Why didn't that claim get paid?

Posted Date: 08 September 2017
Claims misunderstandings

We took a look at some examples we found from around the world and unpicked what we think went wrong with their insurance.

We purchase travel insurance so that if anything unexpected happens on holiday we’re covered, right? So where do the stories of travel insurance not paying come from?

Sometimes it’s because people don’t understand what’s included in their cover, so that’s why it’s really important to read the policy wording and choose an insurance policy that provides sufficient cover for your needs.

Sometimes there can be things that travellers can do to try and not have their claim turned down. To make things easier, we’re decoding some of the stories we’ve heard so you can avoid a bad experience.

My bag was stolen, but they won’t pay!

Here’s the scenario: A traveller returns home after having had his bag stolen on-board a train. He did everything right; the bag was placed in the luggage rack where he could see it, his valuables were kept hidden away and not obvious, he made a police report as soon as he could after he discovered his bag was missing.

When he got back home, this traveller filed a claim for the items that were stolen and included a scanned copy of the receipt.

So why didn’t his claim get paid?

This traveller’s scanned receipt showed signs of tampering, and further investigation showed he had added two extra items to it so he could get a higher pay out.

The total claim, without the extra items added, was around $400, but for the sake of an extra $100 his claim wasn’t covered.

It might seem harmless - adding a couple of extra items for a little ‘perk’ in your pay out – but it’s not. This can be considered as being fraudulent.

It also means he missed out on a legitimate claim being paid out. It’s a shame, because he had done everything else right, and chances are that he would be on his way to purchasing new items.

What should you do?

Although this one seems obvious, there are a few main points to take away from this:

  • If your stuff is stolen, report it to authorities as soon as possible.
  • Try and get a police report within 24 hours of the incident and keep any paperwork.
  • If you’re going to claim you’ll need original receipts, or store printed copies.
  • Always be completely honest on all insurance forms. This includes what you’re claiming for and its true value.

They won’t pay for my medical bill, but they paid for his!

Two unrelated travellers go away to the USA, both with the same travel insurance. Unfortunately, both travellers suffer heart attacks on holiday and are rushed to hospital. They both provide their insurance details to the hospital and receive care.

Luckily, these travellers make full recoveries and return home safe. They both make claims upon their return and submit their receipts and documentation from the respective hospitals.

While one claim was paid in full, the other claim was rejected.

So why did only one claim get paid?

The declined traveller had stated on his insurance application that he did not have any pre-existing conditions to declare, when in fact he did.

Even though it’s up to the traveller whether they want to disclose any pre-existing medical conditions, (as long as the condition isn’t a heart, vascular or lung related illness, or type 2 diabetes) it is important to understand that if they choose not to, they’re not covered for any unexpected medical problems that may arise in relation to the pre-existing condition.

Disclosing a pre-existing condition does mean that the premium price goes up, but it’s far better to pay a bit more to cover existing conditions, than to be stuck with a huge medical bill.

What should you do?

  • Always be careful to disclose all relevant information when filling out any insurance forms.
  • It’s your choice whether you want to disclose any pre-existing medical conditions. However, it’s important to know that if you choose not to disclose the condition, or choose not to pay the extra medical premium for cover, then you won’t be covered for that particular issue, or any unexpected health issues resulting from that problem.
  • If your existing condition is related to Heart, Vascular or Lung illness, or Type 2 Diabetes, you must disclose it on your application.
  • Always keep any paperwork from hospitals, doctors, or medical professionals while you’re away. You’ll need them to make a claim.
  • We offer no excess on covered medical claims, so if you’re not well, seek medical care.

They told me the flight was cancelled, so why isn’t it covered?

A couple are heading away on an overseas vacation. When they get to the airport, their flight is delayed. Another passenger tells them that the flight is cancelled and the next available flight is 48 hours away.

Understandably, the couple are really disappointed and decide to cancel their entire trip based on the other passengers comments. It’s a shame they have to miss out on their holiday, but at least they can claim it back… right?

So why didn’t this claim get paid?

This one is a real shame, because the travellers took advice from someone they considered a reliable source of information, but didn’t contact the people who were actually insuring them.

If only they’d been in touch with their insurance company or waited for official word from the airline. The flight ended up being delayed by 10 hours instead of cancelled.

The problem would have been easily solved by just getting in touch with the insurance company to find out what they were covered for and what steps they needed to take. It’s never a good idea to make a decision based on assumptions, that’s why you should always check with the insurer first.

What should you do?

  • Always get in touch with your insurer if you’re changing your plans or unsure whether you’ll be covered.
  • Don’t rely on word of mouth. If your flight is cancelled, you should wait for official notice from the airline. They will usually also offer an alternative flight or refund, so you’ll only need to claim for accommodation or other prepaid costs if you do need to change plans.
  • Keep all relevant documents in the event of a flight cancellation or major delay so you can make a claim.

Final words:

If you're ever in doubt, keep in touch with your insurance company. It's best to check with them before you make any big decisions, as they'll be able to give you advice on your particular situation.

If you’re after any further info about what we cover at Southern Cross Travel Insurance, check out our policy wording here.

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