Travel Insurance Medical Claim Denied: How to Appeal From Abroad

Travel Insurance Medical Claim Denied: How to Appeal When You're Far From Home

Being ill or injured abroad is frightening. Being denied your travel insurance claim after returning home — after an emergency that may have cost thousands — is both infuriating and financially harmful. Travel insurance medical claim denials are common, and many are successfully challenged.

The challenge of appealing a travel insurance claim is that it involves multiple countries, unfamiliar healthcare systems, and documents in foreign languages. But the process, once understood, is manageable — and your rights are real.

---

Why Travel Insurance Medical Claims Are Denied

Understanding your specific denial reason is the starting point for your appeal.

Pre-existing Medical Condition Exclusion

This is the most common reason travel insurance medical claims are denied. Most travel policies exclude medical conditions that existed before the trip — sometimes defined broadly to include conditions that were "under investigation," had symptoms, or were being treated in the months before travel.

Key challenges:

• The definition of "pre-existing" varies significantly between policies and jurisdictions
• A condition you were unaware of is treated differently from one you concealed
• Many policies cover stable pre-existing conditions if you meet stability criteria (e.g., no change in medication or treatment for 60, 90, or 180 days before departure)
• The medical event abroad must actually be related to the pre-existing condition — a diabetic who breaks a leg in a fall is not claiming related to their diabetes

The Treatment Was "Not Medically Necessary"

Some travel insurers deny claims by arguing the treatment sought was elective rather than emergency. This is particularly common for:

• Dental treatment (often excluded unless resulting from an accident)
• Treatment for conditions that "could have waited" until returning home
• Specialist consultations that the insurer argues weren't required urgently

Failure to Contact the Emergency Assistance Line

Most travel policies require you to contact the insurer's 24-hour emergency assistance number before receiving non-emergency treatment (except in genuine emergencies where contact was impossible). Failure to do so may be cited as a grounds for denial.

Policy Excluded the Activity

Travel insurance policies often exclude or limit coverage for high-risk activities: skiing, scuba diving, adventure sports, motorized vehicles, and more. If you were injured during an excluded activity, the claim may be denied.

Late Claim Filing

Travel insurance typically requires claims to be filed within a defined period after returning home (commonly 30–90 days). Missing this deadline gives the insurer a procedural basis for denial.

Alcohol or Drug Use

Insurers routinely deny claims where they allege the incident involved alcohol or drug use. This is frequently overapplied and worth challenging where the connection is speculative.

---

Step 1: Gather All Documentation Before Returning Home

The most important thing you can do is collect documentation at the time of treatment, before leaving the country where care was received.

What to collect before leaving:

• Physician's report from the treating doctor — in English if possible, or with a certified translation
• Hospital discharge summary — diagnosis codes, procedures, dates, treating physicians
• Original itemized bills — not just total amounts, but line-by-line itemized costs
• Prescriptions and pharmacy receipts
• Police report — for accidents, theft, or assailant-related injuries
• Emergency assistance line records — if you called the insurer's emergency line, get the case reference number and a record of what was discussed
• Photographic evidence — of injury or circumstances where relevant

If you cannot get English-language documents at the time, retain originals and arrange certified translation after returning home. Certified translation services (not machine translation) are required for most insurance claim documents.

---

Step 2: Contact Your Insurer's Emergency Assistance Line (If You Haven't Already)

If you are still abroad and haven't yet contacted the emergency assistance line, do so now — even for ongoing claims. Most travel policies require this contact, and doing it late is generally better than not doing it at all. The assistance line can:

• Authorize further treatment directly, simplifying reimbursement
• Arrange direct billing with the hospital (preventing you from needing to pay upfront)
• Arrange medical evacuation if clinically required
• Create an official record of your claim from the outset

---

Step 3: Challenge the Pre-Existing Condition Denial

If your claim was denied on pre-existing condition grounds, challenge the connection between your pre-existing condition and the medical event:

Was the medical event actually related? For the exclusion to apply, the medical event abroad must be related to the pre-existing condition. A person with high blood pressure who fractures their wrist is not claiming for a blood pressure-related condition.

Did your condition meet the stability requirement? If your policy covers stable pre-existing conditions and your condition was stable (no change in treatment, medication, or symptoms for the required period), you may still be covered. Document your stability with medical records from your home physician.

Was the condition known to you? Policies typically distinguish between conditions you were aware of (and possibly failed to disclose) and truly unknown conditions. An undiagnosed condition that manifests abroad is different from a known condition you didn't disclose.

