All About Claims

You hope you never have to file a claim, but if you do you know that you're going to have to submit some required information to the insurer in order to be reimbursed for your loss.

Filling out paperwork is never fun. But just how onerous is the process? Here's some fairly representative claims forms from two insurers covering two different types of losses:

Insurer:  CSA    Type of loss: Cancellation of the trip due to medical reasons

Insurer:  CSA    Type of loss: Medical expenses incurred during the trip

One nice feature of the CSA form for medical expenses is page (2) -- the affidavit of no insurance. CSA offers "secondary" medical coverage which only pays after any other valid insurance you may have has paid its part. Say you're on Medicare which everyone knows is not going to cover your medical expenses while vacationing in Brazil. With most secondary insurers still you have to submit your claim information to Medicare anyway, wait far a denial of coverage from them, then submit the denial along with the rest of the paperwork to the travel insurer. CSA lets you skip that step by signing this form. Just be 100% sure that your regular health insurer won't cover the bill (or your Medicare Supplemental policy if you have one) -- oftentimes they actually will and you might not know it. And insurers have ways of checking on this.

Insurer:  Travelex   Type of loss:  Cancellation of the trip due to medical reasons
Here's the separate information describing the required documentation

Insurer:  Travelex   Type of loss:  Medical expenses incurred during the trip
Here's the separate information describing the required documentation

So how long does it take to fill these forms out? We put a stopwatch to it and were able to fill out any of these forms in ten minutes or less IF we've rounded up all of the required documentation and have it ready to go. That's a big "if".

It is your responsibility to obtain all of the information required by the insurer's claims department. If you neglected to get some paperwork from that doctor in Bangkok that stitched up your finger don't expect the insurer to round it up for you and don't expect them to process the claim without it. Neither is going to happen.

How do you know what paperwork you're going to need? If you're cancelling your trip that's not a problem -- get the claims forms and they will spell out what you need. But if the loss occurs during your trip be sure to call the insurer's 24-hour assistance phone number and go over with them the circumstances of your loss and the paperwork you'll need to get right then before you leave the doctor's office, or airport, or police station. We even know of some travelers who will get all of the claims information they might need during their trip before they depart so there's no confusion if something happens that might turn into a claim.

Note that some insurers put a time limit on how long you can delay filing your claim from the date of the loss. This can vary by your state of residence and type of claim.

Get it right the first time! If you have any questions about the paperwork or the claims process in general be sure to call the insurer's claims department for a clarification. There's nothing more frustrating than sending everything in only to be contacted a week or two later with the news that something is missing or wrong.

What if a claims decision doesn't go your way? You will be notified by mail that your claim was denied or reduced and it should include information about what your options are from that point on. Many claims are resolved in the clients favor just by submitting some additional documentation or clarifying information that was already submitted so don't hesitate to call the claims person and find out exactly what the problem is.

If you bought your policy through a travel agent or through one of the online comparison sites you might want to contact them to see if they can help. There are many circumstances where a claim falls into a gray area -- the plan wording doesn't really say it's covered but it doesn't say it isn't covered either and a reasonable person could see it either way. Maybe your travel agent sends the insurer thousands of clients every year and goes to bat for you. The claims department just might see a way to pay your claim -- not to make you happy, but to keep the travel agency happy. Unless you bought your policy directly from the insurer itself, someone made a commission on it. Make them earn it.

If a claims dispute can't be resolved by having it reviewed by a supervisor or other internal process the insurer might have, you'll usually be given the option of having your claim reviewed by an independent arbitration service. And as a last resort you always have the option of appealing the denial to your state's department of insurance. They do a good job of making sure that their residents are treated fairly in these matters. If they disagree with the insurer probably 99% of the time it will be resolved right then -- no insurer wants to get into a war with a department of insurance over your claim. And if they agree with the insurer at least you'll know that you were treated fairly and correctly.

If you're mailing in the claims information be sure to keep copies of everything and be sure to spend an extra dollar or two to send it by some method that requires a signature at the insurer's end.

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