Berkely Group

We have reviewed [redacted]’s additional comments and are responding accordingly.   Please note that the [redacted]s’ claim was denied based on the fact that the purpose of the trip was for [redacted] to undergo medical treatment.   As this is specifically excluded from the definition of a Covered Trip, the [redacted]s are not eligible for coverage under this plan.     Further, as advised in our prior response, even if the [redacted]s’ travel plans had met the definition of a Covered Trip under the Plan, the reason for the cancellation was due to the surgeon having an emergency and being unable to perform the procedure as originally scheduled.   We understand that [redacted] disagrees with our classification of such situation as a scheduling conflict of his surgeon.   Please be assured that the situation itself, be it termed a scheduling conflict or an unexpected emergency of the surgeon’s, such situation would not be one covered under the plan.   [redacted] notes that the plan does not list such particular situation as a specific exclusion and he is correct.  However, this is a named peril policy and as such, unless the reason for cancellation falls under one of the specified reasons for coverage contained in the plan, the insured is not entitled to reimbursement under the plan.   Finally, as also previously explained, as the medical condition itself, for which [redacted] had arranged the travel for its treatment, as such condition was not one that had commenced while the plan was in effect, it does not meet the definition of Sickness under the plan and we were unable to consider the requested reimbursement on this basis as well.   Accordingly, we hereby maintain our denial of the [redacted]s’ claim and no reimbursement of their trip costs is due.   However, we have noted [redacted] mentions in his recent correspondence that, had he been aware he was not eligible for such coverage when he initiated his claim, some 10 days after purchasing the coverage on September **, 2016, he would have requested a refund of the plan fees.    Please understand that all claim determinations are made upon receipt of all pertinent claim documentation.   Such documentation was not submitted by [redacted] until September **, 2016.  While [redacted] did not in fact request a refund of his plan fees at the time of his claim initiation, within the 10 day free look period of the plan, we will make a business consideration and honor such contact with our office as tantamount to a request for a refund of the plan fees.  As such, we have authorized the refund of these fees, in the amount of $19.00 per person, to the [redacted]s, in the same form in which payment had been made.     We trust this has provided the further clarification needed regarding the determination made on the [redacted]s’ claim.  Should you have any additional questions, please feel free to contact our office.

We have reviewed [redacted]’s complaint and correspondence and we are responding accordingly.  In his complaint, [redacted] advised that he was unable to travel due to work obligations following his having missed a week’s time from work.   [redacted] was absent from work for one week...

due to flooding in his area.   As a result of having been away from his job for a week, and the financial impact that caused him, he was unable to continue on with his planned travel.  Unfortunately, neither of these issues is covered under the plan. Please understand that the plan purchased provides reimbursement in the event of a cancellation due to a number of both medical and non-medical reasons as specified in the plan.   However, work obligations, a loss of vacation days and any unexpected financial concerns as a result of missing a week of work are not among the specified reasons.   While we certainly appreciate the circumstances in which [redacted] found himself, regrettably as these are not specified reasons for cancellation under the plan, we are unable to consider his request for reimbursement.  Further, pursuant to [redacted]’s correspondence with our office directly, subsequent to the filing of this complaint, please understand that [redacted]’s inability to attend his work obligations, and any loss of income due to his inability to attend to his work obligations, do not constitute a job loss or layoff.    We hope this has provided further understanding of the determination made on [redacted]’s claim.   Should you have any additional questions, please feel free to contact our office.

We have reviewed [redacted]’s complaint and we are responding accordingly.  In his claim, [redacted] advised that he no longer needed to travel as the business contract for which he had purchased the airline ticket was cancelled and he no longer needed to travel.     As was...

explained to [redacted], the plan he purchased contains a listing of specified reasons, both medical and non-medical, which would make one eligible for benefits under the Trip Cancellation coverage.   However, a cancellation due to the loss of a business contract is not among the list of specified reasons.    As such, we are unable to consider [redacted]’s request for reimbursement.   While we certainly appreciate [redacted]’s disappointment regarding the outcome of his claim, we must consider each claim under the terms and conditions of the plan.   Please note the full plan, including all terms, conditions and exclusions, was provided to [redacted] prior to and concurrent with his purchase.   Further, our contact information is provided for any questions regarding the plan.  Finally, the plan contains a 10-day free look period wherein an insured may cancel the coverage within 10 days of purchase should they decide it does not provide the coverage which they are seeking.   We trust that we have provided the requested clarification of the handling of this claim.  Should you have any additional questions, please feel free contact our office.

