Travel insurance claim denied
We asked subscribers to each tell us about a time when they submitted a claim — medical or nonmedical — to a travel insurance company and expected reimbursement but had their claim denied. Our aim was to make travelers aware of what they might be surprised to find they are NOT covered for, in certain situations, under travel insurance policies.
Noting that we would not be printing the names of any travel insurance companies (we just wanted general accounts), we asked subscribers to each describe the situation or what occurred plus where and approximately when (year) the experience took place. We also asked what they thought they were covered for but were not, and we wanted to know the insurer’s reason(s) for rejecting the claim. Lastly, we asked travelers to tell us what they do or look for now to make sure they’re covered when purchasing travel insurance.
A few of the responses we received are printed below — some followed by notes from travel insurance broker Dan Drennen of the Travel Insurance Center (www.travelinsurancecenter.com) — and we’ll have more next month. If you had an experience with a travel insurance claim that was denied, email editor@intltravelnews.com or write to Travel Insurance Claim Denied, c/o ITN, 2116 28th St., Sacramento, CA 95818. Include your mailing address (where you receive ITN).
Over the last 15 years, my wife and I have averaged two international trips a year. On most of these trips, we have taken out travel insurance. In recent years, as my parents entered their 90s, I purchased insurance policies that had some form of trip-interruption protection, should we have to return home unexpectedly.
In late 2013, as part of planning for a trip to the Amazon River, I took out a policy that included the following coverage, as described in the section on Trip Cancellation and Interruption: “If the Insured must cancel or interrupt his/her Trip due to Injury or Sickness of a Family Member not traveling with the Insured, it must be because their condition is life threatening, as certified by a Physician, or because they require the Insured’s care.”
In February 2014, three weeks before our scheduled departure, my father (who was 95 and still walking several miles a day with my 92-year-old mother) started complaining of pains. Tests performed by his doctor determined that he had an advanced stage of cancer in several organs.
Because of his age, it was not possible to start any treatments. Although the doctor would not commit, it was apparent that my father would have a life expectancy of not more than six months. As requested by my parents, I arranged for hospice care in their home.
I considered canceling the Amazon River trip, but my father insisted that we should proceed as planned. My wife and I left for Manaus, Brazil, on March 14 to embark on our cruise. From the ship, I was able to phone home to check with my brother on the status of our father. Unfortunately, it soon became apparent that his cancer had become extremely aggressive.
By the fifth day of the trip, my father was completely bedridden and in need of ’round-the-clock care. We took the first opportunity, on March 24, to return to the United States from Georgetown, Guyana. The family took turns helping my father until continuous professional care was needed, and, less than a week after that, my father passed away on April 3.
Following the funeral, I finally got around to preparing an insurance claim requesting reimbursement for the travel days my wife and I missed and for the extra costs associated with flying home early. The claim, which was submitted on April 28, consisted of an 8-page form plus 10 pages of attachments (including letters from the doctor who performed the original diagnosis and from the company that provided hospice care services).
In a response from a Quality Assurance Adjuster, I was informed that I was not qualified for coverage because the medical condition was not certified by a physician as life-threatening as described in the Trip Cancellation and Interruption section of my policy.
I telephoned the adjuster and told her that the doctor who diagnosed my father with the “life threatening” cancer had concluded that treatment would not be useful. I said that I would provide information from the nurses caring for my father (who were under the direction of the hospice doctor) regarding his “life threatening” condition.
I also pointed out to the adjuster that the referenced policy wording clearly had the words “or because they require the Insured’s care” as an alternative to a physician’s certification. I did not get a satisfactory response to this observation.
I next called the company that had provided the hospice and nursing services and asked them to contact the insurer and provide any needed information.
After not hearing anything for several months, I called the hospice company back and was informed that during conversations with the insurer, the hospice company had been told that my insurance would be denied unless it could be proven that there had been a “change in condition” of my father’s illness during the period of my travel. This was the first I had heard of this request. I was also informed that the insurer had told the hospice company that my case was being closed.
I submitted additional information to the insurer in emails in September and October. I pointed out that the only reference to “change in condition” in the policy appeared to be related to preexisting conditions.
I stated that my father did not have a preexisting condition before I paid for my policy and that he was not diagnosed with cancer until a few weeks before my trip departure. The “change in condition” occurred after I left, when my father became bedridden and uncommunicative.
(In a report dated March 20, 2014, a nurse had written, regarding my father, “impaired decision making: failure to perform usual active daily living situations or inactive daily living situations, inability to appropriately stop activities, jeopardizes safety through actions.”)
I pointed out that there was no “change in condition” of the cancer diagnosis but that there was definitely a “change in condition” of quality of life, as the “cancer diagnosis” changed to “aggressive cancer.” I repeated that I had returned home because my father required my care.
A Complex Claims Adjuster (who had now been assigned to cover my case) sent me an email stating that the hospice company had not indicated that my father’s illness was a “new condition” and that the policy had an exclusion for preexisting medical conditions of family members.
I then reviewed the General Exclusions Section of the policy, which stated that there would be no payment for any injury, sickness or other condition which “within the 180-day period immediately preceding and including the Insured’s coverage effective date first manifested itself, worsened or became acute… .”
I again summarized all of the information that I had previously sent and emphasized that there had been no preexisting condition within the 180-day period before the policy had been purchased (which I considered to be the effective date of the policy).
