Berkely Group

We have reviewed [redacted]’s complaint regarding her and her late companion, [redacted]’s, claim for Trip Cancelation reimbursement.   Based on the information received, [redacted] and [redacted] cancelled their scheduled cruise due to [redacted]’s illness.  ...

However, no verification of such illness has been provided to our office to date.   Rather, [redacted] did submit a copy of [redacted]’s death certificate, confirming his death on February **, 2015.   While we do wish to express our sincere condolences to [redacted] for her loss, please allow us this opportunity to explain why additional information was required. The plan purchased provides for reimbursement in the event of a cancellation due to both specified medical and non-medical reasons.   In order to qualify for reimbursement under the plan, verification of diagnosis and treatment by a physician at the time of the cancellation of the travel plans is required.   Regrettably, the documentation submitted by [redacted] did not confirm such diagnosis and treatment at the time of the couple’s cancellation, namely on or about January **, 2015.  For this reason, we requested that [redacted] provide such verification and submit same to our office for review. While the information provided to date does not confirm [redacted]’s illness at the time of the cancellation, we have agreed to make a consideration and provide payment based on the information contained on the death certificate.   Accordingly, payment in the amount of $249.00 per person is being sent to [redacted]’s attention for both herself and [redacted]’s estate.  Please understand that this reimbursement is being made solely as a goodwill gesture and does not impinge upon any of the plan’s terms and conditions under which this claim is considered. We trust that we have adequately responded to the concerns raised in [redacted]’s complaint.  Should you have any additional questions, please feel free to contact our office.

We have reviewed [redacted]’s complaint regarding his claim for Trip Interruption reimbursement which he had filed with our office.  Based on the information received, [redacted] delayed his return home due to his mother’s medical condition at the time of his scheduled return.  ...

However, in his initial claim submission, [redacted] provided no medical verification of such condition, nor any receipts for additional travel expenses incurred due to his delayed return.   Therefore, we sent [redacted] correspondence requesting the Attending Physician Statement on the claim form be completed and a copy of his credit card receipt be submitted.   In response, [redacted] submitted his late mother’s death certificate, which indicated that his mother had passed some two weeks after the interruption of his trip.   While we were very sorry to hear of [redacted]’s passing, unfortunately, this documentation did not confirm her medical condition at the time he had extended his trip.   As such, we did request he provide us with this information to allow us to finalize his claim.   Upon receipt of this complaint we again reviewed [redacted]’s claim.   While the information provided to date does not confirm [redacted]’s illness at the time of [redacted]’s trip interruption, we have agreed to make a consideration and make payment based on the information contained on the death certificate.   However, as we still have not received receipts for any of the additional flight expenses [redacted] incurred for his new return flight, we have reached out to him several times to request he provide same.   To date, we have been unsuccessful in speaking with [redacted] and have sent him correspondence requesting same.  Accordingly, upon submission of the receipt for his additional airline expense, we will be happy to finalize [redacted]’s claim.     We trust that we have adequately responded to the concerns raised in [redacted]’s complaint.  Should you have any additional questions, please feel free to contact our office.

We have reviewed [redacted] complaint regarding the denial of her claim for payment under her Car Rental Insurance plan.   As the plan [redacted] purchased contains a $250 deductible, and as the amount of [redacted] claim was below that $250 deductible, we were unable to...

provide any reimbursement to [redacted]. We note that in her complaint, [redacted] indicates that she was unaware the plan she purchased contained this $250 deductible.  Further, to demonstrate her point that the plan does not contain an indication of the deductible, [redacted] provided an “[redacted] mock rental” and included this with her complaint.   I have attached the mock rental [redacted] provided and would direct your attention to the section regarding adding the protection plan.   You will note that the full terms and conditions are made available prior to the booking via the link in blue – View terms, conditions and plan sponsor.    The full plan that was provided via this link to [redacted] during her actual booking, as well as during the “mock car rental” [redacted] submitted for reference, a copy of which is also attached here, does indeed contain the notice of the $250 plan deductible.  You will note that under the Description of Coverage of the plan on page 1, it states:               Schedule:  [redacted], Inc.                                    Maximum Benefit Amount               Rental Car Damage                                     ...⇄ ($250.00 Deductible) The plan further goes on to define Deductible as follows: Deductible means the amount, which must be incurred by you before benefits are paid under the plan.  The Deductible is equal to the amount shown in the Schedule for each person insured. While we understand that [redacted] did not make note of the plan deductible in the documents provided to her both during her actual booking as well as during her “mock car rental” booking, as the plan does contain this $250.00 deductible we are unable to consider [redacted] request for reimbursement of the damages incurred which were below this deductible. We trust we have responded to the concerns raised in [redacted] complaint, and have provided clarification regarding the denial of her claim.   Should you have any additional questions, please feel free to contact our office.