We have reviewed [redacted]s complaint and we are responding accordingly.  In her complaint, [redacted] advised that she was unable to travel as her employer rescinded her vacation day approval.     As was explained to [redacted], the plan she purchased contains a listing of specified...

reasons, both medical and non-medical, which would make one eligible for benefits under the Trip Cancellation coverage.   However, a cancellation due to lack of vacation day approval is not among the list of specified reasons.    As such, we are unable to consider [redacted]s request for reimbursement.   While we certainly appreciate [redacted]s disappointment regarding the outcome of her claim, we must consider each claim under the terms and conditions of the plan.   Please note the full plan, including all terms, conditions and exclusions, was provided to [redacted] prior to and concurrent with her purchase.   Further, our contact information is provided for any questions regarding the plan.  Finally, the plan contains a 10-day free look period wherein an insured may cancel the coverage within 10 days of purchase should they decide it does not provide the coverage which they are seeking.   We trust that we have provided the requested clarification of the handling of this claim.  Should you have any additional questions, please feel free contact our office.

We are in receipt of [redacted]’s complaint regarding the denial of her and her boyfriend, Randy Joppie’s, claim.   In her complaint, [redacted] indicates that she cancelled for a number of different reasons.  Please note that the reason for which [redacted] submitted supporting...

documentation with her original claim submission was due to her own medical condition.  However, such condition is one that is specifically excluded under the plan purchased.  The plan contains specified exclusions which preclude such reimbursement.  One such exclusion states the following: We will not pay for any loss caused by or incurred resulting from: mental, nervous, or psychological disorders, except if hospitalized;  Based on the information received, [redacted] was suffering from a mental, nervous, or psychological disorder, but was not hospitalized for such condition.   As the condition which caused [redacted] and her boyfriend’s cancellation was specifically excluded from coverage under this plan, they were ineligible for reimbursement.   Following our denial of the claim, [redacted] contacted our office and advised that the cancellation was actually due to a different illness that she had, other than the one noted on the Attending Physician Statement from her doctor.  As such, we agreed to obtain additional medical documentation from her physician in order to confirm her examination and treatment for such other illness, thus prompting the couple’s cancellation.    We have now received [redacted]’s medical records from Dr. Ice which do not confirm a second illness for which [redacted] underwent an examination and received treatment at the time of her cancellation on February **, 2016, contrary to [redacted]’s contention.   As such, we must maintain our denial of this claim based on the medical documentation received.   We do note that [redacted] indicated in her complaint that there were several other reasons for her cancellation.   Of those, please understand that a cancellation due to either the condition of the resort at that time or any custodial issues [redacted] may have had are not specified reasons under the plan and as such we are unable to consider her claim on such basis.   [redacted] does note two remaining reasons for the cancellation noted in the complaint, one regarding her own medical issue and one regarding Mr. Joppie’s parents’ health.   Please understand that the medical documentation received thus far does not indicate that [redacted] suffered from and was examined and treated by a physician for any other condition at the time of cancellation.   If she in fact had been, we encourage [redacted] to provide us with the contact information for that treating physician and we will be happy to obtain the applicable medical records to further review the claim on that basis.   Finally, with regard to the mention of an illness of Mr. Joppie’s parents, should [redacted] wish to pursue this claim on that basis, she can have the treating physician(s) for these individuals complete the attached Attending Physician Statement and we will further review the claim on that basis.    However, until such time as additional information and documentation is submitted for our review, we must maintain our original denial of this claim.   We trust we have addressed the issues raised in [redacted]’s complaint.  Should you have additional questions, please feel free to contact our office.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me and the matter has been resolved.
Sincerely,
[redacted]

