Trip Insurance - Claim Denied

[hanscarlet]

to be honest, it wouldn't even occur to me to attempt to get insurance money because the trip wasn't interrupted and your DH could have still taken the flight and then you wouldn't have had any expenses at all... but if you can legitimately prove that he really was about to pop his ear drum so close to the day you were leaving and you really had no choice other than risk a ruptured ear, I think they should at least reimburse you for your flight... the original claim with gas, mileage and airfare sounds like it could flag out for possible fraud because a lot of airlines will give a voucher if you avoid booking with a non refundable ticket... If he sincerely would have ruptured his ear drum and you booked trip insurance then I think they should give you the flight $ back... but I wouldn't be surprised if they try and use the no pre-existing conditions to cover themselves and try and avoid paying anything out

 

[Hundredacre]

HATE dealing with insurance companies. It's just like in The Incredibles!

 

[Ofinn]

I would have never thought of filing a claim for anything like this. I normally just insure the cruise. Since my mom is having health issues I may consider spending extra money on "cancel for any reason" insurance. Hopefully that would eliminate any problems if I have to file a claim...but who knows.

 

[BigredNole]

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

I couldn't agree more. I am living that now dealing SF. Thus the reason we have no money to go on vacations until our lawsuit is settled. Many travel insurers are outside the US and are governed by that country's laws. It is based on the ship's registry country which my sister found out.

Off topic...We processed our claims through SF under our policy because we could not get a response from the at-fault driver's insurance. All was great dealing with SF until it turned out the other driver was a SF policy holder also (at the scene, the officer took the wrong insurance information). They had already paid us for the totaled vehicle and we purchased a new vehicle already. They stated they incorrectly valued the vehicle and we would need to return 50% of it back. I laughed. 2 weeks later, our auto insurance went up $150 per month and our home owners went up 25%. I immediately shopped insurance and dumped SF. Our homeowners went down from the original SF fee by $500 a year and our auto insurance went down $150 per month (~$200 per month savings by switch from SF). Now, we are in litigation against SF for bills and bad faith.

 

[hardis5]

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.

This should be a caution for anyone purchasing insurance and adding airfare or another segment to their vacation after the insurance is bought. Since many cruises are book months to more than a year before airfares can even be booked, always make sure if you buy trip insurance when booking the cruise, it could or is able to cover other portions yet booked. Hopefully the OP had coverage for the airfare portion of their vacation.

It always needs to be remembered an insurance companies primary purpose is to maximize the premiums it collects while minimizing the claims it pays. There are a number of reputable and honest companies out there providing good coverage for the need, but many rank down there at the bottom of businesses I like to deal with.

 

[Markonefive]

Ironically, if the original poster hubby had not gone at all due to medical (unable to fly due to medical), this would likely have qualified for compensation for the whole trip. But by being creative with their problem solving (and saving the insurance company money!), the insurance company is using loopholes to avoid any payout.
Perhaps what the poster should have done is contacted the insurance company after the diagnosis with the no fly restriction to find out her options, and getting them to preapprove the ground travel alternative? She should also continue fighting the denial. Should make it clear to the company that this is the kind of issues that a) will influence whether or not they use the company in the future and b) will be sharing this information about the company on social media, and c) will be contacting the government regulatory bodies for insurance. She may also wish to seek legal advice to find out if she has any chance at all.

I tend to be overinsured for vacations but have been fortunate to never need it. Unfortunately, insurance is like parachutes, you can't really test how well it works until you pull the ripcord on the way down, at which point its too late to find out if its going to work like its supposed to or not.

I do tend to make sure I am insured for all legs of the trip, including flights, even if it is with different providers. I also choose the one that gives the widest range of cancellation reasons. At the end of the day, though, it all comes down to whether the company will honor the claim or try to find any legal (if unreasonable) loophole they can to deny.

 

[SirDuff]

I don't understand claiming for a refund of the airfare AND driving expenses. If you had to take a different flight, you wouldn't ask for a refund of the first flight AND the costs of the second flight.

 

[Madani]

OP here. I want to respond to a few of the comments along the lines of "why are you even making a claim in the first place?". Um. Why wouldn't I? My husband experienced a medical condition that disrupted our planned travel and caused us to incur additional expenses. We are fortunate that we can absorb the cost but I feel something of an obligation - since I went to the bother of purchasing a policy - to recoup some of those expenses if I can. That is why I listed everything including the value of the unused flight plus all the the costs associated with the car travel. To file an appeal now is only going to cost me 30 minutes of my time maximum, a few cents to photocopy some documents, and a stamp.

