Travel Insurance Medical Claim Dispute: What to Do Next

Reviewed on: 2026-05-30.

• Insurance Ombudsman
• Bima Bharosa
• IRDAI

• Pre-Existing Disease Claim Rejection: How to Reply to Insurance Company

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When your travel insurance claim for medical expenses abroad is rejected or underpaid, here is the complete guide:

1. Step 1: What is travel insurance? (a) travel insurance covers medical emergencies, trip cancellation, baggage loss, and other risks while traveling abroad (the policy is typically for the duration of the trip — from a few days to a year), (b) medical coverage includes: (i) hospitalisation expenses (room, surgery, medicines, diagnostics), (ii) outpatient expenses (doctor visits, pharmacy — up to the policy limit), (iii) emergency medical evacuation (to India or the nearest adequate medical facility), (iv) repatriation of remains (in case of death abroad), © the coverage is subject to: (i) the policy limits (e.g., $50,000, $100,000, $500,000 — depending on the plan), (ii) the deductibles (e.g., $100 deductible — the first $100 is paid by the insured), (iii) the exclusions (pre-existing conditions, adventure sports, self-inflicted injuries — unless declared and covered).
2. Step 2: Common claim disputes. (a) pre-existing condition exclusion (the insurer says the condition was pre-existing — and rejects the claim, even if the condition was not known or was stable), (b) insufficient documentation (the insurer says the documents are insufficient — but does not specify what is missing), © cashless claim denied (the hospital says the cashless facility is not approved — and you have to pay out of pocket and claim later), (d) claim amount reduced (the insurer pays only part of the claim — citing “policy terms” or “reasonable charges” without explanation), (e) delay in claim settlement (the claim is not settled for months — the insurer keeps asking for more documents), (f) emergency medical evacuation denied (the insurer says the evacuation was not “medically necessary” — or that the nearest facility was adequate).
3. Step 3: How to file a claim. (a) notify the insurer immediately (call the 24×7 helpline — get a claim reference number), (b) collect all documents: (i) hospital bills (itemised — with date, procedure, and amount), (ii) medical reports (discharge summary, lab reports, doctor's notes — translated into English if in another language), (iii) prescription and pharmacy bills (with the doctor's prescription), (iv) travel documents (passport, visa, boarding pass — to prove you were traveling), (v) police report (if the medical emergency was due to an accident — a police report is required), © submit the claim within the policy timeline (typically 30 days of return to India — or 30 days of discharge, whichever is later), (d) keep copies of all documents (and the claim submission proof — courier receipt or email acknowledgement).
4. Step 4: Claim rejected — what to do. (a) demand a written rejection letter (the insurer must provide a written rejection — with the specific clause and the reason for rejection), (b) review the policy (check the specific clause cited — and whether the rejection is justified), © gather additional evidence (if the insurer says “pre-existing condition” — get a doctor's certificate stating the condition was not pre-existing, or was stable and did not contribute to the emergency), (d) file a representation (with the additional evidence — request the insurer to reconsider the claim), (e) timeline: the insurer must respond within 30 days of the representation (if the insurer does not respond — the claim is deemed to be admitted).
5. Step 5: File RTI. File RTI with the insurance company (if PSU — e.g., New India Assurance, Oriental Insurance, United India Insurance) asking for: (a) the status of claim number [number] filed on [date] (policy number: [number], insured: [name]), (b) whether the claim has been processed (if yes: provide the settlement amount and date — if no: the reason for delay), © the specific policy clause cited for rejection (provide the clause number and the full text), (d) whether a claim surveyor was appointed (if yes: provide the surveyor's report — including the surveyor's recommendations), (e) the claim settlement ratio of the company for travel insurance (for the last financial year — total claims received, settled, rejected).
6. Step 6: Escalation. (a) file a complaint with the Insurance Ombudsman (the Ombudsman can settle claims up to Rs 50 lakhs — the process is free and does not require a lawyer), (b) file a complaint with IRDAI (the regulator — through the IGMS portal: bimabharosa.irdai.gov.in), © file a consumer complaint (the rejection or delay is a deficiency of service — the consumer forum can order the insurer to pay the claim with interest and compensation), (d) file a civil suit (the court can order the insurer to pay the claim — with interest, compensation, and costs), (e) file a criminal complaint (if the insurer has committed fraud — e.g., deliberately suppressing documents, falsifying the surveyor's report — it is cheating under BNS Section 318).
7. Step 7: Interest and compensation. (a) the insurer is liable to pay interest on the delayed claim (typically 8-12% per annum — as per the IRDAI guidelines or the court's discretion), (b) the consumer forum can award compensation for harassment (Rs 10,000-50,000 — depending on the delay and impact), © the consumer forum can award compensation for mental agony (Rs 25,000-1,00,000 — if the insurer's conduct was particularly egregious), (d) Example: Claim $10,000 (Rs 8,30,000) + interest Rs 50,000 (6 months at 12%) + compensation Rs 25,000 + costs Rs 15,000 = Rs 9,20,000.

See Travel Insurance Claim and Find PIO.