Denied Claims - Why Travel Insurance Doesn't Always Pay Out
Learn the top 10 reasons travel insurance claims get denied, with real examples and how to avoid common pitfalls that void your coverage.
Why claims get denied
Travel insurance claim denial rates vary by provider, but industry averages suggest 15-25% of claims are denied or partially paid. Understanding why helps you avoid common mistakes.
Top 10 reasons for claim denials
1. Pre-existing condition without waiver
Scenario: Linda had been treating high blood pressure for 5 years. On her Greece trip, she had hypertensive crisis requiring hospitalization ($42,000).
Claim denied because:
- High blood pressure = pre-existing condition
- She bought insurance 45 days after booking (missed 14-day waiver window)
- Policy had 90-day lookback period (she'd seen doctor within that time)
How to avoid:
- ✅ Buy insurance within 14-21 days of first trip payment
- ✅ Insure 100% of trip cost
- ✅ Be medically able to travel when purchasing
- ✅ Or choose policy that covers pre-existing by default (like GeoBlue)
2. Excluded activity without rider
Scenario: Tom broke his collarbone skiing in Colorado. Needed surgery ($22,000).
Claim denied because:
- Policy excluded skiing without adventure sports rider
- Tom assumed "comprehensive" covered everything
- Adventure rider cost $75 but he didn't add it
How to avoid:
- ✅ Read exclusions carefully
- ✅ Add adventure sports rider if skiing, diving, climbing, etc.
- ✅ Verify your specific activity is covered (some policies exclude off-piste skiing, heli-skiing, etc.)
Common excluded activities:
- Skiing/snowboarding (without rider)
- Scuba diving below 30-40 meters
- Motorcycle riding over 125-150cc
- Rock climbing with ropes
- Bungee jumping, paragliding, skydiving
- Professional/competitive sports
3. Filing claim too late
Scenario: Sarah's flight was delayed 18 hours, costing $300 in hotels and meals. She filed claim 6 months later when cleaning out receipts.
Claim denied because:
- Policy required claims within 90 days of incident
- She filed 180 days later
- Insurer's position: "Too much time passed to verify circumstances"
How to avoid:
- ✅ File claims ASAP (within 30 days ideal)
- ✅ Check your policy's deadline (usually 20-90 days)
- ✅ Set reminder to file before deadline
- ✅ Don't procrastinate—denied claims can't be un-denied for being late
Typical claim deadlines:
- Allianz: 90 days
- Travel Guard: 20 days (strict!)
- Travelex: 90 days
- World Nomads: 90 days
4. Insufficient documentation
Scenario: Mike's bag was lost with $1,800 in clothes and electronics. Filed claim but only had credit card statements, no receipts.
Claim denied because:
- Insurer required original receipts or proof of purchase
- Credit card statements don't prove what was in the bag
- No police report filed
- Airline gave compensation ($200), but he couldn't prove items exceeded that
How to avoid:
- ✅ Keep receipts for expensive items
- ✅ Take photos of packed items before travel
- ✅ File police report for any theft/loss
- ✅ Get airline's baggage claim report
- ✅ Document everything with photos
Required documentation by claim type:
Medical claims:
- Medical records and doctor's notes
- Itemized bills (not just credit card receipts)
- Proof of payment
- Diagnosis codes
Trip cancellation:
- Proof trip was non-refundable
- Reason for cancellation (death certificate, doctor's note, evacuation order)
- Communications with travel suppliers refusing refunds
Baggage:
- Receipts for lost items
- Police report (if theft)
- Airline baggage claim report
- Photos of damaged items
5. Alcohol or drug-related injury
Scenario: College student fell off balcony at Cancun resort after spring break party. Fractured spine ($78,000 treatment).
Claim denied because:
- Blood alcohol content was 0.18 (more than 2x legal limit)
- Medical records noted intoxication
- Policy explicitly excluded injuries "while intoxicated"
How to avoid:
- ✅ Drink responsibly while traveling
- ✅ Know that intoxication voids most policies
- ✅ Some policies define intoxication as BAC over 0.08, others "impaired judgment"
- ✅ Injuries from drugs (illegal or not) are almost always excluded
What counts as "intoxication":
- BAC over policy limit (often 0.08-0.10)
- Medical records stating "alcohol involved"
- Police report citing intoxication
- Witness statements
6. Known event / foreseeable circumstance
Scenario: Hurricane Irma was named Sept 5 and tracking toward Florida. Jane bought travel insurance Sept 7 for her Sept 12 Miami trip. Hurricane hit, she tried to cancel.
Claim denied because:
- Hurricane was "named storm" before policy purchase
- "Known events" are excluded
- She should have bought insurance before storm formed
How to avoid:
- ✅ Buy travel insurance immediately when booking trip
- ✅ Don't wait until you see bad news to buy insurance
- ✅ "Known" events include: named hurricanes, travel warnings, volcanic eruptions, political unrest, pandemic outbreaks
Examples of "known events":
- Hurricanes (after named)
- Volcano eruptions (after started)
- Government travel warnings (after issued)
- Strikes/labor disputes (after announced)
- Political unrest (after news coverage)
7. Non-covered cancellation reason
Scenario: David booked $15,000 African safari. Lost his job 2 months before trip. Couldn't afford to go. Tried to file trip cancellation.
Claim denied because:
- Job loss not a covered reason
- He was fired for performance (voluntary termination by employer doesn't count unless it's layoff/downsizing)
- Financial circumstances explicitly excluded
- Would need Cancel For Any Reason (which he didn't have)
How to avoid:
- ✅ Understand covered reasons (illness, death, weather, jury duty)
- ✅ Add CFAR if you want flexibility for non-covered reasons
- ✅ Don't assume "trip cancellation" covers all reasons to cancel
Covered reasons (standard policies):
- Illness/injury (you or immediate family)
- Death (you or immediate family)
- Severe weather (mandatory evacuation)
- Jury duty or court subpoena
- Job relocation (over 100 miles, sometimes)
- Home uninhabitable (fire, flood, etc.)
