Claims Explained: Why They Get Declined and What You Can Do
When you get a travel insurance policy, the last thing you want to do is have to claim on it. Whether it’s because you have to cancel your holiday, or because someone gets really poorly while away. However, that’s ultimately what it’s there for - to get back unexpected, out-of-pocket expenses.
Travel insurance can be tricky, so understanding why a claim might be denied can be useful. You can make sure you have appropriate coverage to begin with, know which information to collect for the claims process, and what to do if you don’t agree with the decisions made.
The Financial Ombudsman Service (FOS), recently submitted parliamentary evidence stating that rejected claims account for 56% of travel insurance-related complaints. There are many and varied reasons why a claim might be rejected fairly, and more often than not this comes down to a misunderstanding of what you can claim for, or expecting cover from a policy ‘under any circumstance’. Here are some of the most common reasons for a declined claim.
Common Reasons for Rejected Claims
Your reason for claiming isn't covered
A Policy Wording explicitly outlines the exact scenarios you can claim for. It will tell you how much you can claim, under which circumstances, if certain events happen outside your control. There are also conditions and exclusions which explain what you cannot claim for.
If you want to cancel your holiday because you’re feeling under the weather and don’t fancy flying, you wouldn’t be able to claim for this reason. But if you become seriously unwell and a medical practitioner actively declares you unfit to travel, this is a coverable reason. However, you should always try to get your holiday plans rearranged or refunded through the appropriate providers before making a claim. Travel insurance is there for non-refundable arrangements you’ve paid for and cannot get back from elsewhere.
Pre-existing medical conditions haven't been declared
A prerequisite of purchasing travel insurance with us is a medical declaration of your pre-existing medical conditions. You’re asked a series of questions during the quote process, which must be answered honestly and accurately in line with your medical records. If you don’t know how to respond to certain questions, you should contact your GP or consultant to get those answers. You must also contact us if there are changes in your health between buying a policy and going on your holiday. This should be done in plenty of time, and can range from a simple change in medication to a serious diagnosis.
Knowing your pre-existing conditions means that associated risk can be assessed appropriately. Having angina, for example, increases your chances of a heart attack. You may never have had one before, but knowing you’ve got a heart condition, and not declaring it, can cause issues later. Say you do end up having a heart attack abroad - if angina isn’t declared on your policy, your insurer doesn’t know that this is something that could happen. It’s therefore not been factored into your insurance, so your insurer may not be prepared to reimburse any medical or associated costs.
An activity isn't included in your policy
Like medical, activities bring risk, and not informing us of your intentions means this risk isn’t factored into your insurance. Going cave diving, for example, can include risks like physical entrapment, strong currents, running out of gas, nitrogen narcosis, and decompression sickness. Whereas going for a walk around the resort might mean (at most) twisting your ankle. An insurance policy must accurately reflect the intentions of your holiday, and if it doesn’t, an insurer can decide not to pay out. Bear in mind that activities also include winter sports and going on a cruise.
The incident happened before your cover began
The key thing to remember is that travel insurance is designed to cover unknown and unexpected situations, whether that’s to do with medical, the weather, strikes, or a number of otherwise unpredictable scenarios. Claims are often rejected because a traveller claims for something that is known to the public before they purchase travel insurance. For example, if there’s flooding in Spain and more is predicted for June (which is when you’ve booked your holiday for), your decision to purchase travel insurance after hearing this would not cover you if June arrives and your hotel becomes inhospitable due to flooding. The timing of cover matters, and it’s important that you get it in place before events like this disrupt plans.
Policy conditions haven’t been met
There are a few things you need to know, do, and provide when it comes to making a claim. You may have to contact certain providers, get reports or evidence, and gather information before your claim is ready to be processed.
In the event of delayed baggage, you might need to contact the airline first. For cancellation, you need legitimate evidence of being unfit to travel or being called for jury service, for example. If there’s a medical emergency abroad, you need to contact the emergency medical assistance team as soon as you can following the event. A stolen watch will need a police report. Making a mistake or not keeping a receipt doesn’t automatically mean your claim will be rejected - but having all that in place means that the policy conditions are met, and the claims team can assess your situation more accurately.
