Super Visa Insurance Claim Denied: Appeal, Complain, OLHI

A denied super visa insurance claim moves through three stages: an internal appeal to the insurer with new evidence, a formal complaint to the underwriter’s complaints officer ending in a final position letter, and then a free review by OLHI, the OmbudService for Life and Health Insurance, which aims to conclude within 120 days. Start by getting the denial in writing with the policy clause. Most denials turn on the stability of a pre-existing condition, and the evidence that overturns them is a dated prescription history from the home-country doctor.

The claims hub explains what the insurer checks. This page is the route after it says no.

What do you need before you start?

The denial letter, the certificate and policy wording, the full claim file, the parent’s medical history for the stability period, and a dated log of every call. Add the OLHI complaint contact for the underwriter.

Item	Why
Denial letter citing the policy clause	Without the clause you cannot answer it; ask for it in writing if the letter is vague
Certificate and full policy wording	Check the clause against the actual definition of “stable” and the stability period for the parent’s age
Questionnaire or eligibility answers given at purchase	The THIA Bill of Rights gives you the right to a copy; the insurer compares them to the records
Home-country prescription history with dates; consultation notes; test results	The evidence that shows no change in the stability period
Hospital discharge summary and admitting diagnosis	Shows what was treated and whether it relates to the excluded condition
Dated log of calls and emails from the first notification	OLHI will ask for it
Insurer’s complaints contact	From OLHI’s insurer complaint contacts list

Note the underwriter, not the brand: iA Financial Group for TuGo and Secure Travel, The Manufacturers Life Insurance Company for Manulife CoverMe and 21st Century, Zurich Insurance Company Ltd (Canadian Branch) for Destination, CUMIS General Insurance for Allianz, Old Republic Insurance Company of Canada for Travelance, and GMS for GMS. See underwriters explained.

How do you challenge a denial, step by step?

Eight steps across three stages. Do not skip to OLHI; it will send you back for the final position letter.

Ask the claims administrator for the denial in writing, with the policy clause relied on and the medical finding behind it. Ask at the same time for a copy of the questionnaire or eligibility answers.
Read the clause against the policy’s definition of stable and the stability period for the parent’s age. A 62-year-old on Secure Travel needs 90 days; on Manulife, 180. Many denials cite the wrong period or treat a repeat prescription as a change.
Gather new evidence. Ask the home-country doctor for a letter stating the diagnosis dates, every medication with doses and start dates, and that nothing changed in the stability period. Attach the pharmacy printout.
Write the internal appeal: one page, the clause, the facts, the evidence attached, and the outcome you want. Send it to the claims administrator and copy the underwriter. Keep the send receipt.
If the appeal is upheld, submit a formal complaint to the underwriter’s complaints officer using the contact on OLHI’s list. State that you request a final position letter. Insurers generally respond within 90 days.
Receive the final position letter. If the insurer has not provided one within 90 days of the complaint, ask OLHI whether it will accept the complaint without it.
Submit to OLHI through its portal with the final position letter, the signed authorization form and your supporting documents. See how to complain to OLHI.
Respond to OLHI’s analyst promptly. If the insurer’s position is found reasonable, OLHI closes the file with written findings; if not, it negotiates or escalates to an OmbudService Officer and, if needed, a Senior Adjudicative Officer.

Sources: OLHI process and the THIA Bill of Rights, which states “you may challenge decisions and request additional reviews with new information.”

How long does each stage take, and what does it cost?

Nothing in fees at any stage before court. In time, expect weeks for the appeal, up to 90 days for the complaints officer, and up to 120 days at OLHI.

Stage	Who decides	Cost	Time
Written reasons	Claims administrator	None	Days to weeks
Internal appeal with new evidence	Insurer’s claims review	None	Weeks
Formal complaint, final position letter	Underwriter’s complaints officer	None	Up to 90 days
OLHI review	Independent analyst, then OmbudService Officer	Free	Aims for 120 days from acknowledgement; OSO investigations 45 days
Senior Adjudicative Officer	OLHI	Free	If the insurer declines the OSO recommendation
Court	Judge	Legal fees	Years

Sources: OLHI states its services are “free, independent, and impartial,” and its process page gives the 120-day and 45-day targets. One cost to note: Manulife deducts a $300 handling fee from any super visa premium refund where a claim was withdrawn or denied, per its policy.

