Trip Insurance - Claim Denied

[Madani]

I submitted a claim to trip insurance for our May vacation. The denial letter arrived yesterday stating I was getting nothing from them. I am going to file an appeal but I don’t know that it will get me anything either. For what it is worth, here is what happened in case it can be of help to others.


In early May we (myself, DH and DD5) had a 4 night stay in WDW followed by a 4 night cruise on the Dream. Our plan was to travel by air from Wisconsin to Florida. I purchased trip insurance when the cruise was booked, about 18 months prior to our travel dates. In April my husband’s ears were bothering him. He has tubes. He went in, and the doctor found he had developed a polyp and the ear tube in one ear was blocked. He received some steroid drops to help reduce the swelling and get things draining again. He went for a follow up visit a week before our scheduled departure and his condition was not improved. The doctor told him that if he tried flying, he risked a ruptured ear drum. We discussed it and decided the risk was not worth damaging his hearing so he drove to Orlando, leaving on May 3 and arriving at the same time as our flights (I kept the original plan and flew down with DD5 on May 5). I called in the information to the trip insurance company and received a claim number and the paperwork to complete the claim process. We proceeded with our planned trip, and then I flew home with DD on May 13, and husband drove, arriving in Wisconsin on May 14.


I submitted a claim for the driving expenses – gas, food consumed, and 3 nights in a hotel, plus the cost of the unused airfare – incurred during the drive to and from Orlando. The claim was denied in total. My understanding of the denial letter is that 1: only land and water travel was covered, not flights; 2: the travel expenses occurred outside of our coverage period (which was May 5 – May 13); and 3: illness is not a coverable cause under “travel delay” and the illness was not sufficiently documented to fall under “travel interruption” and didn’t occur during the scheduled travel (see point 1).


I’m not sure what to say about the air travel except I *thought* it was covered but apparently I didn’t read the policy closely enough? At any rate, should I purchase trip insurance in the future I will certainly scrutinize that part of the coverage more closely.


My husband’s doctor did complete the paperwork the insurance company provided so I’m not sure what part of the medical care was not sufficiently documented. I also have a letter directly from the doctor stating he advised no air travel which I did not submit originally but will include in my appeal, where I will also argue [probably unsuccessfully] that the trip interruption clause kicked in the moment he was supposed to board the flight but was advised against it by his doctor.


In hindsight, I’m not sure there was anything I could have done differently to have this claim approved. Maybe if my husband had begun his travel to Florida on May 5, the day coverage began? But then he would have missed 2 days of vacation and I would rather have done what we did (have him leave early to meet us there) rather than have him miss a chunk of the trip, even if it rendered our claim ineligible.


So I will try and find some rebuttal points and include the letter from the doctor in my appeal, but I don’t think I’m going to be getting anything from this claim. That doesn’t mean I won’t purchase trip insurance in the future but I will certainly spend more time analyzing the fine print. I know the whole "is trip insurance worth it" topic comes up frequently, maybe my experience can point out a limitation that I didn't imagine before I bought a plan.

 

[PrincessShmoo]

I submitted a claim to trip insurance for our May vacation. The denial letter arrived yesterday stating I was getting nothing from them. I am going to file an appeal but I don’t know that it will get me anything either. For what it is worth, here is what happened in case it can be of help to others.


In early May we (myself, DH and DD5) had a 4 night stay in WDW followed by a 4 night cruise on the Dream. Our plan was to travel by air from Wisconsin to Florida. I purchased trip insurance when the cruise was booked, about 18 months prior to our travel dates. In April my husband’s ears were bothering him. He has tubes. He went in, and the doctor found he had developed a polyp and the ear tube in one ear was blocked. He received some steroid drops to help reduce the swelling and get things draining again. He went for a follow up visit a week before our scheduled departure and his condition was not improved. The doctor told him that if he tried flying, he risked a ruptured ear drum. We discussed it and decided the risk was not worth damaging his hearing so he drove to Orlando, leaving on May 3 and arriving at the same time as our flights (I kept the original plan and flew down with DD5 on May 5). I called in the information to the trip insurance company and received a claim number and the paperwork to complete the claim process. We proceeded with our planned trip, and then I flew home with DD on May 13, and husband drove, arriving in Wisconsin on May 14.


I submitted a claim for the driving expenses – gas, food consumed, and 3 nights in a hotel, plus the cost of the unused airfare – incurred during the drive to and from Orlando. The claim was denied in total. My understanding of the denial letter is that 1: only land and water travel was covered, not flights; 2: the travel expenses occurred outside of our coverage period (which was May 5 – May 13); and 3: illness is not a coverable cause under “travel delay” and the illness was not sufficiently documented to fall under “travel interruption” and didn’t occur during the scheduled travel (see point 1).


I’m not sure what to say about the air travel except I *thought* it was covered but apparently I didn’t read the policy closely enough? At any rate, should I purchase trip insurance in the future I will certainly scrutinize that part of the coverage more closely.


