Claims

A claim is the actual notification you give the insurance company that a covered event has happened.

For Emergency Medical Travel Insurance, the event would be the onset of an accident, injury or sickness. In Trip Cancellation, for example, the event is the reason to cancel or interrupt your trip e.g. a snow storm that makes you miss your flight, or a sickness that forces you to come back from your trip before planned.

Most insurance companies will require that you notify them immediately a covered event that can originate a claim has occurred, especially if it is medically related. Many insurers will even limit your coverage if you fail to notify them before you are hospitalized or major tests are done.

It is in your best interest to contact your insurance company when you incur in a loss.

Once the event happens and you contact (call) the insurance company to notify them, the agent that takes your call will open a claim: she will create a file where all the information relative to you and the event will be registered. Some of the information that you can find in a claim file is:

  • The policy number;
  • your name and/or name of the caller;
  • date the event happened;
  • details of the event;
  • date the claim was opened (for medical emergencies it should be on the same date of the event);
  • medical files (if applicable)
  • comments of conversations between you and the company through its authorized agents,
  • etc.

A claim can be paid directly to the service provider, e.g. the hospital, or reimbursed to you; it depends on the type of claim and the specific situation. In some cases, hospitals in small cities or walk-in clinics will want you to pay up front. The insurance company cannot guarantee that they will pay directly as it depends on the service provider.

To process your claim, insurance companies will require proof of the expenses you made, for example: a doctor’s consultation receipt, prescriptions, etc. For Trip Cancellation/Interruption they might ask you to get a letter from the airline stating the delay; or if your bags where stolen from a hotel, you will have to get a police report.

Golden rule for opening a claim: Be sure to keep original receipts of all expenses: medical bills, prescriptions signed by the doctor, etc. Copies are not accepted. You also want to make all that is necessary to provide the documentation required by the insurer. Claims can take several weeks to be processed. Incomplete files can stretch the process to months of waiting before you get your compensation money. Verify that you have all the required documentation before you send it to avoid any delays.

TIP! Make your own claim file with a detailed list of the documents you sent to the insurance company and a copy of each one.

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