Your Travel Claim Was Refused: The Free Review Path

A refusal letter reads like the end of the matter. It is not the end of the published procedure, and the procedure is free. What follows is the order it runs in, taken from the bodies that publish it, with nothing said about what any of it will decide.

The five reasons, and when they actually happened

The OmbudService for Life and Health Insurance publishes the reasons travel claims are refused most often. There are five: undisclosed pre-existing medical information, pending medical tests, changes to health before the trip, failure to notify the insurer about a claim, and submitting a claim too late.

Read them in order of when they occur and something becomes obvious. The first three happened before the traveller left the house. They are about what was on the application and what changed afterwards, not about what happened abroad. The OmbudService puts it in terms of the contract: undisclosed medical information is treated as material to the risk.

The last two are about the days after an incident rather than the days before a trip: telling the insurer, and doing it within the time the contract allows.

None of that helps somebody holding a refusal letter today. It does tell them which part of their own file the review is likely to turn on, which is worth knowing before the first letter is written.

The first step is with the insurer, and it produces a document

Every route described here begins in the same place. The complaint goes to the insurer first, through the insurer’s own complaint process, and the object of that step is not only a reconsideration. It is a document.

The OmbudService states the requirement plainly: before it can begin its review, the consumer must first try to resolve the complaint directly with the insurer and obtain a final position letter. That letter is the key to the next door, and a file without one is a file that is not yet ready to go anywhere.

In Quebec the same step carries obligations on the other side. The firm must send an acknowledgement of receipt, must treat the complaint fairly, and must provide its final response in writing together with any settlement offer. It must also offer the option of transferring the file to the regulator, which means the second route is one the firm itself is required to tell the consumer about.

The national route: the OmbudService, and what it is

The OmbudService for Life and Health Insurance describes itself as a free, fast, independent and impartial alternative dispute resolution public service for Canadian life and health insurance consumers, and says it provides those services in English and French to any Canadian consumer whose insurance company is a member. Travel medical insurance is health insurance, so a refused travel claim sits inside that mandate.

Its published process runs in four stages. First it decides whether the complaint falls within its mandate. Then a complaints analyst makes contact, explains the process and reviews the information, with a stated objective of completing the review within 120 days. Where the analyst finds merit, the file may go to an OmbudService Officer for an investigation aimed at 45 days, which can end in a settlement recommendation. And where the insurer does not accept that recommendation, a Senior Adjudicative Officer may investigate further and attempt to negotiate a settlement.

One feature of that structure should be said out loud rather than inferred. The settlement recommendation is described as non binding. The OmbudService is not a court and it does not order anybody to pay. What it provides is an independent examination of the file and, where it finds merit, a recommendation that carries the weight of having been made independently.

The OmbudService also gives the plainest instruction in this whole subject, and it is aimed at the trip that has not happened yet: read the policy thoroughly before leaving, clarify anything unclear with the insurance provider, and never assume anything about the conditions of the policy.

The Quebec route: transferring the file to the regulator

A Quebec consumer has a second door, and the firm is required to point at it. After the firm’s final written response, the consumer may ask to have the complaint file transferred to the Autorite des marches financiers, using the regulator’s transfer form.

What the regulator does with a transferred file is published as well. It may offer conciliation or mediation services. It examines the situation as part of its supervisory activities. It may remind a firm or a representative of their obligations. And it may open an investigation and institute penal proceedings.

That list is worth reading twice, because the second half of it is not about the individual complaint at all. A transferred file also feeds the regulator’s supervision of the industry, which means a complaint that goes nowhere for the person who made it can still be part of why a practice changes.

The two routes are not alternatives to be chosen between blindly. The regulator’s conciliation and the OmbudService’s review are different things, and which is available and appropriate depends on the firm, the product and the province. Both begin after the same first step.

The clock nobody mentions until it has run out

Before any of this, there is the claim itself, and it has a deadline that belongs to the contract rather than to any review body.

The federal consumer agency states that most insurance companies have time limits within which a claim must be submitted, and that the limit usually varies from 90 days to 12 months from the date of the loss or event. Its advice on a claim is short: contact the insurer as soon as possible and provide all the supporting documents required.

Two of the five reasons the OmbudService gives for refused travel claims are on this ground: failure to notify the insurer about a claim, and submitting a claim too late. A claim that was never made in time is a harder file than a claim that was refused on its merits, because the review body is then examining a deadline rather than a diagnosis.

Separately, and this is a matter for a lawyer rather than for this page, a limitation period for legal action runs on its own schedule and is not paused by a complaint process.

What none of this promises

This article describes a procedure, and a procedure is not an outcome. The OmbudService decides whether a complaint is within its mandate, and many are not. Where it investigates, what it may produce is a non binding recommendation. The regulator may offer conciliation or mediation, which are processes rather than results.

Nothing here suggests that a refused claim will be paid, that a review is likely to succeed, or that any particular file has merit. What the published procedures establish is narrower and still worth knowing: a refusal letter is not the last word in the published process, the next steps cost nothing, and they are described openly by the bodies that run them.

Where to read this at the source

Four documents, all free, all read on 20 September 2026 and listed in the sources below: the OmbudService pages describing what it is and how its process runs, its travel insurance guide, the Quebec regulator’s page on making a complaint, and the federal consumer agency’s page on making an insurance claim.

The fifth document is the one that decides the file, which is the policy, and the sixth is the insurer’s final position letter, because everything after it is built on what it says.

Frequently Asked Questions

Continue Learning

The disclosure question behind most refused travel claims is taken up in credit card travel insurance, and what the public plan pays is in what your provincial health plan pays when you are ill abroad. The product itself is on the travel insurance page.