Home » Blog » #insurance » 10 Common Reasons Why Your Visitors to Canada Insurance Claim Could Be Denied

Last updated on December 22nd, 2023

With the last of the COVID-19 travel restrictions lifted, now is a great time to visit one of the most magnificent countries on the planet – Canada!

Once you’ve packed your bags, gathered necessary documents and bought a suitable insurance policy, you might be wondering if there are any further steps you need to take to secure your finances while abroad.

That’s why, we’ve compiled a list of the most common reasons why your travel insurance claim could be denied, so that you have peace of mind while taking in our beautiful Canadian scenery!

Undeclared or Unstable Pre-Existing Medical Conditions

Having medical conditions before traveling can lead to denied claims. But if you disclose them properly, you can get coverage for your health needs while abroad. If you are buying your policy with a broker or an agent, they will be able to explain how pre-existing medical conditions coverage would work in your case.

A pre-existing condition is any medical condition that exists before the start of your coverage. This includes recognized complications and recurrences of a condition you might have too. But, if these conditions have been stable and controlled for a certain period of time, you may be eligible for an additional level of coverage.

Travel medical insurance for visitors and immigrants to Canada safeguards you against unforeseen medical expenses, such as emergency treatment. Your claim may be denied if you fail to disclose a previous serious illness or a condition for which you regularly take medication.

If you have a medical condition and it gets worse before your trip, you are required to notify your insurance provider or a broker you bought your policy from. If your condition worsens during your visit, your insurer might argue that you didn’t take the necessary steps to control it before traveling. Therefore, it is important to let your insurance agency know of any changes to your medical conditions status.

  • When in doubt, declare your condition. Transparency is key to avoiding claim denials.
  • Seek a physician’s advice or permission before traveling if you have a medical condition. Their expertise will help you determine if you are fit to travel.
  • Make sure your condition is well-managed before your trip. Taking proactive steps to control your condition will increase the likelihood of coverage.

Understanding how pre-existing conditions and stability periods relate to your medical history and policy coverage is crucial. Don’t let an unforeseen medical condition ruin your travel experience.


Claiming Ineligible Expenses

Visitors’ insurance plan descriptions make it clear that coverage is only available for medical emergencies, excluding routine checkups, cosmetic procedures or regular healthcare needs.

It’s important to understand that your policy is designed for emergency expenses such as ER, hospital or clinic visits for treating an accidental injury or a sudden sickness. Claiming for routine medical costs will result in claim denial.

Stay prepared and avoid any unforeseen issues by taking care of your medical needs before you travel.


Engaging in Risky Activities

Before doing adventurous activities on vacation, like hiking or city-biking, it’s important to have the right insurance. Insurance is necessary for recreational sports. These activities have a higher likelihood of injury compared to leisurely activities like golf, for example.

Fortunately, there are travel insurance policies that include appropriate coverage. It is essential to ensure that you purchase this type of coverage to protect yourself and your wallet.

Be mindful that there are strict exceptions to this type of coverage i.e. extreme sports like heliskiing, ski jumping or sky-diving are not covered under visitors insurance plans. Talk to your insurance representative to learn the ins and outs of your policy.


Alcohol-Related Injuries

A glass of wine on vacation could be an ideal time to unwind and destress. However, as an adult, it’s crucial to be wary of the potential consequences related to alcohol consumption. If you sustain an injury while under the influence, your insurance claim might be denied.

Why? This boils down to the “alcohol abuse” clause, which most insurance providers adhere to. Failing to exercise control and excess drinking puts you at risk of not having your medical expenses covered.

Take charge of your alcohol consumption and enjoy your vacation responsibly!


Missing the Deadline for Filing Claims

Please ensure that you submit your valid claim within the designated time frame to prevent any potential rejection by your insurer. Usually, it is around 90 days from the date of occurrence in order to submit your complete claim.

However, it is your responsibility to notify the emergency assistance center as soon as you need to seek medical treatment, if it is physically possible.

Alternatively, someone on your behalf should contact the call-center using the number on your insurance policy right away.


Insufficient Evidence

If you lack concrete evidence to support your case, the claim may be denied. For example, If you visit a hospital or a medical clinic for an emergency, you will need to provide evidence of that treatment.

What could be qualified as evidence when submitting a claim? It depends on the nature of your claim and the items lost, if any. The required evidence may include:

  • A doctor’s note with medical records
  • Completed Claim Form
  • Itemized receipts for medicine expenses and proof of payment
  • A police report, if applicable

To ensure the best chance of success, it is crucial to be specific when completing your visitors insurance claims form. Additionally, submit any relevant evidence that you possess. Accuracy is paramount. Verify every detail before submitting your claim to avoid unnecessary delays.


File Claims for events before purchasing insurance

Travelers should purchase insurance coverage promptly after booking a trip.

Although it is possible to buy coverage at the last minute, claims for events that have already occurred or were known about before obtaining a policy are likely to be denied. Moreover, policyholders may face allegations of fraud in such cases.


No Pre-Authorization

Some procedures or treatments require “pre-authorization” from your insurer before they will cover the expenses. Certain costly services like repatriation may require pre-authorization unless they are part of emergency care.

To ensure that your claim is not affected, we recommend that you consult with your insurer. It is especially important if you are unsure whether pre-authorization is required.


Canada’s Travel Advisory Released Before Your Booking

The Government of Canada maintains travel advice and advisories for all countries. These updates cover all countries and can impact your travel insurance coverage.

Claims related to a warning given before booking and buying travel insurance will not be covered. For example, let’s say you booked a side-trip to Mexico during your coverage period from Canada but discovered a travel advisory had been issued about the Zika virus before you traveled. If that is the case, side-trips coverage may not work.

If a travel advisory is issued after your coverage period starts, you can make a successful claim.

To ensure you have all the necessary information, always check the Government of Canada’s website before making any travel arrangements for side-trips.


Coverage Eligibility, Exclusions and Limitations

When purchasing an insurance policy, it’s important to meet the eligibility requirements and truthfully answer any applicable medical questionnaires. Failure to do so may result in only receiving a refund of the premium for the policy and your claim being denied.

Remembering that your previous medical history will be verified in the event of a claim is crucial.

When buying travel insurance for visitors to Canada, make sure to provide your licensed insurance broker with an accurate and comprehensive medical history.

Understanding your policy benefits, exclusions and limitations will give you peace of mind while traveling. If you have any questions about the policy you’ve purchased, don’t hesitate to ask your broker.

For questions about travel insurance or to avoid common mistakes, talk to your Arbetov Insurance broker or call +1 (604) 875-8878.

*Please note that coverages, benefits, exclusions, limitations, and terms and conditions can vary between providers. Contact your insurance representative for the information.


What Should You Do If Your Travel Insurance Claim Gets Denied?

Appeal a Travel Insurance Claim

If the insurance company has rejected your insurance claim, there is no need to start worrying. Mistakes happen, and there’s a chance that the insurance company made an error in their decision.

If you disagree with their decision, you can appeal it. Look at the company’s website, the policy’s fine print or your policy for guidance on what to do next.

Get Your Travel Insurance From Arbetov Insurance

Searching for travel medical insurance for visitors and immigrants to Canada? Consider Arbetov Insurance as your one-stop shop!

We have over 15 years of experience helping travelers like you find the best coverage for your trip.

From competitive rates to comprehensive policies, we have you fully protected. Explore our website today to discover more about our travel medical insurance options!

Photo by Pixabay from Pexels

#insurance | #travel
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