Travel Insurance Appeal Denial: How To Challenge Successfully (2024)

A travel insurance denial is when your travel insurance company refuses to pay or reimburse you money you’ve paid for travel that was interrupted or never took place. When you make a claim for coverage under your travel policy and the insurance company declines the claim, this is referred to as a claim denial. Insurers sometimes decline claims that involve someone receiving medical treatment or spending extra money to complete a trip.

Your travel policy’s terms and conditions spell out the details under which you’re covered by the insurance policy. The policy also lists all exclusions for coverage. What the company considers covered events and what exclusions exist — these are central to the policy’s terms and conditions. It’s important to know them before you start your trip.

The financial implications of a denied claim can be significant. Depending on your situation, you may have to pay thousands of dollars yourself if a travel insurer denies your claim and gives no reimbursem*nt.

There are multiple steps to appealing a travel insurance claim denial. We’ve broken these down below to give you a clear understanding of the process.

Step 1: Review the Denial Letter

A denial letter is a document an insurance company sends you to inform you that it has denied your travel claim. Read the letter in detail to understand why your claim wasn’t approved. Understanding the exact reason for a denial helps you plot the next steps in your appeal.

Common reasons why insurance providers deny your initial claim are:

• They believe you didn’t take reasonable care to avoid the problem.
• You didn’t follow the proper claims process.
• There were issues with your insurance application.
• There’s a lack of proper authorization.

Step 2: Gather Relevant Documentation

At the start of filing your claim, any documentation supporting your claim is crucial to have on hand and to submit. Examples include receipts from your trip and proof of paid healthcare costs. These are proof that you paid out of pocket to cover services. In addition, you should have receipts for any trip cancellations or lost baggage. It’s important to gather these if they become relevant to your claim.

If your incident is related to health care, call the doctor’s office you visited and get copies of any medical records generated while you were there. Be sure to keep copies of each relevant document; these will be useful in supporting your claim.

Step 3: Craft a Persuasive Appeal Letter

When you fight a claim denial, you must write an appeal letter to send alongside the documentation you collected. In the letter, explain why you’re appealing the insurance company’s denial. A well-structured, well-written appeal letter will address in order:

1. Details of the person who is appealing the travel insurance denial, their policy number and contact information
2. Details of the claim that was denied, on what terms the denial was made and the date you received the denial letter
3. The explanation of the denial, followed by the reason you are appealing the denial
4. The existence of—and context to—supporting documentation for your appeal, such as receipts, medical notes, etc.
5. Any other documentation that may be useful to support your appeal

You can make a compelling argument in your appeal letter by sticking to the facts and getting straight to the point. Being as specific as possible will support your appeal. The more details you can give, the easier it will be for someone else to agree with your reasoning.

You can talk about your feelings, but only if they help deliver and support your overarching message. Don’t try to manipulate the reader into supporting your case.

Finally, compose the letter with a respectful and professional tone throughout.

Step 4: Submitting the Appeal

Send your appeal via certified mail to the address of the travel insurance provider, which should be spelled out in your insurance policy or in your denial letter. Track your appeal letter to see when your insurance provider receives it.

The appeals process itself can take time, so prepare to be patient. Call the insurance company every two to four weeks to find out the status of your appeal.

Each insurance company has its own appeals review process and time period for handling appeals. The process usually takes 30 to 90 days. If you file an appeal beyond a specified deadline, it will likely get denied because of the filing delay. Your policy or the claim denial letter should detail the timetable for filing an appeal. You also might find it on the insurance company’s website.

The most common reasons for a denied claim include:

• There’s insufficient documentation or evidence to support a claim. These include a lack of receipts, proof of payments or proof of the incident that you’re making the claim for, such as a cancellation, necessary medical care or anything else that cost you money.
• The circ*mstances are not covered by the insurance provider and your specific travel insurance plan. It may just be that your travel insurance policy does not cover the incident you’ve faced. An example may be that you are involved in a winter sports accident, but your travel insurance plan does not cover any incidents, injuries or medical services associated with this high-risk activity.

While an appeals process is often straightforward, there are tips to keep in mind to help your chances of winning your claim.

Provide Any New or Undisclosed Information

The more information you have about your appeal and the more detail you can give, the more you increase the odds of getting your claim approved. If you come across additional information relevant to your case that the insurance company hasn’t seen, submit those details.

Seek Legal Advice if Necessary

If you need help with your appeal, you can turn to external appeals and legal services that can guide you. Legal help can strengthen your application by making it clearer and more straightforward. An attorney also may look for provisions in your explanation of benefits that call for an external review of your claim or the insurer’s denial.

Be Polite

Don’t underestimate the tactic of good manners and professionalism. Being polite goes a long way when communicating with travel insurance companies about your appeal. While the process can be lengthy and potentially frustrating, keep your temper in check and your language on point. Treat representatives from your insurance company with respect.

If you find out your appeal is unsuccessful, you can take other action to support your travel insurance claim. For example, you can file a complaint with insurance regulatory bodies, such as the Federal Insurance Office, which monitors all aspects of the insurance sector. State governments regulate insurance, so your state’s insurance office may also be able to help.

Mediation is another way to have a structured and dynamic process toward resolving the claim denial. A neutral third party is involved, which can be a useful way to help review your appeal and give it a better chance of being heard.