Travel medical claim: don't let the stability clause sink you

At the time of the emergency

Where you can, call the insurer's 24-hour emergency assistance line before you're treated. Many policies require prior notification, and the assistance team can direct you to approved facilities, arrange direct billing so you're not paying tens of thousands up front, and start the file. If it's a true emergency, get care first — but call as soon as possible.

How to file

Keep and submit everything:

• Itemized hospital and physician bills (not just totals).
• Medical records describing the diagnosis and treatment.
• Proof of trip dates (boarding passes, bookings).
• The completed claim form and any assistance-line reference numbers.

The #1 denial reason: the stability clause

Most travel-medical denials come down to one clause. Your policy typically covers a pre-existing condition only if it was stable for a defined period before departure — often 90 or 180 days — meaning no new symptoms, no new tests or investigations, and no changes in treatment or medication. Crucially, a dosage change usually counts as instability, even for a drug you've taken for years. If you're denied on stability grounds, have your physician document the actual timeline of your condition and treatment; insurers sometimes assume instability that the medical record doesn't support.

If your claim is denied

Request the exact clause and the facts the insurer relied on, in writing. Then escalate through the insurer's complaints office, the OmbudService for Life & Health Insurance (OLHI), and the regulator. Because a serious out-of-country hospitalization can run into the tens of thousands, a lawyer may be worthwhile for a large denied claim. The Fight-Back Kit has the letters — and next trip, check your stable-by date with the Travel & Snowbird tool.