Why visitors and Super Visa insurance claims get denied, and how to avoid it
Most refused claims come down to a handful of reasons, and nearly all of them can be prevented before you buy.
Families usually find out how their policy works on the worst day: in a hospital, with a bill in hand. This page goes through the reasons insurers refuse visitors and Super Visa claims, with what to do about each one before it happens.
In short
Claims are most often refused because a pre-existing condition was not stable for the plan's required period, the medical questions were answered wrongly, the illness began during a waiting period, or the care was not an emergency. Missing the call to the assistance line, excluded activities, missing paperwork and care outside the policy dates make up most of the rest. Buy before the visitor leaves home, answer the questions with the medicine list in hand, and keep every bill.
The 8 most common reasons claims are refused
From the policy wordings we sell and the claims Pankaj has helped families with.
| Reason | What happened | How to avoid it |
|---|---|---|
| Pre-existing condition not stable | The condition changed (new pill, dose change, new symptoms, tests pending) inside the plan's stability period, or the plan you bought excludes pre-existing conditions altogether. | Count the days since the last change before you buy, and pick a plan whose stability period you meet. |
| Wrong answer on the medical questionnaire | A "no" that should have been a "yes". The insurer checks medical records after a claim, and a wrong answer can void the policy even if it was an honest mistake. | Fill it in with the prescription list and doctor's notes in front of you. Ask before you guess. |
| Waiting period | Policies bought after the visitor arrives usually don't cover sickness that starts in the first days: often 48 hours, 7 days, or 15 days for older ages. | Buy before the visitor leaves home, so the waiting period does not apply. |
| Not an emergency | Check-ups, refills, planned surgery and tests that could wait are not covered. Visitors insurance pays for sudden, unexpected illness or injury. | Bring enough medicine for the whole visit and keep routine care for home. |
| No call to the assistance line | Most policies ask you to call their 24-hour line before treatment, or as soon as you can. Some reduce what they pay if you don't. | Save the assistance number in your phone and the visitor's wallet on day one. |
| Excluded activity or cause | Injuries from excluded sports, alcohol or drug use, self-harm, or travel against a doctor's advice are common exclusions. | Read the exclusions page of the wording, not just the benefit summary. |
| Missing papers or late claim | No itemized bills, no medical report, or a claim sent after the deadline in the policy. | Keep every bill and report, and send the claim as soon as treatment ends. |
| Outside the policy dates | Care after the policy ended, or on a side trip longer than the plan allows. | Extend before the end date and check side-trip rules before travelling. |
The big one: pre-existing conditions
Most refused claims for older visitors come back to a health problem they had before the trip. Insurers don't refuse these because the visitor was sick. They refuse because the condition was not stable for long enough, or because the plan chosen never covered it.
"Stable" has a strict meaning: no new medicine, no change in dose, no new or worse symptoms, no hospital visit and no tests or referrals waiting, for a set number of days before the policy starts. That period is often 90 days for younger visitors and 180 days or more from age 70.
For example, suppose a father's blood pressure pill was increased two months before he flew to Toronto, and he had a stroke in week three. If his plan required 180 days of stability, the insurer would review the stroke claim against his blood pressure history and could refuse it. A plan with a 90-day rule, or waiting to buy until he qualified, would have changed that.
Read more in our guide to pre-existing medical conditions, and the pages on heart conditions and diabetes.
If a claim is refused
- 1. Ask why
- Get the reason in writing, with the policy clause
- 2. Check the facts
- Compare it with the medical records and your answers
- 3. Appeal
- Send new evidence, such as a doctor's letter, to the insurer's appeal team
- 4. Ombudservice
- If you still disagree, the OLHI ombudservice reviews complaints for free
Before you buy: a 5-minute checklist
Medicine list
Every pill and dose, and the date of the last change.
Start date
Coverage from the day they leave home, so no waiting period applies.
Right plan
A plan that covers stable pre-existing conditions, if they have any.
Phone number
The insurer's assistance line saved before the flight lands.
Questions people ask
Can a claim be refused for an honest mistake on the medical questions?
Yes. Insurers judge the answer, not the intention. A wrong "no" can lead to a refused claim or a cancelled policy.
If you are unsure about a question, ask the advisor or insurer before you buy and keep a note of their answer.
We bought the policy after my mother arrived. Is she covered?
Yes, but sickness that starts during the waiting period, often 48 hours to 15 days depending on the plan and age, is usually not covered.
Injuries from accidents are usually covered from the start. Buying before departure avoids the waiting period.
Will the insurance pay for my father's regular check-ups or medicine?
No. Visitors and Super Visa insurance cover emergencies only, not routine care or refills.
Bring enough medicine for the whole visit, in the original containers with the prescription.
How long do we have to send a claim?
Each policy sets a deadline, often within 90 days of treatment. Check the claims section of your wording.
Send the claim as soon as you have the bills and medical report, and keep copies of everything.
What can I do if the claim is denied?
Ask for the reason in writing, then appeal to the insurer with any new medical evidence.
If the appeal fails, you can take the complaint to the OmbudService for Life and Health Insurance (OLHI), which is free.
Does a refused claim affect the Super Visa itself?
No. The Super Visa and the insurance claim are separate. A refused claim leaves you with the bill, but it does not cancel the visa.
Keep the policy in force for the whole stay, as IRCC requires coverage for each entry.
Sources and related pages
General information, not legal or medical advice. Each policy's wording decides what is covered.