Why Travel Insurance Claims Get Denied (And How to Make Sure Yours Doesn't)
This article contains affiliate links. I partner with TuGo because their "Medical Questionnaire" model minimizes the post-claim underwriting risks detailed below.
You bought the policy. You paid the premium. You assumed you were covered.
Then you filed a claim and discovered you weren't.
The denial letter cites something you forgot, something you didn't think mattered, something your doctor never even told you. A medication adjustment three months ago. A test you were waiting on. A "stable" condition that wasn't stable by the insurer's definition.
This isn't bad luck. It's how the system works.
Travel insurers don't investigate your medical history when you buy. They investigate when you claim. That gap—between application and adjudication—is where coverage vanishes. The premium they collected assumed your answers were accurate. If they weren't, the contract unravels.
The good news: this is preventable. Full, precise disclosure at the application stage is the single most effective way to ensure your claim gets paid.
How Post-Claim Underwriting Works
Investigating every applicant for a $50 travel policy is economically impossible. So insurers accept applications based on the presumption of honesty, then reserve the cost of investigation for the small percentage of policyholders who file large claims.
When you submit a significant claim—hospitalization, evacuation, anything over a few thousand dollars—the process shifts from "processing" to "investigation." The adjuster's job is now to verify that the risk they're being asked to pay for was accurately described when you applied.
They'll request your medical records. Your pharmacy history. Notes from your GP covering the past one to two years. They're cross-referencing your application answers against the documented record.
If there's a discrepancy—you said "No" to a question the records say should have been "Yes"—the claim is denied and your premiums refunded. The contract is treated as if it never existed.
The Databases They Check
When you sign a claim authorization, you're granting access to more than your family doctor's notes.
Medical Information Bureau (MIB): A shared database among insurers containing codes for medical conditions, hazardous activities, and risk factors reported during previous insurance applications. If you disclosed a heart condition to a life insurer five years ago but denied it on your travel application, they'll find it.
Pharmacy records: In Canada, provincial databases like PharmaNet track every prescription dispensed. In the US, Pharmacy Benefit Managers hold the same data. If your application says your condition was "stable" but the pharmacy records show a new prescription filled three days before departure, the stability claim is objectively disproven.
Foreign hospital admission notes: When you're hospitalized abroad, the admitting doctor asks what medications you take and what conditions you have. Your answers go into the medical record. If you tell the foreign doctor about a condition you didn't disclose on your application, the insurer will use your own words against you.
The "I forgot" defense doesn't survive this level of data access.
If an insurer questions your history while you are in a foreign hospital, you need to prove them wrong immediately.
Access Your Records: I keep digital copies of my own medical history in the cloud. I use NordVPN to access them securely on hospital WiFi so I can show the treating doctor exactly what my history is—preventing them from writing down incorrect info that could hurt my claim later.
Stay Connected: You cannot negotiate with an adjuster if you can't make a call. I use Airalo eSims to ensure I have a direct line to my insurer 24/7.
The Stability Clause Trap
The "pre-existing condition exclusion" is expected. The "stability clause" is where most travelers get caught.
Policies define a condition as "stable" if, during a lookback period (typically 90-180 days before departure), none of the following occurred:
New symptoms or worsening of existing ones
Medical consultations for the condition
Referrals for testing, waiting for tests, or receiving results
Any change to medication—including dosage adjustments
That last point is the trap.
Dosage decreases count as changes. Clinically, lowering your blood pressure medication because you lost weight is a sign of improved health. Contractually, it's a change that resets the stability clock to zero. If you reduced your dosage 30 days before departure and suffer a related event abroad, the claim is denied.
Pending tests break stability. If your doctor ordered an MRI "just to be safe" and you travel before getting results, you're traveling with an "undiagnosed symptom under investigation." Any claim related to that symptom will be denied.
Routine checkups are fine—unless they lead to something. A checkup where nothing changes doesn't break stability. A checkup that results in a referral, a new prescription, or a "let's monitor this" note in your file does.
The insurer's definition of "stable" is not your doctor's definition. Read the policy wording.