The adjuster replied by email the next day, referring me to another section of the policy, “Eligibility, Effective and Termination Dates,” which stated that only Trip Cancellation coverage is related to an “effective date” tied to payment of the policy and that all other types of coverage begin when the trip starts. I replied that I had returned early (and was seeking reimbursement for Trip Interruption) because my father required my care.
The final response from the adjuster stated that the policy I had purchased excluded coverage for preexisting conditions, and if an existing condition worsens, it is considered preexisting and is excluded.*
I ended my claim efforts that day.
I would like to hear from any travelers who found themselves in a similar situation as I did but were reimbursed by their insurance company.
Ronald P. Merlo
Glendale, CA
*It is a great idea to get an insurance plan with a preexisting-medical- conditions-exclusion waiver.
I am a retired travel agent and tour guide, having been in the business for 32 years. I remember a travel insurance claim I once fought for for two clients to no avail. This occurred in 2001 but still is relevant today.
My clients were an elderly couple who purchased insurance prior to a family cruise. The man had had ongoing back problems and had been treated for it by his physician for many years. Just before the cruise, he was doing some home repair and fell, severely wrenching his back. He was unable to travel and applied for compensation from the insurance company.
His claim was denied, as the insurer concluded that his back problem was a “previous condition,” not recognizing that the recent injury was totally unrelated to his chronic problem. His doctor and I sent letters protesting this, but the results did not change.
My client and his wife lost their entire cruise fare as well as their round-trip airfare to the port. Ever since then, I have always advised clients to purchase insurance that waives any “preexisting condition” clauses.
Maxine Riell
Arroyo Grande, CA
The issues my wife and I had with travel insurance involved a January 2014 trip to Assam, India. Our Portland-Amsterdam flight was delayed and we barely made our connection to Mumbai to continue on to Guwahati, but our luggage did not make it. We could not continue on our tour without luggage, so we had to stay overnight in a Guwahati hotel and delay our hired transportation and cancel some meals.
Without a way to get reliable information about our luggage, we could only return to the airport the next day to inquire. Miraculously, both bags arrived and we continued on with our trip.
Our travel insurance company later informed us that we were not eligible to be compensated for our extra expenses due to “lost baggage”* or “interrupted travel”** (even despite our travel agent’s follow-up).
On our return trip, we had to leave a day early from Kaziranga National Park because of a daylight road closure planned for a workers’ strike. Along with several other travelers, we hired a driver and vehicle to drive us through the night to avoid the daytime checkpoints. The insurance company denied this “interruption in travel” as well.***
Neither of our specific issues were considered covered in the insurance policy’s fine print, therefore the company would not be held accountable.
My wife and I have traveled internationally a lot. We now have elected to get only medical insurance. Though not a recommendation to others, we have chosen to — with less-expensive trips — NOT purchase a full-feature policy, as, for us, we have only lost money on the travel-interruption coverage.
With many trips, full payment is required 90 days out, and, potentially, we could lose a down payment before then anyway. That is, if we pay a nonrefundable down payment months ahead, then that’s the only thing we lose if we cancel before paying the balance. That’s OK for a less-expensive trip, but for an upcoming $18,000 safari we will insure the land portion by buying a full-feature policy.
Besides, with the land portions of many trips, you’re allowed to rebook for free. Just ask. (You just have to pay any flight-rebooking fees.)
For example, in February 2012 we had to postpone a safari in Tanzania. The safari company in Tanzania allowed us to rebook for the next year, and we didn’t get any penalty from them or from our travel agent for the delay. In fact, we ended up adding four people, so the price per person was less.
For that trip, we had paid $350 for flight-cancellation insurance, but when we learned that the flight-rebooking fee was $300, we paid the fee and kept the insurance for the trip the following year.
More recently, we could have rescheduled a February 2016 Costa Rica trip for a year later, again for free, but we ended up taking the trip as scheduled.
David Smith, Bend, OR
*The baggage was only delayed, not lost. However, depending on the policy purchased and the number of hours the bags were delayed (12? 24?), it is possible that a claim for baggage delay would have been approved, helping to reimburse for essential personal items that needed to be purchased because the bags were missing (but the cost of a hotel room would likely not be covered).
**Delayed baggage is not a covered reason for trip interruption.
***The hiring of the vehicle to leave early was an arbitrary choice made by the traveler (just because you hear that something is going to happen, it doesn’t mean it will happen) and, thus, was not a covered reason.
When my wife and I went to Peru in January 2014, we purchased the insurance sold by our tour operator to cover any trip-interruption and medical expenses. On our return, we got stuck in Lima due to an ice storm in Atlanta and had to spend an extra day, incurring unexpected expenses for taxis and a hotel.
When I submitted a claim to the insurance company, we were told that since it was for a flight home, it took place after the tour was over, so tough luck (even though the flights were part of the tour package).*
It wasn’t a huge amount of money, but I was rather surprised, as I thought it was one of the reasons we had purchased the insurance in the first place.
Jim Schottel
Basehor, KS
*Some tour companies’ insurance plans cover travelers only while they’re on the tour and not during the periods of travel (from home before the tour and heading back afterward) before and after the tour. If you seek such coverage, be sure you have an insurance plan that covers you for your entire trip.
More Travel Insurance Claim Denied letters next month.