Travel Insurance Claim Denied: What to Do Step by Step

If your travel insurance claim is denied, do three things in order. Read the explanation of benefits to find the exact reason and the policy clause behind it. File a written appeal with new evidence inside the deadline in your certificate, which is 90 days on the carrier documents we reviewed. If the insurer upholds the denial and you still believe it is wrong, complain to a state insurance department and review the dispute clause in your policy.

Key facts at a glance

• WorldTrips says in its Atlas Travel description of coverage that a written appeal must be submitted within 90 days from the later of the date the claim was denied or the termination date of the policy.
• IMG's 2026 Patriot America Plus certificate gives 90 days from the date the notice of denial was mailed, and says IMG will respond in writing within 90 days of receiving the appeal.
• WorldTrips allows a second appeal, reviewed by medical or claims personnel who were not involved in the original decision or the first appeal.
• IMG requires an appeal before any legal action, and bars any action more than 3 years after the time written proof of claim was required.
• The WorldTrips wording sends disputes to binding individual arbitration unless you opt out in writing no later than 60 days after the last day of your certificate period.
• According to the National Association of Insurance Commissioners, filing a complaint with a state insurance department is free, and the department forwards it to the insurer, which must respond.

What should you do first when a travel insurance claim is denied?

Find the reason in writing. The insurer sends an explanation of benefits, often shortened to EOB, for each claim line. It shows the billed amount, the amount allowed, what was paid, and a remark or reason code for anything refused. A denial letter may follow with the policy clause relied on.

Then sort the denial into one of three kinds, because each needs a different response.

• Pended, not denied. The insurer is waiting for something, usually medical records or a signed form. This is fixed by sending the item, not by appealing.
• Denied on the facts. The insurer believes the condition was pre-existing, the acute onset conditions were not met, or precertification was missing. These can be appealed with evidence.
• Denied on the contract. The service is excluded, such as a routine checkup, or the claim falls outside the policy dates. An appeal rarely changes these.

If the reason is unclear, call and ask which provision the decision rests on and what document would change it. Note the date, the name of the person and what was said. Our article on why travel insurance claims get denied explains each reason and the rule behind it.

How long do you have to appeal a denied claim?

Check your own certificate, since the clock starts at different points. Under the WorldTrips Atlas wording the written appeal is due within 90 days from the later of the denial date or the policy termination date. Under IMG's Patriot America Plus certificate it is 90 days from the date the notice of denial was mailed to your last known address.

That last detail matters for visitors. If the traveler has gone home and the letter went to a US address, the 90 days are already running. Update the mailing and email address with the insurer as soon as a claim is open, and check the online member portal for letters.

A pending records request has its own limit. IMG's certificate gives 60 days from the date of a request for medical records or additional documents, after which previously submitted and later claims will be denied. Treat every request as a deadline.

How do you write an appeal that gets a real review?

An appeal is a written request to reconsider, with reasons and documents. WorldTrips says it must identify the claim and specify the reasons for the appeal with supporting documentation. IMG says its review will take into account all comments, documents and records you submit, whether or not they were considered in the first decision. New evidence is therefore the heart of a good appeal.

• Quote the denial. Copy the reason and clause from the EOB or letter word for word, so the reviewer answers that point.
• Give a dated timeline. Arrival date, policy effective date, first symptom, first treatment, admission and discharge.
• Answer the specific reason. For a pre-existing denial, supply home country records showing no diagnosis, symptoms or treatment for that condition in the look back period.
• Add a physician letter. Ask the treating doctor to state the diagnosis, when it began, and why it was sudden and unexpected, if that is the case.
• Show the 24 hour window. For acute onset, document the time symptoms began and the time care started.
• Explain any precertification gap. If the admission was an emergency, show when the insurer was first contacted.
• State what you want. Ask for the claim to be reprocessed and paid under the named benefit, and ask for a written decision.

Keep the tone factual. Send copies, never originals, and use a method that gives proof of delivery. WorldTrips accepts appeals online, by email or by post. IMG's certificate gives a postal address for its benefit review team.

