Travel insurance exists so that in an unexpected situation abroad you are not left alone with large bills. However, compensation is not paid automatically: the insurer assesses every case against the policy terms, and some claims are rejected. The good news is that most refusals happen for a few typical reasons, and they can be avoided. In this article we look at the most common causes in general terms, without referring to any specific insurer.

The most common reasons for refusal

  • Alcohol and intoxicating substances. If an accident happened under the influence of alcohol or other intoxicating substances, policy terms usually list this as an exclusion. It is not only about severe intoxication - the causal link between the substance and the event can also matter.
  • Undeclared active sports. A standard policy usually covers a calm holiday. Skiing, diving, mountain hiking, riding a scooter and other activities often require additional cover. If it was not purchased, an injury related to such an activity may be left without compensation.
  • Late notification. Policy terms usually set deadlines for reporting the event and submitting documents. The later you apply, the harder it is for the insurer to verify the circumstances, and this can affect the decision.
  • False or incomplete information. Distorted facts in the claim or concealment of significant circumstances is one of the most serious grounds for refusal.
  • Exclusions in the policy terms. Every policy has a list of exclusions: events and expenses it does not cover. They are often related to circumstances already known before the trip, professional sports or travelling against official warnings.
  • Chronic illnesses without additional cover. Standard policies often cover only a sudden, acute illness. An exacerbation of a chronic illness may be covered to a limited extent or only if the appropriate additional cover was chosen.

What the law says

The Latvian Insurance Contract Law (Apdrošināšanas līguma likums) provides that the insured must notify the insurer of the insured event without delay, as soon as possible, take all reasonable measures to reduce the losses and follow the insurer's instructions. If these obligations are breached with malicious intent or through gross negligence, the insurer may refuse the payout; if the duties were breached through ordinary negligence, the compensation may be reduced, but by no more than 50%. Providing misleading information can also affect both the validity of the contract and the compensation. At the same time, the law requires the insurer to justify its decision - you have the right to receive a motivated explanation of the refusal.

How to reduce the risk of refusal

  • Read the terms before the trip, especially the exclusions section and the notification deadlines.
  • Choose cover that matches your plans. If you are going to ski, dive or hike, add active leisure cover when choosing travel insurance.
  • Provide truthful information both when buying the policy and when submitting a claim.
  • Report without delay. Contact the insurer's assistance service at the moment of the event and agree on the next steps, including the choice of medical facility.
  • Keep the documents: doctor's statements, invoices, receipts, police reports, airline certificates.

If the payout is refused anyway

First, request a written, motivated justification of the refusal and compare it with the policy terms. If you believe the refusal is unfounded, submit written objections to the insurer; the dispute can also be resolved out of court or in court. A broker's support also helps - a broker assists with preparing the claim and communicating with the insurer. Read more about the claims procedure in the claims section.

Conclusion: most refusals are not about a "bad insurer" - they follow from policy terms that were not read or obligations that were not fulfilled. Choose cover that matches your plans, be honest and report the event on time - then your chances of receiving compensation increase significantly.

Frequently Asked Questions

How quickly must an insured event be reported when travelling? The Insurance Contract Law requires notifying the insurer without delay, as soon as possible. Policy terms may also set specific deadlines - check them before the trip, and at the moment of the event contact the insurer's assistance service straight away.
Can an insurer's refusal be disputed? Yes. Request a written, motivated justification and compare it with the policy terms. If you believe the refusal is unfounded, submit written objections to the insurer; the dispute can be resolved out of court or in court. A broker can also help.
Is a claim always denied after alcohol consumption? Not always, but the influence of alcohol or intoxicating substances is usually listed as an exclusion in policies. The decisive factors are the policy terms and the circumstances, including the link between the consumption and the event. The safest option is not to take the risk.
Does a chronic illness mean travel insurance will not work? Standard policies often cover only a sudden, acute illness, and an exacerbation of a chronic illness may be covered to a limited extent. If you have a chronic condition, check before buying whether suitable additional cover is available, and always provide truthful information.