Guide
Claim denied: the ladder above your insurer
By Covered Abroad Research Desk · Last verified July 2026
Rung one: the insurer, properly
Every ladder starts inside: insurers run formal complaints channels, and the national bodies above them generally require that step first — Spain's framework names the insurers' customer-service departments and customer defenders as the entry stage. Do it in writing, cite the policy wording's exact line, and mind the deadlines that run regardless: on the plans we arrange, claims must be submitted within two months of the event, and disputes route per the wording — mechanics our claims guide and policy-reading guide walk in detail.
Most denials are wording disputes in costume: exclusion scope, pre-authorisation missed, a benefit ceiling. The winning file quotes the contract back, line by line.
Rung two: the national body — Spain and Germany as worked examples
Spain: the supervisor's Servicio de Reclamaciones at the DGSFP handles consultas, quejas and reclamaciones under the procedure of Orden ECC/2502/2012, with its GASPAR guide and downloadable forms — the formal stage after the insurer's channel. Germany: the Versicherungsombudsmann describes itself in one line — out-of-court dispute resolution, independent and free of charge (« außergerichtliche Streitbeilegung, unabhängig und kostenfrei ») — the industry-funded but independent ombudsman most German private-insurance disputes visit before any court.
Other countries run parallel machinery; the pattern — insurer first, named body second, courts last — is the constant.
Source: DGSFP, Servicio de Reclamaciones — información sobre el procedimiento, read 5 September 2026.
Source: Versicherungsombudsmann e.V., read 5 September 2026.
60-second check
Not sure the policy you have meets your destination's written rule? Run it through the policy check now, before you build the rest of the file around it.
Check my policyRung three: FIN-NET, for cross-border lives
Expat disputes are often cross-border by construction — insurer in one country, treatment in another — and the EU built a network for exactly that: FIN-NET “helps customers resolve cross-border disputes out of court”, with members in most EEA countries listed by country on the Commission's page, so a complaint filed at home reaches the competent body abroad. It is a router, not a court — but for an international policyholder it is the router that matters.
On the plans we arrange, the wording's own dispute route applies — read it before escalating anywhere. And before there is ever a dispute, the cheapest fix is upstream: cover that matches the rule from day one:
Source: European Commission, FIN-NET — financial dispute resolution network, read 5 September 2026.