What if the insurer upholds the denial?

You may have another internal step. WorldTrips allows a second appeal after its response to the first, reviewed by personnel who were not involved earlier, and then issues a final determination. IMG's certificate refers to exhaustion of one appeal before any legal action. Decisions about precertification have their own appeal route in the IMG certificate.

Use the second step only if you can add something: a record that was missing, a clearer physician statement, or a specific error in how the clause was applied. Repeating the first letter rarely changes the outcome.

Can you complain to a state insurance department about a travel medical plan?

Yes, and it costs nothing. The National Association of Insurance Commissioners advises trying to resolve the problem with the insurer first, then filing with your state department of insurance. Its guidance says to include your policy number, bills, a dated account of events, the policy language you rely on and the outcome you want. The department forwards the complaint to the insurer, which must respond.

Be realistic about what this achieves. Many visitor and travel medical plans are issued under a master policy held outside the United States. The WorldTrips wording, for example, names a Cayman Islands insurer and trust. A state regulator's authority over that kind of arrangement can be more limited than over a domestic health insurer, and outcomes vary by state. A complaint still creates a record and often prompts a second look, so it is worth filing in the state where the traveler stayed or where the policy was bought.

Is arbitration or court an option for a denied travel claim?

The policy decides the forum. The WorldTrips Atlas wording provides for final and binding individual arbitration under JAMS rules, with a right to opt out by written notice postmarked no later than 60 days after the last day of the certificate period. IMG's certificate requires an appeal first, sets venue in Indiana, and allows no action more than 3 years after proof of claim was required.

These clauses are technical and the amounts at stake can be large. This article is general information, not legal advice. For a substantial hospital claim, speak with an attorney who handles insurance disputes before a deadline passes.

What about the hospital bill while the appeal is pending?

The provider's billing cycle does not pause for your appeal. Tell the hospital billing office in writing that the claim is under appeal and ask it to hold the account. Request a fully itemized bill and check it for duplicate or incorrect charges. Ask about the hospital's financial assistance policy and self pay rates. The medical cost estimator gives a reference point for typical charges.

To make the appeal itself easier, download our free Claim Appeal Letter Template below. It lays out the sections a reviewer needs, in order, so you only have to fill in your own facts and attach the evidence.

How to get covered

If a denial has shown that the current plan does not fit the traveler, compare alternatives before the next trip or before an extension. Enter age, home country and dates on the visitor insurance quote page to compare plans on Ombrela, and read the acute onset and precertification terms for each. Our guide on how to file a visitor insurance claim covers the first submission.

Frequently Asked Questions

How do I appeal a denied travel insurance claim?

Send a written appeal to the insurer within the deadline in your certificate. Identify the claim, quote the denial reason, explain why it is wrong, and attach supporting documents such as medical records and a physician letter. Both WorldTrips and IMG set a 90 day window in the documents we reviewed, counted from slightly different starting points.

How long does a travel insurance appeal take?

It varies by carrier and by how complete your documents are. IMG's 2026 Patriot America Plus certificate says the company will respond in writing as soon as reasonably practicable, and in any event within 90 days from receiving the appeal. Sending every record with the first letter avoids a further request and a longer wait.

Can a denied pre-existing condition claim be overturned?

Sometimes. The appeal has to show either that the condition did not exist during the look back period, or that the event met every condition of the acute onset benefit, including treatment within 24 hours and the age limit. Home country medical records and a clear statement from the treating physician are the evidence that carries weight.

Who regulates travel medical insurance complaints in the USA?

Insurance is regulated by the states, and each state has an insurance department that accepts consumer complaints at no cost. The National Association of Insurance Commissioners links to every state's complaint page. Plans issued under an offshore master policy may sit partly outside a state regulator's reach, so results differ, but filing is still worthwhile.

A denial is a decision you can test, as long as you act inside the deadlines. Start with the written reason, build the appeal around evidence, and escalate in order. For future trips, compare visitor insurance plans on Ombrela with the terms that caused the dispute in mind.