Why Are Some Claims Denied?
The most common reasons are:
- You had a pre-existing condition your insurer didn’t know about.
- You failed, deliberately or inadvertently, to accurately or completely disclose your medical history when asked.
- Your doctor changed your medication prior to you departure, thus according to the terms of your policy your condition was considered “unstable” and uninsurable. Read your policy definition of Stable.
- You “authorized” a medical procedure against the advice or without the knowledge of your assistance service.
- You didn’t notify your insurer of a change in your medical status after buying your policy and before it became effective.
- Your insurer or assistance service didn’t do their homework properly and neglected to get all of the paperwork from the hospital or doctors who worked on you.
- Your own family doctor, who had nothing to do with treating your emergency, neglected several requests from your insurer for medical records which could validate whether your emergency was the result of a pre-existing condition or not.
It’s not only you who can be responsible for a claim denial. Insurers, assistance services, hospital and doctors make mistakes too. You should make sure they are all accountable.