NOT covered reasons:
- Job loss (unless qualifying layoff)
- Financial hardship
- Change of mind
- Fear of travel
- Work conflicts
- Family events (wedding, graduation, etc.)
8. Travel against medical advice
Scenario: Emma had cancer treatment scheduled. Doctor advised against international travel. She went anyway and had complications in Spain ($95,000).
Claim denied because:
- Policy stated: "Coverage void if travel against physician's advice"
- Doctor had written note advising against travel
- Insurer obtained medical records showing this
How to avoid:
- ✅ Get medical clearance if you have health conditions
- ✅ Don't travel if doctor says no (voids coverage entirely)
- ✅ Get written clearance from doctor before trip
- ✅ Some policies require this for pre-existing condition coverage
9. Traveling to high-risk destinations
Scenario: Journalist traveled to Syria (State Department Level 4: Do Not Travel) for work. Kidnapped, ransom paid, medical treatment after release ($250,000 total).
Claim denied because:
- Syria is Level 4 "Do Not Travel" destination
- Policy excluded coverage for Level 3/4 destinations
- Even specialized adventure policies exclude war zones
How to avoid:
- ✅ Check State Department travel advisories
- ✅ Know your policy's destination restrictions
- ✅ Level 3/4 destinations often excluded
- ✅ Special policies exist for journalists/humanitarian workers (but very expensive)
Travel advisory levels:
- Level 1: Exercise Normal Precautions (covered)
- Level 2: Exercise Increased Caution (usually covered)
- Level 3: Reconsider Travel (often excluded, sometimes requires rider)
- Level 4: Do Not Travel (almost always excluded)
10. Misrepresentation on application
Scenario: Gary failed to disclose heart attack from 2 years ago when applying for insurance. Had another heart attack in Italy ($120,000).
Claim denied because:
- Application asked: "Have you had a heart attack in past 5 years?"
- Gary answered "No" (knowing it was false)
- Insurer obtained medical records proving prior heart attack
- Misrepresentation voids policy entirely
How to avoid:
- ✅ Answer all questions truthfully
- ✅ Disclose ALL pre-existing conditions
- ✅ Don't omit information hoping they won't find out
- ✅ Fraud voids policy AND you may have to return any prior claim payments
What counts as misrepresentation:
- Lying about age
- Hiding medical conditions
- False trip cost information
- Incorrect trip dates
- Omitting relevant information
Partial denials: When they pay some, not all
Common partial denial scenarios:
1. Per-item limits on baggage Claim: $3,000 camera equipment lost Paid: $800 (policy had $400 per-item limit × 2 items)
2. Depreciation applied Claim: $2,000 laptop stolen Paid: $1,200 (40% depreciation on 3-year-old laptop)
3. Deductible applied Claim: $5,000 medical emergency Paid: $4,750 ($250 deductible subtracted)
4. "Reasonable and customary" limits Claim: $50,000 hospital bill Paid: $35,000 (insurer deemed $15k "unreasonable" for that treatment in that location)
How to appeal denied claims
Step 1: Request written denial
Ask for denial in writing with specific policy language cited
Step 2: Review your policy
Verify the denial is actually correct based on policy terms
Step 3: Gather additional documentation
Often denials are due to missing info, not actual exclusions
Step 4: Write formal appeal
Include:
- Policy number
- Claim number
- Why you believe claim should be covered
- Additional documentation
- Specific policy language supporting your case
Step 5: Escalate if needed
- State insurance commissioner
- Better Business Bureau
- Legal action (for large claims)
Success rate: 20-30% of appeals succeed with additional documentation
Prevention checklist
Before you file a claim, verify:
- [ ] You bought insurance before the insured event
- [ ] You're filing within the claim deadline
- [ ] You have all required documentation
- [ ] The reason for claim is covered by your policy
- [ ] You weren't intoxicated (if injury claim)
- [ ] You disclosed all relevant medical conditions
- [ ] Your activity was covered (not excluded)
- [ ] You weren't traveling against medical advice
- [ ] Destination wasn't under travel warning when you departed
Red flags that increase denial risk
🚩 Bought insurance days before departure 🚩 Didn't read exclusions section 🚩 Have pre-existing conditions but no waiver 🚩 Injured during adventure activity 🚩 Filed claim months after incident 🚩 Missing receipts/documentation 🚩 Alcohol involved in incident 🚩 Traveling to high-risk destination 🚩 Reason for cancellation is "I changed my mind" 🚩 Lied on insurance application
Statistics on claim denials
Denial rates by claim type (industry estimates):
- Trip cancellation: 15-20% denied
- Medical claims: 10-15% denied
- Baggage claims: 25-35% denied (often due to lack of documentation)
- Travel delay: 20-30% denied (missed filing deadlines, insufficient delay time)
- Medical evacuation: 5-10% denied (rigorous medical necessity review)
Top 3 denial reasons:
- Insufficient documentation (30-40%)
- Pre-existing conditions without waiver (20-25%)
- Excluded activity/circumstance (15-20%)
Next steps
- Read your policy exclusions before traveling
- Keep all receipts and documentation while traveling
- File claims promptly (within 30 days ideal)
- Be honest on insurance applications
- Add riders for adventure activities
- Buy early (within 14 days of booking) for maximum coverage
Travel insurance works—when you understand what's covered and avoid common denial triggers. Prevention is far better than appeals.