Thank you for taking the time to return a reply to me. This reply is completely unacceptable, nor is it truthful.1) The on line advertisement to buy their service did not in any way include any on the information they have enclosed in their reply to you. It is a complete lie, which does not really surprises me as their entire conduct is highly questionable2) The statement which claims that a home owner insurance should be contacted is in fact discriminatory in nature, as it clearly suggests that anyone who buys a policy from them has to have a "home owners insurance"...Or own a home to begin with...really? very interesting. This may be a clear violation of a federal law, as I personally had never heard such a "rule"3) As for their statement that I "have to" contact the airline, I have submitted that I did contact the airline and they have not send me the required form to fill, although I have contacted them 3 times by phone. I can not force them to reply, I can only ask. Their lack of reply does not void my policy with this company, whom I have paid a fee to, for being protected.The fact I have had this insurance policy in place made feel that the insurance company job is to do just the, as I was under the impression that this what I was charged a fee for. This is the insurance company job, not mine, otherwise, what else have they done in the past 8 weeks since this claim was filed ( to include taking their time for almost 3 weeks to email a claim form to me...)???? This is their job. I am not employed by them. I have purchased their service and paid them a fee for it in order to be worry free ( per their advertised offer..) Should such misfortunate event was to take place...I think is should be clear by now to the Revdex.com that a company who has managed to "collect" so many complaints against them in the past 3 year alone, and I have no doubt that there are many more who have most likely gone unreported, that there is a bigger issue here. An issue which probably should be reported to the appropriate governing agencies who control such companies in order to protect future victims .Therefore, I regretfully and respectfully denying their inaccurate, misleading statements made in their reply to me via the Revdex.com. Thanks again,[redacted]

We have reviewed [redacted]’s complaint and we are responding accordingly.  In her complaint, [redacted] advised that after booking the trip, her sister and traveling companion advised her that she had a scheduling conflict with the travel dates and they would have to cancel their...

planned trip. 

 

Unfortunately, [redacted] and her sister’s reason for cancellation is not one covered under the plan.   Please understand that the plan purchased provides reimbursement in the event of a cancellation due to a number of both medical and non-medical reasons as specified in the plan.   However, a scheduling conflict is not one such specified reason.   As such, we are unable to consider their request for reimbursement.

 

Please note that the plan in its entirety is provided to the traveler prior to and concurrent with the purchase.   Further, the traveler must initial their understanding and acceptance of such terms in order to complete the purchase.

 

While we understand [redacted] and her sister’s disappointment’s at the outcome of their request for reimbursement.   We hope this has provided further clarification of the claim determination and understanding that we must review each request in accordance with the terms and conditions of the plan purchased.

We are in receipt of the complaint submitted by [redacted] and are responding accordingly.   As per the information originally provided, [redacted] cancelled her Carnival Cruise due to concerns related to the Zika virus and her pregnancy.   The Plan [redacted] and her family purchased...

provides a reimbursement as a result of a trip cancellation in the event of certain risks, both non-medical and medical.   One such specified medical reason is a cancellation due to a Sickness.   Sickness is defined in the Plan as follows:   Sickness means an illness or disease of the body which: 1) requires examination and treatment by a Physician, and 2) commences while the plan is in effect. An illness or disease of the body which first manifests itself and then worsens or becomes acute prior to the effective date of this plan is not a Sickness as defined herein and is not covered by the plan.   The Plan also contains specific exclusions to the eligibility for coverage.   One such exclusion states the following:   General Plan Exclusions In Parts A & B: We will not pay for any loss under the plan, caused by or incurred resulting from: 3. normal pregnancy, except if hospitalized; or elective abortion;   From the information originally received from [redacted] and her physician, there was no indication that [redacted] was suffering from a Sickness, as defined under the Plan, at the time of her cancellation.   Rather, we understand that the reason for [redacted]’s decision to cancel her travel plans was due to her pregnancy and the concerns for the potential of an illness occurring in relation to the Zika virus.  While we certainly can appreciate and empathize with [redacted]’s decision to cancel the trip, unfortunately, as the reason for such cancellation, namely the concerns for the potential of contracting an illness, is not a specified reason under the Plan, we were unable to consider her request for reimbursement.    However, upon receipt of this complaint, we did reach out to [redacted] to discuss the matter.  [redacted] advised that she in fact experienced a complication with her pregnancy and indicated that was the basis of the decision to cancel the trip.   In order to allow us to further review [redacted]’s claim, it is necessary to obtain additional medical documentation from [redacted]’s physician.   Accordingly, we are currently working with [redacted]’s physicians, [redacted] and [redacted], to secure this additional necessary documentation.  Once received, we will be able to further review [redacted]’s claim to determine if her reason for cancellation does in fact fall within the bounds of the plan purchased.   We anticipate receipt of this information shortly.   We will notify [redacted] of our final determination at that time.   Please note that the Plan in its entirety, including all specified reasons for cancellation, as well as all specific exclusions to the eligibility for coverage, are provided to the participant prior to and concurrent with their purchase of the plan.  In addition, our contact information is provided should a potential plan participant have any questions regarding the plan.   While we await receipt of the requested documentation, should you have additional questions, please feel free to contact our office.

Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me and the matter has been resolved, upon receipt of the payment agreed to in the response by the business.Sincerely, [redacted]

We have reviewed [redacted]s complaint and are responding accordingly.  We are certainly sorry to hear that [redacted] was not satisfied with her experience with our office.   However, the information provided to her was correct.   From the particulars received, [redacted]...

and her husband cancelled their scheduled flight due to [redacted]s job loss.   As explained to [redacted], in order for our office to review the claim, we must receive sufficient documentation confirming that the reason for cancellation meets the plan’s terms and requirements, in particular that the employment from which [redacted] was released was one that he had had for at least one continuous year prior to his termination.   Please note that subsequent to receipt of this complaint, we did reach out to [redacted] to discuss further the documentation needed.  [redacted] did then submit additional documentation to us and we have reviewed same.   As advised to [redacted] directly in correspondence sent on May **, 2017, the documentation submitted indicates that the employment from which [redacted] was released was only for a term of seven months prior to his termination.  As such, based on this documentation, the reason for cancellation does not meet the terms and requirements of the plan.  Accordingly, we are unable to provide the [redacted] with the requested reimbursement at this time.   As also indicated in our correspondence, should the [redacted] have any additional information or documentation from [redacted]s former employer which they feel may have a bearing on their claim, they should feel free to submit same and we would be more than happy to review.   We trust that we have responded to the issues raised in [redacted]s complaint.  Should you have any additional questions, please feel free to contact our office.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID# [redacted], and have determined that my complaint has NOT been resolved because:

The explanation provided by the business is not accurate, nor was my previous request for proof of receipt of said information provided. At the time of purchase (through the Expedia website), the information provided is inconsistent with the 'fine print' the business is attempting to leverage to prove their case. Upon further investigation I see that this is a very common problem for this business, hence their horrible customer satisfaction rating on multiple sites. Since this business is unwilling to resolve this claim, other avenues will be pursued.
In order for the Revdex.com to appropriately process your response, you MUST answer the question above.
Sincerely,
[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID# [redacted], and have determined that my complaint has NOT been resolved because:
 According to the response, they did not explain the situation.  The reason for cancellation had nothing to do with conflicting schedule, my companion is the clergy of a Church, the day before oie departure, he was notified of a death in his congregation, after the cancelation,  neither company would allpw is to reschedule our trip.  Within the time period of our trip, he had 12 deaths and he eulogized the funerals for his members on the congregation.   What happens when other professions had to cancel at a moments notice i.e, doctors, lawyers, surgeons, judges etc.  What rule would apply without penalty and reassurance they will be able to travelat a later date?  Things happen and if the rule applies to certain people then others are discriminated and penalized; an injustice have been done. [redacted]

We have reviewed [redacted]’s complaint regarding the denial of her and her companion’s claim for Trip Interruption due to the airline’s inability to land at the scheduled destination as a result of volcanic conditions on Costa Rica.  Please note that we did approve [redacted] and her...

