excess you have to pay yourself on your policy. The amount varies but is generally between 100 and 300. You will not be able to claim for amounts less than the excess.
  • If the amount of a claim is small, consider whether it is worth making a claim. If you make a claim, you may lose your no-claims discount with certain insurers and you may find it difficult to shop around for certain types of cover the next time you renew your policy.

When Should I Buy Insurance

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You can purchase travel insurance up until the day before you travel from some travel insurance companies, but the sooner you buy your policy, the better.

Why? Well, lets say your airline declares bankruptcy between the time you book your vacation and your departure date. Youll still be able to buy a policy the day before your departure, but if your airline has already filed for Chapter 11 protection, then the policy wont cover you if the airline stops flying.

Another reason: Most travel insurance policies will offer coverage for preexisting medical conditions that are under control, if you buy the insurance within a couple of weeks of your first trip payment . Since up to 20 percent of claims could be traced to pre-existing medical conditions, this could be an important point, and it removes another potential reason for denying a claim.

So buy the policy sooner rather than later, keep it in the 4 to 8 percent range, and youre on your way.

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If You Bought Your Travel Insurance Through A Travel Agent Or Tour Operator

You can go to the Financial Ombudsman if your complaint is about your insurance policy. If your complaint is about the way the way you were sold the policy, this may be against the law.

You should get help from the Citizens Advice Consumer helpline.

If youre in Northern Ireland, contact Consumerline.

Could I Get Less Money Then I Claimed For

In some cases, your claim may be reduced. For example, if you have underestimated the cost of rebuilding your home and replacing your belongings when taking out home insurance, you could get less money than you claimed for. This is due to an average clause, which is included in some policies.

For example, if the contents of your home are worth 40,000 but you insure them for just 20,000 and they get completely destroyed by fire, the most you will get from your insurance company is 20,000.

Even if you claim 10,000, the insurance company will look at the overall amount you insured your contents for and will consider that you are only half insured. So they may pay out only 5,000 or half of the total damage.

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I Just Bought A Travel Insurance Policy Now What

Conventional wisdom says you wait until something goes wrong, and then file a claim, but theres a little more to it.

Your travel insurance company wants to hear from youneeds to hear from youif you want to be a successful user of a travel insurance policy.

Heres when to contact your insurance company:

Timing is important. Read your policy when you receive it, and call if you have questions. Many travel insurance companies offer a free look period for all of their insurance policies. If, after reviewing your policy, you decide that it doesnt meet your needs, you can cancel it , and receive a full refund.

If Someone Is Claiming Against You

Doctor

Insurance companies do not have an obligation to inform you of the outcome of a claim made against you and can agree a settlement without your knowledge or consent. Keep in contact with your insurance company, in particular the claims manager appointed to the claim.

If you disagree with the finding, you can make your feelings known to the claims manager and the customer complaints department at the insurance company. If you need to make a complaint, follow our complaints procedures.

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