What exclusions are and why they exist
Exclusions are the scenarios the policy does not cover. By law (Spanish LCS art. 3) they must appear specially highlighted (usually in bold) in the particular conditions, and the insured must expressly accept them at contracting. They exist because insurance that covered everything without limit would have unaffordable premium. Delimiting assumed risk is what allows competitive prices.
Most common sector exclusions
- Undeclared pre-existing conditions at contracting.
- Alcohol, drugs and narcotics at time of incident (analysis at hospital).
- Adventure and extreme sports without specific supplement.
- Wars, WHO-declared pandemics, riots per conditions.
- Gross recklessness or wilful misconduct by insured.
- Undeclared work activities (volunteering, internships, paid work).
- High-value objects not previously declared.
How to question an applied exclusion
Even if the exclusion is correctly applied, you can complain questioning: (a) interpretation — the exclusion does not exactly fit the case; (b) information at contracting — the exclusion was not sufficiently highlighted; (c) quality of evidence — the insurer denied without sufficient verification. Route: SAC → DGSFP → arbitration or judicial.
How to strengthen your review if you share one
If you have been denied a claim for exclusion, provide: specific exclusion alleged by IATI, exact policy text if you have it, your argumentation (why you think it does not apply), documentation provided to refute and current case file status (SAC, DGSFP, judicial). This helps other travellers know what to expect.