companion’s claim for coverage and provided payment in accordance with the terms and conditions of the plan – namely providing reimbursement of their unused land travel arrangements.   The plan also provides coverage for any additional transportation expenses incurred to either catch the traveler up to their scheduled destination or return home.  However, based on the information received, [redacted] and her companion did not in fact incur any such additional transportation expenses.   Rather, as per [redacted]’s complaint, the insureds were requesting reimbursement of their full trip cost, including the cost of the airfare that was used for their flights to and from Panama.   Please note that original used and/or unused airfare is not a covered benefit under the terms of the plan and therefore, we were unable to comply with [redacted]’s request. However, we have considered the full circumstances of the pair’s trip and we have agreed to make a business consideration and provide them with the requested reimbursement of their original used and/or unused airline tickets.   Accordingly, an additional payment in the amount of $509.43 per person is being sent to [redacted] and her companion under separate cover.   This amount, together with the original payment provided of $188.93 per person, represents the full trip cost for the pair’s booking. We trust that we have sufficiently responded to the concerns contained in [redacted]’s complaint and are pleased we have been able to bring a satisfying close to this matter.    Should you have any additional questions, please feel free to contact our office.

We have reviewed [redacted]’s complaint regarding the claim payments made on her claim.   Please understand that when [redacted] initiated her claim, she did so without requesting a claim on behalf of her traveling companion.   As such, only a claim for [redacted] was initiated...

and paid.   Following receipt of this complaint, we did reach out to [redacted] to determine the basis of her contention.   We have confirmed that [redacted]’s travel companion also cancelled her travel plans.  As such, we are working with [redacted] to have her traveling companion submit a claim on her own behalf.  Once we are in receipt of the completed claim form from the companion, we will be happy to finalize her claim as well. We trust this shall address the concerns raised in [redacted]’s complaint.  As we are currently working with [redacted] and her companion on the finalization of the outstanding claim, we presume this shall conclude this matter.   Should you have any additional questions, please feel free to contact our office.

We have reviewed [redacted]’ complaint regarding her sister’s claim for Trip Cancellation benefits.   Please note that [redacted]’ sister, [redacted], was booked to travel on December *, 2015 but cancelled several days prior to departure due to her own medical...

condition.   A claim was initiated for [redacted] and a claim form was sent to her for completion.   As a part of this claim form, there is an Attending Physician Statement that is to be completed in full by the treating physician.   When the claim form was originally returned it did not include a completed Attending Physician Statement.  Rather, a letter was submitted which provided only partial medical information regarding [redacted]’ reason for cancellation.   As the balance of the information was needed to enable us to review the claim, we did send correspondence to [redacted] to request the Attending Physician Statement be completed and returned. Prior to receipt of this complaint, [redacted] contacted our office on her sister’s behalf to discuss the matter, explaining the language barrier with her sister’s physician and the documentation previously submitted as verification of the medical condition and treatment of [redacted].   I am pleased to advise that, after further review, we did agree to honor the claim despite not receiving the full response requested.   Accordingly, payment was provided to [redacted] on March *, 2016 in the amount of $660.15, representing the full airline ticket cost. As this claim has now been settled we trust this will conclude this matter.   Should you have any additional questions, please feel free to contact our office.

We have reviewed [redacted]’s complaint and are responding accordingly.   Please note that [redacted] states she canceled her scheduled flight due to her own medical condition.  The plan [redacted] purchased does provide a cancellation due to a Sickness.   However, in...

order to qualify for reimbursement, the reason for cancellation must meet the plan requirements.   These requirements are as follows:   The Sickness or Injury must: a) commence while your coverage is in effect under the plan; b) require the examination and treatment by a Physician at the time the Covered Trip is canceled; and c) in the written opinion of the treating Physician, be so disabling as to prevent you from taking your Covered Trip.   [redacted] purchased her airline ticket on February **, 2015 and cancelled it on March *, 2015 for a trip scheduled from March *, 2015 returning March **, 2015.   Accordingly, in order to qualify for coverage under the plan, [redacted] would have had to have been examined and treated by her physician at the time of his cancellation on March *, 2015, in accordance with the plan’s terms and conditions.     However, based on the information received, [redacted] underwent no such examination or treatment at the time of her cancellation or while she was covered under the plan.  Rather, the information received indicates merely that [redacted] requested a note from her physician on April *, 2015 advising of her inability to travel in March, without having had undergone an examination or received any treatment from her doctor for such condition.     As the information received confirms that [redacted] did not undergo any examination or receive any treatment from her physician at the time of her cancellation, her reason for cancellation does not meet the plan requirements and we are unable to consider her request for reimbursement.    We trust that we have responded to the issues raised in [redacted]’s complaint.  Should you have any additional questions, please feel free to contact our office.