My husband’s doctor did complete the paperwork the insurance company provided so I’m not sure what part of the medical care was not sufficiently documented. I also have a letter directly from the doctor stating he advised no air travel which I did not submit originally but will include in my appeal, where I will also argue [probably unsuccessfully] that the trip interruption clause kicked in the moment he was supposed to board the flight but was advised against it by his doctor.


In hindsight, I’m not sure there was anything I could have done differently to have this claim approved. Maybe if my husband had begun his travel to Florida on May 5, the day coverage began? But then he would have missed 2 days of vacation and I would rather have done what we did (have him leave early to meet us there) rather than have him miss a chunk of the trip, even if it rendered our claim ineligible.


So I will try and find some rebuttal points and include the letter from the doctor in my appeal, but I don’t think I’m going to be getting anything from this claim. That doesn’t mean I won’t purchase trip insurance in the future but I will certainly spend more time analyzing the fine print. I know the whole "is trip insurance worth it" topic comes up frequently, maybe my experience can point out a limitation that I didn't imagine before I bought a plan.

Did you purchase insurance through DCL? I believe they don't cover pre-existing conditions. Every insurance policy is different in what they cover. It's generally a good idea to purchase insurance through a 3rd party company than with the cruise line, as you can get better coverage, for lower cost most of the time.

I'm sorry you're having problems, but be sure to read your specific coverage to see what may, or may not, be covered.

I know airfare isn't covered under DCL, if you purchased it independently (not through DCL).

 

[2prettygirl]

Did you have insurance through Disney?

When we were looking into trip insurance, we were working with a TA on our cruise and she recommended going with an outside agency for trip insurance because they tend to offer more coverage for a cheaper rate. Come to find out, we had airfare, cruise, hotel, taxi, etc covered. We unfortunately did not have to use it but we were very close due to a stomach bug hitting our oldest daughter the night before we were set to cruise. We were stuck in FL with a sick child and a cruise quickly approaching. I called the travel insurance company and it was not an easy process to enable reimbursement but it was do-able after going to a doctor, getting a statement, etc....fortunately by morning she was better and no fever so we were ok to cruise but the idea behind the difficulties that go along with the reimbursement is a painful one.

 

[Madani]

Did you purchase insurance through DCL?

No, it wasn't DCL. The policy is through TripMate (underwritten by US Fire Insurance Company). I purchased as soon as the trip was booked and chose a policy that waived pre-existing conditions. The denial letter says "we are unable to consider this claim to have resulted from a loss that occurred at a time when the Trip Interruption coverage was in effect." So not sure how that weighs with "pre-existing condition waiver."

 

[PrincessShmoo]

No, it wasn't DCL. The policy is through TripMate (underwritten by US Fire Insurance Company). I purchased as soon as the trip was booked and chose a policy that waived pre-existing conditions. The denial letter says "we are unable to consider this claim to have resulted from a loss that occurred at a time when the Trip Interruption coverage was in effect." So not sure how that weighs with "pre-existing condition waiver."

Well, if it's outside the coverage time, I'd say that's probably the only answer you're going to get.

 

[kamik86]

I think part of the problem is that really your trip wasn't interrupted or cancelled. Everyone got to go on the full trip. Espeically if airfare wasn't included as that means you went on every part they covered.

I wouldn't have expected them to cover everything you had anyway as covering either the driving expenses or the flight would have made more sense. (If they paid both you woudl have actually made money off the deal)

 

[Paula Sedley-Burke]

We find in the UK ( America might be different so forgive me ) a lot of our airfare is tax. So if we haven't been on the flight we can claim the tax back.

 

[BigredNole]

Travel insurance is a very hokey game. My sister and her husband were scheduled for their 30th Anniversary cruise (another cruise line). His mother fell ill (already had Alzheimer's). She wound up dying 2 days before their cruise. They canceled due to a death in the family. They filed all necessary paperwork and answered all inquiries. The claim was denied. The reason was she did not die during the dates of the cruise and that they could have still traveled. They could have taken care of funeral arrangements after they returned. Also, the fine print states that a death in the family only applies to those that live within the home full time and claimed within the tax bills for the household.

They wound up losing $4,000. You need to know EVERY fine detail within the policy. You almost need an attorney to make sure you are protected. They fought and fought, but the policy was very clear on what is covered with a death in the family. Even with a death in the family, if it didn't occur within the travel dates, it is not covered any way.

 

[FigmentSpark]

I don't know about your driving expenses, but I'm surprised they wouldn't cover the airfare. Is there a chance that whatever credit card you used has some airfare insurance attached? How about his work? Some companies have limited insurance.

Your husband driving was probably the best solution. For your family and his ears, his driving was the right choice, no matter what your insurance company thinks.

 

[PrincessShmoo]

Travel insurance is a very hokey game. My sister and her husband were scheduled for their 30th Anniversary cruise (another cruise line). His mother fell ill (already had Alzheimer's). She wound up dying 2 days before their cruise. They canceled due to a death in the family. They filed all necessary paperwork and answered all inquiries. The claim was denied. The reason was she did not die during the dates of the cruise and that they could have still traveled. They could have taken care of funeral arrangements after they returned. Also, the fine print states that a death in the family only applies to those that live within the home full time and claimed within the tax bills for the household.