We are in receipt of [redacted]’ additional comments and respond accordingly.   We apologize for any misunderstanding however, the issue regarding [redacted] being unable to cash a check over $500 for an individual who is not a client of that institution is a bank restriction.  Further, as previously advised, we are unaware what issues the check cashing facility may have had with regard to cashing the check for [redacted].   In response to [redacted]’ statement that he never asked that a replacement check be issued, please note that in an email communication with our office on June **, 2017, [redacted]  [redacted] did in fact request a replacement check be sent to him.   We called [redacted] the following day to discuss the matter but, when our representative reached out to him, [redacted] disengaged the call.   As indicated in our original response, the check that [redacted] currently holds is a fully negotiable check and we offered a number of suggestions with regard to how he may have such check cashed.    It is at [redacted]’ discretion as to how he wishes to effectuate such process.   We trust we have responded to the additional comments from [redacted].   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] initiated a claim with our office seeking reimbursement for his Trip Interruption benefits.   Such claim was reviewed and payment was issued to [redacted] in the amount of...

$975.39 on June *, 2017.   Following our payment, [redacted] contacted our office to advise that he attempted to cash the settlement check at a [redacted] bank, from which the check was issued, but was advised that as the check was over $500, and as [redacted] did not have a bank account with [redacted], they would not accept the check for cashing.  [redacted] advised us that he has no bank account in any bank and as such is unable to cash the check in question.  [redacted] also advised that he was refused cashing at a check cashing facility.   Please note that we are aware of no such restrictions at such a facility, unless that facility itself has certain restrictions.    [redacted] has requested a new check be issued to him.   We have advised [redacted] that we are more than happy to issue him a new check, upon return and voiding of the original check.  However, please understand that such replacement check will be subject to the same bank restrictions at [redacted] Bank regarding cashing.      As [redacted] maintains that he has no bank account to use for cashing or depositing this check we have researched the matter and offer him two suggestions.  Should [redacted] wish to, he has the option to open a bank account and deposit this check and then draw on that account, in accordance with that particular bank’s requirements.   Should [redacted] not choose that course of action, from our research it appears that some larger stores will cash insurance settlement checks.   Our research indicates that Walmart Stores provide this service to their customers, for insurance settlement checks up to $1000, and for a nominal fee.    We have also confirmed that there are a number of Walmart Stores within a 3 – 5 mile radius of [redacted]’ home.   We hope this information is helpful to [redacted].   We trust we have provided sufficient information to respond to the concerns raised in [redacted]’ 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.   Based on the information received, [redacted] cancelled her scheduled trip, a visit to her family member for the Thanksgiving holiday, because her family member was no longer going to be in town to host her during her...

trip.   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, as a change in plans due to the cancellation of a planned event, or a family member being unable to host a traveler, is not one of the covered reasons under the plan, we were unable to consider her request for reimbursement.    Please note that the plan in its entirety is provided prior to purchase for review.  Further, the confirmation provided to [redacted] contained a link to the plan, including the specified reasons for cancellation as well as the contact information for our office for any questions regarding the plan.   Finally, with regard to [redacted]’s request for a credit, please note that if she cancelled her flight prior to the departure time, we would kindly suggest that she reach out to the airline to determine if there is any credit available to her on her canceled ticket.     We trust that we have addressed the concerns raised in [redacted]’s complaint.   Should you have any additional questions, please feel free to contact us.

Please allow this response to confirm our receipt of [redacted]’s claim form.   While it had been received in our office concurrent with our prior response it had not been processed and filed until after our response was submitted.   Please be assured that there have been no delays in the review of [redacted]’s claim.   Rather, upon receipt of the claim form we did reach out to [redacted] directly on June [redacted], speaking with him on June [redacted] regarding the additional information needed to complete our review of the claim. As explained to [redacted], we did agree to consider his claim for Trip Cancellation benefits due to his loss of income under the coverage afforded to an individual who suffered an involuntary job loss, provided he met the remaining requirements for such coverage.  In particular, we required confirmation that he met the three consecutive year time requirement of employment – or receipt of benefits, in this instance – prior to termination.  As per [redacted], he was not in fact receiving such benefits for that length of time prior to their termination.   As such, we did advise him that, based on the fact that he does not meet the full eligibility requirements under this coverage, we would be unable to consider his request for reimbursement. Formal notice of our decision has been sent to [redacted] under separate cover.   We trust we have responded to the additional concerns raised in [redacted]’s complaint.  Should you have any further questions, please feel free to contact us.