What evidence overturns a stability denial?

Dates. The insurer’s finding is that something about the condition changed inside the stability period: a new drug, a dose change, a new symptom, a test, a referral. The answer is a record showing that it did not, or that the change fell outside the period, or that the denial applied the wrong period.

Denial reason	Evidence that answers it
Medication changed within the period	Pharmacy printout showing the same drug and dose across the period; doctor’s letter confirming no change
New symptom or consultation within the period	Consultation notes showing the visit was routine monitoring, not a new complaint
Undisclosed diagnosis	Records showing the diagnosis was never made or never communicated; see misrepresentation and voided policies
Wrong stability period applied	The certificate’s age band and the policy’s table
Treated condition unrelated to the excluded one	Discharge summary; treating physician’s letter on causation
Late assistance call	Hospital admission record showing the parent was unconscious or in surgery

The Hamilton case is instructive: the family said congestive heart failure “never appeared in her prescriptions over the previous three years,” and Manulife reversed its denial after CTV News contacted it. The same evidence, submitted as an appeal, is the orderly version of that outcome. How to buy so the check passes is on pre-existing conditions.

What if it goes wrong?

Problem	What to do
Insurer will not give the clause	Write citing the THIA right to “fair claims” and “escalate and appeal”; copy the complaints officer
Home-country doctor will not write a letter	Ask for the pharmacy’s dated dispensing record instead; most pharmacies print it on request
Hospital is chasing the family meanwhile	Tell patient accounts in writing that the claim is under appeal with the insurer and give the file number; ask for a hold
No final position letter after 90 days	Contact OLHI; it may accept the complaint
OLHI finds the insurer’s position reasonable	Ask for the written findings; consider a lawyer for a court claim; the limitation period in Ontario is generally two years
Complaint is about SuperVisaDirect’s advice, not the claim	That goes to SuperVisaDirect first, then FSRA; see complaints

FSRA does not settle claims: its complaint page says it cannot resolve contract disputes, issue refunds or obtain compensation. The claim route is insurer, then OLHI. SuperVisaDirect helps at every step by email at [email protected] or callback, Monday to Friday, 8:00am to 6:00pm Eastern Time. Your rights throughout are summarized on the THIA Bill of Rights page.

Questions people ask

Why are super visa insurance claims denied?

Most often for a pre-existing condition judged unstable in the stability period, for an undisclosed condition on a no-questionnaire plan, for a late or missing assistance call, for a lapsed monthly instalment, or for treatment outside the emergency such as unapproved follow-up. The $96,311 Hamilton denial in 2025 was an undiagnosed heart condition on a Manulife Basic plan, later reversed.

Who do I appeal to, the broker or the insurer?

The insurer named on the certificate as underwriter. The brand that sold the plan, such as 21st Century, Secure Travel, Destination or Travelance, is a managing general agent and cannot overturn a denial. The claims administrator, such as Active Care Management or MSH, issues the first decision; the underwriter's complaints officer issues the final position.

What is a final position letter?

The insurer's written decision at the end of its internal complaint process, stating its final answer and the reasons. OLHI requires it before it will open a review, and FSRA asks for it too. Ask for it by name once the insurer has upheld the denial; if the insurer does not provide one within 90 days, OLHI may accept the complaint anyway.

How long does an appeal take?

The internal appeal takes weeks, the insurer's complaints process up to 90 days, and OLHI aims to conclude its review within 120 days of acknowledging the complaint, with OmbudService Officer investigations targeted at 45 days. From first denial to an OLHI outcome is commonly six months to a year. Keep the hospital informed in writing throughout.

Does OLHI's decision bind the insurer?

No. OLHI's recommendations are non-binding, and its page says an insurer may decline an OmbudService Officer's recommendation, in which case a Senior Adjudicative Officer may investigate further and attempt a settlement. In practice insurers participate because OLHI is their own dispute-resolution body. The court route remains open after OLHI.

Can SuperVisaDirect overturn a denial?

No; only the insurer can. Super Visa Direct Insurance Services helps you obtain the written reasons, assemble the medical evidence, draft the appeal and the complaint, and track deadlines, by email at [email protected] or callback, Monday to Friday, 8:00am to 6:00pm Eastern Time. We also give you the insurer's complaints contact from OLHI's list.

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Super visa insurance claim denied: what to do next