Things to Remember When Submitting a Claim
There’s no guarantee that every travel insurance claim will be accepted, but there are steps you can take to avoid common problems. Reading your Policy Wording, keeping relevant paperwork, and following the emergency medical and claims processes can make things smoother for you.
Choosing suitable cover is one of the most important steps you can take.
- Buy travel insurance as soon as you book your holiday. Having cover in place early helps with unexpected events and puts you in good stead if you need to make a cancellation claim.
- Declare your medical conditions fully, accurately, and honestly. Speak to your GP ahead of time if you’re unsure of any diagnoses, and get in touch with us if you need any assistance with the screening process.
- It might seem obvious, but make sure your dates and destination accurately reflect your holiday. Include additional activities like winter sports or scuba diving, and if you’re going on a cruise, make sure this is included.
- Look at cancellation cover, emergency medical expenses, baggage limits, excesses, and circumstances that aren't covered. Understand your policy limits and exclusions. The cheapest policy won't necessarily provide the protection you need.
Your circumstances and travel plans can change after purchasing insurance, so keep your cover in mind.
- If there are updates to your health situation, update your policy too.
- Check official travel advice. The Foreign, Commonwealth & Development (FCDO) guidance is constantly updated, and gives you information about everything from vaccines to no-go areas.
- Keep information accessible. It’s a good idea to make sure all of your booking, insurance, and emergency details are available offline.
If you need to make a claim, being organised can help your insurer assess it and reduce delays.
- If it’s an emergency medical issue, follow the emergency assistance guidance. Seek the necessary medical assistance first, and call the emergency medical assistance team as soon as you can.
- Keep everything. Medical reports, receipts, booking confirmations, police reports, cancellation documents, and any correspondence with travel companies and providers.
- Before making a claim, double-check that you cannot get any funds or reimbursement from another provider. For example, if an airline cancels your flight, they have a duty of care to provide alternatives.
- Contact the claims team promptly. Your Policy Wording will contain a section on how to make a claim, and you should follow these instructions when you do so.
- Once you’ve submitted a claim, save your completed claim form, supporting documents, and communications with any providers in case further information is needed.
Taking these precautions won't mean that you’ll absolutely get a payout, but they can help you understand your responsibilities, avoid misunderstandings, and provide the information needed for your claim to be assessed fairly.
Ultimately, whether a claim is approved or denied lies in the decision of your insurer’s claims team. Your Policy Wording is your most useful document, and can answer a lot of questions on whether your reason for claiming is coverable.
Frequently Asked Questions
Can I appeal a rejected travel insurance claim?
Yes. If you disagree with the insurer’s decision, you can ask them to review it. Request an explanation, including the relevant policy terms, and provide any additional information that might support your claim. If you’re still unhappy, you can make a formal complaint with the Financial Ombudsman Service. They can ask an insurer to meet the costs of a claim that was incorrectly declined, or to reconsider a claim where relevant.*
Can my travel insurance claim be declined if I don't have receipts?
Your insurer will likely ask for receipts or other supporting documents to verify your claim. If you can't provide these, you can sometimes offer alternative evidence, like bank statements, booking confirmations or photographs. This depends on the circumstances of the claim, but if you cannot provide sufficient evidence to support your claim, your insurer is entitled to decline it.
Can an insurer reject my claim because I didn't declare a medical condition?
If you haven't provided an accurate medical condition, your insurer may be able to decline a related claim. However, this isn't an automatic denial, and the insurer must consider factors such as what you were asked, whether you took reasonable care when answering, and whether the missing information would have affected the cover offered.
When can I contact the Financial Ombudsman Service about a rejected claim?
You should usually make a formal complaint to your insurer first. If you're unhappy with their final response, or they haven't provided one within eight weeks, you can refer your complaint to the Financial Ombudsman Service for an independent review. You normally have 6 months from the date of your insurer's final response to do this, although exceptions can apply.
BY HOLLY GARWOOD
Last reviewed