The Solution: Forced Honesty
The reason I recommend TuGo Travel Insurance is specifically because of their Medical Health Questionnaire.
Unlike "tick-the-box" credit card plans that ask three vague questions, TuGo forces you to answer detailed questions about your history before you buy. This is a feature, not a bug. It eliminates the "I forgot" risk. By declaring your history upfront, you ensure the policy you buy actually covers the body you have.
➜ Get a Quote (Canadian Residents Only)
What a Denial Actually Costs
A denied claim isn't an inconvenience. It's financial exposure to the full, unsubsidized cost of foreign healthcare.
US hospitalization: A cardiac admission runs $10,000-$20,000 per day. Complex surgeries exceed $200,000. One Ontario woman incurred $600,000 USD in Florida medical bills after her claim was denied over a heart condition disclosure issue.
Medical evacuation: A private air ambulance from the Caribbean to Florida costs ~$20,000. From Asia or Europe to North America: $100,000-$200,000. If your claim is denied, the evacuation company requires upfront payment. If you can't pay, you're stranded.
The debt follows you home. US hospitals use collection agencies with international reach. They report to Canadian credit bureaus, sell debt to Canadian collectors, obtain US court judgments and apply to Canadian courts for enforcement. "Foreign debt stays foreign" is a myth.
The Three Categories of Disclosure Failure
When investigation reveals a discrepancy, the insurer categorizes it:
Fraudulent misrepresentation: You knew the statement was false and made it intentionally. The policy is void. You may be placed on industry watchlists. Future coverage becomes nearly impossible.
Negligent misrepresentation: You didn't intend to deceive but failed to exercise reasonable care—rushed through the application, misunderstood a question, forgot a medical event. If the error was "material" (affected the risk assessment), the claim is still denied. Lack of malice doesn't save the policy.
Innocent misrepresentation: You answered incorrectly but honestly believed the answer was true. This is legally contested territory. Some policies explicitly cover innocent errors; most don't. If the fact was highly material, the policy may still be rescinded.
The takeaway: intent matters less than accuracy. An honest mistake about a material fact still kills your claim.
How to Protect Yourself
Disclose everything. When in doubt, disclose. An insurer who knows about a condition and covers you anyway cannot later deny a claim for that condition. The risk is in what you didn't tell them.
Use the policy's definitions, not your doctor's. Read how your policy defines "stable," "treatment," and "change in medication." These are legal terms with specific meanings that may differ from clinical usage.
Don't travel with pending tests. If you're waiting for results or a specialist referral, postpone travel or accept that the condition is excluded. The "under investigation" exclusion is absolute.
Understand the lookback period. Know exactly how many days your policy reviews. If you had a medication change 85 days ago and your policy has a 90-day lookback, you're not yet stable.
Consider a pre-existing condition waiver. Some policies offer waivers that cover existing conditions if you purchase within a specific window (usually 14-21 days of your initial trip deposit) and meet eligibility criteria. This neutralizes the stability trap entirely.
Use a broker for complex health.
If you have a terminal illness, multiple recent surgeries, or a history so complex it won't fit on a form, do not buy online. Call a licensed human broker. If they make a mistake that costs you your coverage, they have professional liability (E&O) insurance to cover the damages—a layer of accountability you don't get when applying on your own.
For everyone else (Standard to High Risk):
If your health is stable but you just need a policy that asks the right questions (so you aren't denied for a "forgotten" fact), I use TuGo. Their automated questionnaire acts like a digital broker, forcing you to verify your history before they issue the policy.
The Bottom Line
Travel insurance isn't a product you buy. It's a contract you qualify for.
The premium gets you in the door. The claim gets investigated. If your application doesn't match your medical record, the contract unravels and you're exposed to costs that can devastate a family's finances.
Full, precise disclosure is the only protection. Not because insurers deserve your honesty—but because the alternative is discovering you're uninsured while lying in a foreign hospital.
I work with TuGo Travel Insurance for travel medical coverage. Their application process is built around proper disclosure—which means when you claim, the coverage is actually there.