Was the condition properly disclosed? If you did disclose the condition when purchasing the policy (as a screening question) and the insurer still issued the policy, they may have waived the right to deny based on that condition.

---

Step 4: Challenge "Not Medically Necessary" Denials

If the insurer argues treatment wasn't necessary:

• Obtain a letter from the treating physician abroad explaining the medical necessity of the treatment in their clinical judgment
• Show that delaying treatment would have created a materially worse clinical outcome
• Provide your home physician's opinion that the treatment received was appropriate and necessary

For dental claims specifically — which many policies cover only for emergency treatment — have the overseas dentist document the emergency nature of the treatment (acute pain, infection, accidental trauma) as opposed to routine care.

---

Step 5: Appeal the "Failure to Contact Assistance Line" Denial

If the denial cites failure to contact the emergency assistance line, argue:

• The situation was a genuine emergency that precluded prior contact (e.g., unconscious, heart attack, severe accident). Most policies waive the notification requirement for genuine emergencies.
• The insurer suffered no prejudice from the failure to notify — the treatment provided was the same treatment they would have authorized, and the cost is the same
• You notified as soon as reasonably possible given the circumstances

In many jurisdictions, courts and ombudsmen have found that failure to notify cannot be used to deny claims where the insurer was not prejudiced by the failure.

---

Step 6: File Your Formal Internal Appeal

Send your appeal to the insurer's formal appeals or complaints department (not the regular claims line). Include:

• Your policy number and claim reference
• A formal letter disputing each denial reason with specific arguments
• All supporting documentation — physician's report, hospital bills, emergency assistance records
• Certified translations of all foreign-language documents
• Your demand for payment of the full claim amount

Send by registered mail or email with delivery confirmation. Keep all copies.

---

Step 7: Escalate to Your Home Country Regulator

After exhausting the internal appeal, escalate to your home country's insurance regulator:

Home Country	Regulator for Travel Insurance
UK	Financial Ombudsman Service (FOS) — financialombudsman.org.uk
Australia	AFCA — afca.org.au
USA	State Department of Insurance
Canada	General Insurance OmbudService (GIO)
Malaysia	OFS (Ombudsman for Financial Services)
Singapore	Financial Industry Disputes Resolution Centre (FIDReC)
India	Bima Lokpal / IRDAI
South Africa	OSTI

Travel insurance is regulated based on where the policy was purchased and where the insurer is licensed — not where the medical treatment occurred.

---

Currency and Foreign Exchange Considerations

If you paid medical bills in a foreign currency, you are entitled to reimbursement based on the exchange rate at the time of payment (or the rate your bank used for the transaction). Keep the foreign currency amounts on all bills, plus your bank or credit card statements showing the actual amount charged in your home currency. The insurer should reimburse the amount you actually paid.

---

Common Mistakes in Travel Insurance Medical Appeals

1. Not collecting documentation at the time of treatment. This is the most costly mistake. Once you return home, getting records from overseas hospitals is difficult, slow, and sometimes impossible.

2. Assuming the pre-existing condition exclusion automatically applies. The connection between your pre-existing condition and the medical event abroad must be established by the insurer. Challenge the causation argument.

3. Not getting a certified translation. Machine-translated documents are generally not accepted. Use a certified translation service.

4. Missing the claim filing deadline. Most policies require claims within 30–90 days of return. Check your policy immediately on returning home.

5. Not keeping receipts for everything. Hotel stays during extended medical treatment, additional flight costs to return home after delayed departure, meal costs during hospitalization — many of these may be claimable under emergency travel assistance provisions of your policy.

6. Not challenging "failure to notify" denials. The emergency exception is real and frequently applicable. Make this argument explicitly.

---

Getting Your Appeal Letter Written

A travel insurance medical claim appeal involves coordinating overseas medical documentation, foreign language records, exchange rate calculations, and regulatory arguments specific to your home jurisdiction. ClaimBack can generate a structured travel insurance appeal letter that addresses your specific denial reasons and presents your case clearly to your insurer and regulator. Visit claimback.app to create your letter.

---

Summary: Travel Insurance Appeal The Full Fight

1. Collect all documentation at the time of treatment — physician's report, hospital bills, emergency line reference
2. Get certified translations of all foreign-language documents
3. Challenge pre-existing condition denials on causation and stability grounds
4. Appeal "not medically necessary" findings with treating physician's letter
5. Argue the emergency exception if the "failure to notify" is cited
6. File a formal written appeal with all supporting documentation
7. Escalate to your home country's regulator or ombudsman if the internal appeal fails