They wound up losing $4,000. You need to know EVERY fine detail within the policy. You almost need an attorney to make sure you are protected. They fought and fought, but the policy was very clear on what is covered with a death in the family. Even with a death in the family, if it didn't occur within the travel dates, it is not covered any way.

On that policy. There are policies that cover "immediate family" that include people, not necessarily living in the same house.

That's why you need to read the policies before you buy, to ensure that you're getting the coverage you think you are.

 

[DisneyWishes14]

I'm a little surprised about the airfare, too, as that was within the covered travel period and your husband couldn't fly because of a documented medical condition. I would think, therefore, cancelling the airfare would fall under the trip cancellation portion of the policy IF airfare was included. If it wasn't and only land and cruise was and that wasn't affected during the policy travel period, you may be out of luck.

 

[PrincessShmoo]

I'm a little surprised about the airfare, too, as that was within the covered travel period and your husband couldn't fly because of a documented medical condition. I would think, therefore, cancelling the airfare would fall under the trip cancellation portion of the policy IF airfare was included. If it wasn't and only land and cruise was and that wasn't affected during the policy travel period, you may be out of luck.

But, if the person actually took the trip, it wasn't cancelled. If missing the flight was part of cancelling the trip, it may be covered, or not. If anything, cancelling the air flight MIGHT fall under "due to medical reasons" if the policy covered that.

 

[Madani]

I think part of the problem is that really your trip wasn't interrupted or cancelled. I wouldn't have expected them to cover everything you had anyway as covering either the driving expenses or the flight would have made more sense. (If they paid both you woudl have actually made money off the deal)

Yes, it is a situation that doesn't slot neatly into their categories. I think we made the right decision to have him drive and I'm glad this was doable (what if it was a flight to Europe for a Mediterranean cruise?). And even if they were willing to reimburse driving expenses AND the lost flight I would still not "make money" as I'm out the cost of the policy itself.

 

[IBelieveInTheMagic]

Thanks for sharing your story OP as hopefully it will help others.

In the past the insurance I have used, has covered air fare, then not, then covered it again. One time it was complimentary, then other time it was not and you had to add the amount of the airfare in order to be covered (this was true for our European cruise so airfare wasn't "cheap"), so I also highly recommend people ask - does this cover airfare does it cover hotels, etc. Then if it does, ask the company where it's covered or stated in their information sometimes it's really buried in there.

Heather

 

[wombat_5606]

You should just keep pushing the company. Tripmate does not have very good reviews, so I'm sure they make it very hard for you to collect, hoping you will just give up.

If you go with an outside insurance agency, and you really should never buy insurance from the cruise line, always check the reviews before purchasing. It can save a lot of time and frustration.

 

[bumbershoot]

Keep on going with them.

The problem didn't exist at the time insurance was purchased, so even having the waiver doesn't make a difference in this case. If it had existed at the time you bought the insurance then the waiver would be important, but this isn't a pre-existing condition in terms of that waiver.

If you included the air expenses in the insurance then the missing of the flight would be covered.

The expenses for getting there, however, would not. It would be one or the other. IMO.

I would keep pressing for the FLIGHT to be covered, and that's it, honestly.

 

[kamik86]

Yes, it is a situation that doesn't slot neatly into their categories. I think we made the right decision to have him drive and I'm glad this was doable (what if it was a flight to Europe for a Mediterranean cruise?). And even if they were willing to reimburse driving expenses AND the lost flight I would still not "make money" as I'm out the cost of the policy itself.

I meant make money over having the trip have gone on exactly as you planned.

If the trip went as planned you would have spent money on airfare for everyone. Plus the cost of the insurance.

So they should cover either the cost of airfare or the costs he DID have to get to your destination. Which would bring you back to haven't spend about the same amount of money as if the trip went as planned.

 

[Tozzie]

Let me preface my post by stating I think insurance companies in general are the most legally corrupt industry in our nation.

That being said I can see why her claim was denied, The trip wasn't cancelled, hence no coverage under cancellations, the Medical is for actual medical expenses and not applicable since he didn't use the medical treatment on the trip. The trip wasn't interrupted nor delayed the dates of the trip were May 5 through May 13 and you went on your vacation on those dates. The pre existing condition waiver would only apply to cancellation (which you did not cancel) and medical expenses which there were none. I think your case falls into a black hole. I think you should go to the consumer advocate site www.elliott.org and go to the forums, they have very experienced people who can advise you how to handle it and also they list executive contacts for many companies that you can contact should the appeal be denied.

 

[shelbell77]

Along with what previous poster said, I'd add that if insurance was taken out for the cruise and not amended to include airfare when the flights were booked then I can completely understand why it was denied. The cruise itself was insured. Not the travel to get there.

 

[xavier2001]

Alternatively you could investigate whether the credit card you booked the flight on offers any kind of insurance protection. Also you could have notified the airline beforehand that your husband wasn't flying and they could have given you a credit for all or some of the amount (sometimes a change fee applies). That happened to me once when I needed to have surgery the day before leaving for a trip, I couldn't get on the plane so they gave me a voucher in the amount of my ticket to be used anytime within a year to any location in the US.