What happens if my claim is rejected?
If your claim is rejected, it does not necessarily mean the matter is closed. There are clear steps you can take to understand the decision and, if appropriate, challenge it.
Understanding why a claim was rejected
Claims are typically rejected where the treatment, item, or circumstances fall outside the terms and conditions of your policy. Common reasons can include incomplete documentation, treatment that was not pre-approved when required, or a claim that falls under a specific policy exclusion. If your claim is rejected, you are entitled to ask for a clear explanation of the reason.
What to do if you disagree with the outcome
If you believe a claim has been rejected incorrectly, or you would like to provide further information that was not included in your original submission, you can contact the Expatriate Group Claims Administrators directly to discuss the decision.
It is worth checking whether:
- All requested documentation was provided in full
- Pre-approval was required and obtained, where applicable
- The treatment or item falls within the scope of your specific policy
Making a complaint
If you remain dissatisfied after raising the matter with the claims team, you have the right to make a formal complaint. Complaints can be addressed directly to Expatriate Group’s complaints handling process.
Where applicable, you may have the right to refer your complaint to the Financial Ombudsman Service, an independent body that reviews unresolved disputes between customers and financial services providers.
Contact the Expatriate Healthcare claims team
Before escalating a disagreement, it is generally most effective to contact the claims team directly to clarify the reason for rejection. The claims team will review your query and explain the reasons behind the decision. Many claim issues are resolved at this stage without the need for a formal complaint.
