Travel Health Insurance Denied in Canada: Appeal

Travel health insurance is one of the most commonly purchased — and most frequently disputed — insurance products in Canada. For Canadians who travel internationally, particularly retirees who spend winters in the US or Caribbean (the "snowbird" market), a denied travel health insurance claim can result in catastrophic out-of-pocket medical costs. This guide explains why travel health claims are denied and how to fight back.

Canada's Travel Health Insurance Market

Canada's travel health insurance market is dominated by a handful of specialised providers:

• TuGo (formerly Western Life Assurance) — one of Canada's largest travel insurers, offering emergency medical, trip cancellation, and multi-trip annual plans
• Manulife TravelEase — Manulife's travel product, particularly popular for snowbirds and frequent travellers
• Allianz Global Assistance — part of the German Allianz group, a major Canadian travel insurer
• Sun Life — through employer group plans that often include out-of-country emergency medical coverage
• Medipac — specialising in snowbird coverage for Canadian retirees in the US
• RBC Insurance, TD Insurance, CAA, and Blue Cross — all offer travel health products

Many Canadians also have some out-of-country emergency medical coverage through their employer group benefit plan — but this coverage often has relatively low maximums (sometimes as low as $1–5 million), which is insufficient for serious medical events in the US.

Provincial Health Coverage and the 183-Day Rule

Before discussing private travel insurance denials, it is important to understand how provincial health plans interact with travel:

Provincial health outside Canada. Provincial health plans (OHIP, MSP, AHCIP, etc.) provide very limited coverage outside Canada. Most provinces cover out-of-country emergency services at a fixed low rate — often around $400 per day for hospital care — far below actual costs in the US, where a single day in an ICU can cost thousands of dollars.

The 183-day absence rule. Most Canadian provinces require residents to be physically present in the province for a minimum number of days per year to maintain provincial health eligibility. The most common threshold is 183 days (approximately six months). Snowbirds who stay in the US for longer than their province allows risk losing OHIP or MSP eligibility — which can also affect travel insurer payouts if the insurer assumes provincial coverage will respond first.

• Ontario (OHIP): 153 days absence rule is the stricter limit; travellers should confirm current rules with OHIP.
• BC (MSP): 183 days total absence in a calendar year is generally the limit.
• Alberta (AHCIP): Residents must be present in Alberta for at least 183 days per year.

Provincial rules change periodically — always verify the current rules with your provincial health authority before extended travel.

The Pre-Existing Medical Condition Stability Clause

The most common reason Canadian travel health insurance claims are denied is the pre-existing condition stability clause. Almost all Canadian travel health policies cover emergency medical events arising from pre-existing conditions only if the condition was "stable" for a defined period (typically 90, 180, or 365 days) before the departure date.

What "stable" means. A condition is generally considered stable if, in the defined stability period before departure, there was:

• No new prescription or change in dosage of existing medication relating to the condition
• No new medical treatment or investigation for the condition
• No hospitalisation or referral to a specialist for the condition
• No new symptoms or worsening of the condition

The interpretation of "stable" is where most disputes arise. Insurers often argue that a routine dosage adjustment, a specialist referral, or even a diagnostic test ordered as a precaution constitutes instability — even when the policyholder's condition had been entirely under control.

Common Travel Insurance Denial Scenarios

Dosage change before departure. Your physician adjusts a blood pressure medication by 5 mg three months before you travel. The insurer says this medication change constitutes "instability" and denies a cardiac event that occurs during travel. You argue the adjustment was routine and the condition was fully controlled.

Specialist referral for monitoring. Your cardiologist orders a follow-up echocardiogram for routine monitoring before your trip. You are symptom-free and your condition is well-managed. The insurer argues the referral itself constitutes investigation of the condition, creating instability.

New diagnosis in the stability period. You are diagnosed with a condition for the first time during the stability period — even if the condition is mild and treated — and the insurer argues the new diagnosis creates instability.

Failure to disclose a condition. If you did not disclose a medical condition when purchasing your policy, and a claim arises related to that condition, the insurer will deny the claim for non-disclosure and may void the entire policy.

How to Appeal a Travel Insurance Denial

Step 1: Read the stability clause carefully. Your policy document defines exactly what "stable" means for your policy. Compare the insurer's denial letter against the exact policy language. Insurers sometimes apply a broader interpretation of "instability" than the policy wording supports.

Step 2: Gather your medical records. Request your complete medical records for the stability period from your family physician and any specialists. The records should show the exact nature of any changes — dosage adjustments, appointment reasons, test results — to allow a precise assessment of whether "instability" under the policy definition actually occurred.

Step 3: Get your physician's written opinion. Ask your family physician to provide a letter stating whether, in their clinical opinion, your condition was stable in the period before departure as defined by the policy. A physician who treated you throughout the period is well-positioned to address the stability question specifically.

Step 4: Internal appeal. Submit a written appeal to your travel insurer's claims review department. Provide the medical records, physician's letter, and a point-by-point rebuttal of the insurer's denial rationale.

Step 5: OLHI. For individual travel insurance policy disputes, the OmbudService for Life & Health Insurance (OLHI) at olhi.ca provides free, independent review. OLHI regularly handles travel insurance stability clause disputes and has issued guidance that helps policyholders understand what "stable" means in different contexts.

Step 6: Provincial insurance regulator. If the insurer has acted in bad faith or misrepresented the policy terms, file a complaint with your provincial insurance regulator (FSRA in Ontario, BCFSA in BC, AMF in Quebec, etc.).

Tips for Snowbirds

• Purchase travel insurance annually at the start of your travel season — if your health changes during the year, you can update your disclosure at renewal rather than midtrip.
• Call your insurer before departure to confirm your medical conditions are disclosed and that your coverage status is confirmed.
• Use a travel insurance broker who can compare products from multiple insurers and identify which policies have the most favourable stability clauses for your medical profile.
• Keep the stability period in mind when scheduling medical appointments. A routine check-up shortly before departure is low risk, but any prescription change or new referral within the stability period should be discussed with your insurer before travel.
• Check your provincial health absence rules before booking extended travel to ensure you will not inadvertently jeopardise your provincial health eligibility.

Travel insurance disputes are among the highest-stakes insurance complaints Canadians face. OLHI reports that travel insurance is consistently among the most complained-about insurance products. With careful documentation and a focused appeal, many denials can be overturned.

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Related Reading:

• How to Write an Insurance Appeal Letter
• What Is Medical Necessity?
• Internal vs External Insurance Appeal