In­sure against claim re­jec­tions

Of­ten travel agents and tour op­er­a­tors pay lit­tle or no at­ten­tion to travel in­sur­ance and it is looked upon as an obli­ga­tion. Here are some points that agents should in­form their clients to avoid their travel in­sur­ance claim from get­ting re­jected.

TravTalk - India - - GUESTCOLUMN - Sukhesh Bhave Deputy Vice Pres­i­dent (Ac­ci­dent & Health Claims) SBI Gen­eral In­sur­ance

Plan­ning a va­ca­tion for clients can some­times get stress­ful in an ef­fort to make it per­fect and mem­o­rable for them. How­ever, many travel agents and tour op­er­a­tors pay lit­tle at­ten­tion to a cru­cial el­e­ment – travel in­sur­ance – which is of­ten ac­quired more as an obli­ga­tion than as a pro­tec­tive cover against risks in­volved in trav­el­ling on a for­eign land. Worse, your client could get a shock when their claim gets re­jected due to their care­less­ness in deal­ing with the pol­icy. Here are some cir­cum­stances un­der which their travel in­sur­ance claim can get re­jected that you, as the ser­vice provider, can help them un­der­stand. In­cor­rect in­for­ma­tion:

One of the ma­jor rea­sons to af­fect claims set­tle­ment is in­ac­cu­rate in­for­ma­tion fur­nished by the claimant while ex­plain­ing the cir­cum­stances un­der which the loss/dam­age has oc­curred. For ex­am­ple, if the in­sured has in­curred a loss due to ne­glect (leav­ing valu­ables on dis­play in car or bag­gage kept unat­tended or un­locked etc), it may re­sult in non-set­tle­ment. Sim­i­larly, if the in­sured gets in­volved in an ac­ci­dent un­der the in­flu­ence of al­co­hol or any in­tox­i­cat­ing drugs, the in­sur­ance com­pany can re­ject the claim. If the in­sured - while ap­ply­ing for in­sur­ance - has not an­swered all ques­tions truth­fully and ac­cu­rately, the claim can be re­jected later on. Un­de­clared med­i­cal con­di­tions:

Of­ten, we gloss over the need to de­clare ex­ist­ing med­i­cal con­di­tions in the in­sur­ance form. How­ever, this could prove a costly mis­take. In case the ex­ist­ing med­i­cal con­di­tion leads to an ac­ci­dent or fall­ing sick in the tran­sit, you could end up pay­ing your own money for the treat­ment with­out any re­im­burse­ment. Ex­clu­sions in the pol­icy:

You will have to look for ex­clu­sions in ev­ery pol­icy and judge whether you need them or not. These are the most com­mon rea­sons for in­ter­na­tional travel in­sur­ance claims get­ting re­jected. Trav­ellers mostly buy a pol­icy by merely sign­ing and pay­ing the pre­mium rather than read­ing a sin­gle line though they will take ex­treme care to fill up other travel doc­u­ments such as visas. Hence, it is ad­vis­able for clients to un­der­stand the terms and con­di­tions of a pol­icy be­fore buy­ing one to avoid any un­pleas­ant sur­prises. Miss­ing doc­u­men­ta­tion:

When the client files a claim, en­sure that it is sub­stan­ti­ated with enough proof such as copy of bills and re­ceipts (es­pe­cially if it is a med­i­cal emer­gency), prov­ing that they have availed the ser­vices. More­over, they may fur­nish or keep ready con­tact de­tails of the doc­tor who treated them. Ad­ven­ture ac­tiv­i­ties:

If the clients in­jure them­selves while in­dulging in an ad­ven­ture sport, the claim is un­likely to be en­ter­tained as ma­jor­ity of poli­cies are un­clear re­gard­ing which sports should be cat­e­gorised as ad­ven­ture sports and a risk to life. Trav­el­ling against in­ter­na­tional ad­vi­sory:

For­eign and Com­mon­wealth Of­fices (FCO) and World Health Or­gan­i­sa­tion (WHO) have a list of lo­ca­tions and places that are termed risky or un­safe for travel. If your clients are plan­ning a va­ca­tion to such black­listed ar­eas, an in­sur­ance claim will be re­jected out­right. Claim­ing be­yond a time frame:

In­sur­ance com­pa­nies usu­ally ex­pect trav­ellers to file a po­lice re­port or seek med­i­cal as­sis­tance within 24 hours for their claim to be viewed as valid. Thus, a prompt record of the same on pa­per can get them faster re­im­burse­ment. Chang­ing rules:

The in­sur­ance com­pany will mod­ify or al­ter rules as per reg­u­la­tory or in­ter­nal guide­lines. Trav­ellers must read and un­der­stand the terms and con­di­tions. The in­sur­ance com­pany may be well within its right to re­ject the claim but if clients feel ag­grieved with the de­ci­sion, they have a right to com­plain.

They must check de­tails of their pol­icy to see if the ex­pla­na­tion of­fered by the com­pany is a valid rea­son for the re­jec­tion. Some­times, poorly ex­plained doc­u­ments can ham­per their claims. ( The views ex­pressed are solely of the au­thor. The publi­ca­tion may or may not sub­scribe to the same.)

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