Thanks also to the poster who mentioned the Elliott.org site. I browsed a bit through the forums and read a few horror stories. Lots of expensive lessons there on what NOT to do. And yes, in hindsight, I wish I had called the insurance company BEFORE we left on the trip to review options instead of arguing about it after. Too bad I never seem to learn my lessons the easy way.

 

[Maggie'sMom]

Two problems I see:

1) You cannot get reimbursement for both the unused airfare and the additional travel expenses.
2) Because your DH had to leave early to drive down, his travel occurred before the coverage period of your policy.

You can certainly appeal, but the most I'd expect is to get the unused airfare reimbursed and you'll be lucky to get that because your trip ultimately didn't experience an interruption.

 

[GrannyDee]

We have very good health travel coverage through my job and some additional coverage through our credit card. We have almost always chosen to "self-insure" for trip interruption/cancellation, that is, we understand that if our trip is cancelled through some unforeseen circumstance, we might have to eat that cost.

I feel like every time I've checked with travel insurance companies, they won't cover the things that most likely will be the cause of our cancellation. Perhaps that's obvious? Last year, both my parents were ill, age-related stuff. I asked if our trip cancellation would be covered if one of them passed. I was told it would depend on why ... any pre-existing conditions they had wouldn't be covered. In pressing her for more detail, it appeared to me that we wouldn't be covered if one of them passed before or during our trip unless they were, I dunno, hit by a bus. Unlikely.

One of our "self-insure" options is that we always leave a good buffer between our flight out to the port city and the day the ship actually sails, winter weather being quite unpredictable here. We routinely are where we need to be earlier than we need to be, and we have back-up contingencies where possible.

No plan is infallible and we understand that.

 

[Hundredacre]

We have very good health travel coverage through my job and some additional coverage through our credit card. We have almost always chosen to "self-insure" for trip interruption/cancellation, that is, we understand that if our trip is cancelled through some unforeseen circumstance, we might have to eat that cost.

I feel like every time I've checked with travel insurance companies, they won't cover the things that most likely will be the cause of our cancellation. Perhaps that's obvious? Last year, both my parents were ill, age-related stuff. I asked if our trip cancellation would be covered if one of them passed. I was told it would depend on why ... any pre-existing conditions they had wouldn't be covered. In pressing her for more detail, it appeared to me that we wouldn't be covered if one of them passed before or during our trip unless they were, I dunno, hit by a bus. Unlikely.

One of our "self-insure" options is that we always leave a good buffer between our flight out to the port city and the day the ship actually sails, winter weather being quite unpredictable here. We routinely are where we need to be earlier than we need to be, and we have back-up contingencies where possible.

No plan is infallible and we understand that.

We are the same. We self insure. Generally, we find most insurance to be a "scam" at worst, not worth it at best. Dealing with them is hellish. The one time we had to deal with an insurance company they made the process so exhausting. They made us fight for what was rightfully due to us. We got it in the end but it was not worth the misery. Their existence in some industries also inflates the cost of everything. Awful, awful companies. Just my personal experience and opinion.

 

[SirDuff]

OP here. I want to respond to a few of the comments along the lines of "why are you even making a claim in the first place?". Um. Why wouldn't I? My husband experienced a medical condition that disrupted our planned travel and caused us to incur additional expenses. We are fortunate that we can absorb the cost but I feel something of an obligation - since I went to the bother of purchasing a policy - to recoup some of those expenses if I can. That is why I listed everything including the value of the unused flight plus all the the costs associated with the car travel. To file an appeal now is only going to cost me 30 minutes of my time maximum, a few cents to photocopy some documents, and a stamp.

Thanks also to the poster who mentioned the Elliott.org site. I browsed a bit through the forums and read a few horror stories. Lots of expensive lessons there on what NOT to do. And yes, in hindsight, I wish I had called the insurance company BEFORE we left on the trip to review options instead of arguing about it after. Too bad I never seem to learn my lessons the easy way.

It's not that I don't think you should have made the claim at all, just shouldn't have included both the new expenses and the flight expenses. That is trying to milk the system, it would be as if you went to a store to return a shirt and expected both a refund and a replacement product - you'd end with the shirt for free. In your case, you're trying to have your husband travel for free. That's what I don't understand in your logic.

 

[yellowfish78]

Was the airfare cost included in the cost of insurance coverage? Or did you just cover the cruise? (Did I miss that?) If airfare was included in the cost to be covered, and he could not fly due to a medical reason, then his airfare should be refunded. But not travel expenses down - that would be more of a 'I had a layover and my second flight was delayed and had to drive to make it to the ship" then they'd cover those expenses.

 

[Madani]

That's what I don't understand in your logic.