We have reviewed [redacted]’s complaint and we are responding accordingly.  In his complaint, [redacted] advised that he cancelled his travel plans because the surgical procedure for which he had booked this trip was cancelled due to a scheduling conflict of the surgeon.  As such, he no...

longer needed to travel at that time and submitted his claim seeking reimbursement of his and his wife’s trip cost. Unfortunately, we are unable to consider [redacted]’s request on several basis.   The Plan [redacted] purchased will provide a reimbursement for a cancellation of a Covered Trip due to a number of both medical and non-medical reasons, as specified in the plan.   However, based on the information received, namely that [redacted] had booked this trip for the purpose of obtaining medical treatment, such travel plans do not qualify under the definition of a Covered Trip and we are unable to consider his request for reimbursement on such basis.    Further, even if [redacted]’s travel plans had met the definition of a Covered Trip under the Plan, the reason for the [redacted]’s cancellation, namely the scheduling conflict of his surgeon, is not among the specified reasons for coverage under the Plan and we would have been unable to consider the request for reimbursement on such basis.    Finally, a cancellation due to a sickness or injury are among the specified reasons for eligibility of coverage, however, the medical condition must meet the plan’s definitions for such Sickness or Injury, more particularly in this instance, that said condition first occurs or commences while the plan is in effect.   As [redacted] booked said travel plans on September *, 2016 for the sole purpose of undergoing said surgical procedure, the condition in question was not one which had first occurred or commenced after his purchase of the plan.   Based on all of the above, we are unable to consider [redacted]’s request for reimbursement of his and his wife’s travel expenses.   Please note that, prior to purchase, the plan in its entirety, including the complete listing of the specified reasons for eligibility for coverage, as well as the plan’s definitions, is provided to each prospective insured.   As such, [redacted] was advised of the full terms and conditions of the plan prior to his purchase. While we understand [redacted]’s disappointment at the outcome of his request for reimbursement, we hope this has provided further clarification of the claim determination made and understanding that each request must be considered in accordance with the terms and conditions of the plan purchased.   Please note that at the time of receipt of this complaint, we had not yet received [redacted]’s completed claim form.   Please be advised that such claim form was received on September **, 2016 and we advised [redacted] of the determination made on his claim by letter of that same date.

We have reviewed [redacted] complaint and we are responding accordingly.  In her complaint [redacted] states that she cancelled her trip for her own illness and submitted the required documentation.     Please note that while the plan does contain coverage for a...

cancellation as a result of an illness of the traveler, the plan contains specific requirements which would make said insured eligible for reimbursement.  In particular, in order to qualify for coverage as a result of an illness, the insured must undergo examination and treatment by his or her physician during the coverage period and at the time of cancelation.  From the information submitted, [redacted] did not meet these plan requirements, not having undergone an examination and received treatment from a physician at the time of her cancelation.   As such, [redacted] was not eligible for reimbursement under the plan and we were unable to consider her request for refund.    Please note that the plan in its entirety was provided to [redacted] prior to and concurrent with her purchase, including the plan requirements regarding a cancelation due to an illness.   Further, an additional copy of the plan was provided with her booking confirmation.  As such, [redacted] had ample opportunity to review these plan requirements.   We trust this has responded to the concerns raised in [redacted] complaint.   Should you have any additional questions, please feel free to contact our office.

We are in receipt of the complaint filed by [redacted] and are responding accordingly.   [redacted] cancelled his scheduled trip due to his own medical reason.   In order to determine that the reason for the cancelation meets the plan requirements, sufficient medical...

documentation is needed.   However, the original submission from [redacted] did not contain such information and we reached out to his medical providers to obtain the additional medical documentation necessary to allow us to make a determination on his claim.   I am pleased to advise that we did receive the additional information needed to finalize [redacted] claim and payment was provided to him and his traveling companion, in the amount of $864.00 per person.   As this claim is now settled we trust this will conclude this matter.   Should you have any additional questions, please feel free to contact our office.