Good advice.

Good advice.

My Travel Insurance Is Being Denied

DBM Law Blog

How can I appeal it when they’ve denied my claim?

If your travel insurance claim for emergency medical services while travelling outside BC or Canada was denied, you must take steps immediately to:

  • Determine if your travel insurer has already submitted a claim to the BC Medical Plan for basic coverage on your behalf;
  • If not, you must apply yourself to BC Medical Plan for basic coverage usually within 90 days of treatment or within 6 months if you have an in-patient hospital claim, visit Medical Service Plan, Out-of-Province Emergency Medical Coverage or Out-of-Country Emergency Medical Care at www2.gov.bc.ca.
  • Request from your travel insurer a complete copy of your travel medical insurance claim file concerning your claim;
  • If you purchased the policy from an insurance broker, contact them and request a complete copy of the broker’s travel insurance file concerning your purchase;
  • Contact a lawyer.

“I’m out of pocket the expenses. What can I do?”

Often an insurer will send you a denial letter and invite you to appeal their decision and to send more information for the appeal.

In my experience, this appeal offer delays you getting proper advice or taking action to pursue payment.

You have two years to file an action in court against the insurer for the wrongful denial of benefits.

It is best to assume that the two years is running from the date you required medical services being the earliest date.

If you miss this limitation period to file an action in court, you cannot pursue the claim. If you believe you may have missed it but are unsure, ask a lawyer. There may be ways to extend that date in a particular circumstance. However, key point is not to delay taking action or getting advice.

When you meet with your lawyer, bring with you:

  • The complete policy wording;
  • Any communications with the insurer from you or to you;
  • Any application or medical records, documents or receipts you have concerning your claim;
  • The travel insurance claims file the insurer sent you if you have it;
  • The broker’s file if there is one.

Reviewing the reason for the denial and the documents gathered and reviewed by the insurer in their assessment will help determine what the issues are and allow for a consideration of the merits of your claim.

In general, travel insurance claims are typically denied because the claimant has misrepresented their medical history on the application form when applying for the insurance, or they suffer from a pre-existing medical condition that was unstable in the 90 days before leaving on their trip.

Also, common policy exclusions that result in a denial of coverage include injuries while impaired and injuries while participating in high risk sports or leisure activities.

Who can help me?

If denied coverage for travel insurance or any other insurance benefit or insurance claim, contact our lawyers for an initial legal consultation. Do not delay!

 

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