My logic was to put it all out there and let them tell me what they are willing to do. Answer: nothing. I see it as the first step in a negotiation. Now that I have a documented response with THEIR logic I can respond to the points where I feel I have the best case to make (which I think is the driving expenses). I am not trying to milk the system or scam the insurance company, or get a free ride to Florida for my husband (never mind the mileage on the car, the additional PTO days used, etc). I think I have an arguement to make but I do not expect it to carry the day. If this were a straightforward case I wouldn't even have bothered to share it here, but I thought it was an interesting twist that might be worth considering when weighing if trip insurance is "worth it" and how important it is to consider what is really covered in any policy despite our lack of a crystal ball.

I guess my final thought on this is IF I had called before we left and was told "sorry, nope, nothing in this situation is a covered expense" I still would not have let my husband risk experiencing a very painful, vacation ruining injury when we did have a viable plan B. But since I did purchase the policy and it is a minimal investment of time and effort to appeal, why not present my best rebuttal and see what happens, understanding the likelihood of success is small?

 

[Markonefive]

I agree with your approach. At least try. If you get the airfare covered, that would strike me as a fair settlement (wasn't able to fly). Then, theoretically, you are able to apply that money against the cost of alternate travel.

 

[kdogfister]

I understand the basis of the denial, but other than time you don't have much to lose in filing an appeal. Included with that appeal, I'd draft a a nice concise cover letter explaining why you feel the insurance company should reconsider the claim, even if it may not follow the letter of the policy to the detail. One, the letter may actually get read. Two, if you wish to pursue this further, you've documented that you are acting in good faith in providing information rather than simply trying to fleece the insurance company.

The second point can be useful if they deny you again and you decide to pursue this further by contacting the state Insurance Commissioner. If you feel you aren't being treated fairly and are a Wisconsin resident, I'd consider preparing a letter to the State of Wisconsin Office of the Commissioner of Insurance. The letter should concisely detail the specifics (which you already sent to the insurance company with your appeal) and why you feel the insurance company is acting in bad faith. A certified mail copy to the insurance copy in question usually means that they'll take quick action to give you the most fair resolution you'd see. They will stick to their guns if the policy is crystal clear, but if there is any question you may get some consideration from them.

 

[su_A_ve]

When you purchase insurance, did you had your flights purchased already? Insurance is from the day you leave the house, to the day you arrive back. If you were to move the dates back to drive, you need to adjust the dates with them. If you purchase the flights at a later time, you need to adjust covered cost amount to include anything that it's non-refundable.

If the coverage date included the day you were going to fly, you could argue that for medical reason, you had to cancel the flight. Then you could get reimbursed for that potentially.

Not a lawyer, nor play one on TV...

 

[kiford]

you really had no choice other than risk a ruptured ear, I think they should at least reimburse you for your flight

If the flights are insured. You have to specify everything that you are covering. If, as the insurance company stated, only the land and cruise portion was covered, then they wouldn't reimburse for that. If that had been added, the premiums would be higher.

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.

That is why I listed everything including the value of the unused flight plus all the the costs associated with the car travel.

But if there had not been an issue, you would have paid for at least one method of travel, thus, even if insured, an insurance policy will never cover the costs of both potential travel methods - only one and that would be the unused one.

The cost of the policy doesn't enter into the calculations at all. You would be deemed to "make money" on the transportation costs, not all of the costs of your trip. Thus, they would only reimburse for the flights, if they had been insured and all of the other terms of the policy met (i.e., dates, what is covered, etc.).

One thing you can definitely guarantee with insurance, is that the more you cover, the more you want to include under that coverage (i.e., dates, reason, pre-existing conditions, etc.) the more you will pay. No two insurance policies are the same and every one must be very carefully read to determine when they will and won't pay out, for what, and for how much.

However, for all of those who posted that insurance is a scam: my father (who is 82 with a heart valve replacement and some other medical issues) went on a 2.5 week trip to Spain in March. He had insurance covering a number of different things. He ended up in the hospital in Spain after 1.5 weeks with a lung infection. He spent 10 days in the hospital there and was sent home (first class) accompanied by an EMT with oxygen. He estimates the cost was $40K. None of which he had to pay. He also cruised a couple of years ago and had to miss the first two nights in a hotel (in Chile) due to weather here. His insurance compensated him for the two nights missed (about $1100).

It sucks that the OP isn't going to get paid out but insurance exists for a reason. It isn't necessarily easy to figure out and should never be considered as an afterthought or something that you don't spend any time investigating fully. Always read the policy, ensure that you know what you're covering, determine what you may be willing to pay for out of pocket if something happens. Spend the time and find insurance that covers what you want and expect because when you need it, it can be very helpful.