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:

It appears that the Insurance company is applying an exclusion that is irrelevant.  Exclusion Section, item 10, “medical treatment during or arising from a Covered Trip undertaken for the purpose or intent of securing medical treatment", would have applied had I suffered any illness or injury during my trip.  I feel the contract language is ambiguous at best. However, I read contract exclusion #10 as the company is protecting itself from travelers that get injured during their trip and then try to file claims.  I find it extremely self-serving that the insurance company can spin the language any way that is needed to avoid issuing a refund.My surgeon did not have a scheduling conflict.  He had an unexpected emergency that forced his office to cancel over two weeks of surgery and appointments.  There is no exclusion for a doctor cancelling surgery.  Let's be real here.  Contract language rarely covers every possible event that may occur.  At some point, common sense must prevail. My surgeon wrote a letter that I previously attached for your review, stating clearly that the cancellation was on him not me.  The bottom-line is that I notified the Insurance Company nine days after I booked my reservation and four days before departure.  The company insisted that I had to file a claim.  The Insurance Company never offered to reimburse me for my Flight Plan Insurance despite being within nine days of purchase.  So, I filed the claim and then learned that the Insurance Company extended its empathy but denies any reimbursement for itinerary expenses. We could have saved each other a lot of time had I been told by the Insurance Company agents that I was wasting my time filing a claim, that my only option was to request a refund for my Flight Protection Plan payment.  That action alone would have been enough to tell me that the Insurance Company had no intention to honor my claim.  Instead, I do not even qualify for my Flight Plan Protection insurance refund because I followed the Insurance Company’s instructions to file a claim.  I missed the policy reimbursement because of the lengthy claim process.

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:

[Let us summarize:1] I book a Carnival cruise and purchase the recommended travel insurance. Good2] Airline flight is cancelled "DUE TO SEVERE WEATHER", No other flight available. I miss the cruise. Bad3] But wait, I have travel insurance.Good.4] No, the travel insurance company responds with an endless list of restrictions and conditions which seem to release them from ever having to pay any claim. It would seem fairly obvious that if I, in good faith, purchase travel interruption insurance, and that travel does not occur, then the insurance company will honor their responsibility.      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:

[Then they need to change the title of the cancellation plan - it should be a termination plan.  I have used cancellation plans from Am track, Southwestern, etc.  Not please and warn people in the St. Louis area about the policy.  ]
 
 
 
 
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:
 
 As I stated prior, my reason for requesting the reimbursement was due to the event being cancelled by the event coordinators. This was something totally out of my control and therefore gave me no reason to continue my trip plans. The stated fact by the insurance that this was a "peril plan" was not made clear to me at the time of purchase. The reason I cancelled was not listed in the covered portion for legitimate reasons, but it was also not listed in the non covered portion for non legitimate reasons. I believe this is a grey area and the insurance company should better clarify their future explanations of benefits so as not to mislead potential future customers of which I will not be one. I am very unsatisfied with this resolution and I will be sure to make it known that this company was not willing to reason fairly in this matter. I thank the Revdex.com for attempting to help me with this matter. 
 
 
In order for the Revdex.com to appropriately process your response, you MUST answer the question above.
Sincerely,
[redacted]

We have reviewed [redacted]’s complaint and correspondence and we are responding accordingly.  In his complaint, [redacted] advised that he cancelled his scheduled trip due to the death of an immediate family member.   He contends that he has submitted the necessary documentation and...

has failed to receive a response from our office.   Please note, [redacted] submitted his claim form and noted his reason for cancellation was due to the death of an individual he noted as a close friend/cousin, a [redacted], DOB [redacted], indicating she passed on or about [redacted].  Though [redacted] provided no verification of the death of this individual, as the relationship noted by [redacted] on his claim form, that of close friend/cousin, was not within the definition of an Immediate Family Member contained in the plan, we were unable to consider [redacted]’s request for reimbursement and the claim was denied.   We advised [redacted] of this determination on September **, 2016.   Following this denial, [redacted] sent correspondence to our office claiming that per the African American culture, as the individual in question was raised in the same home with him, they were considered to be immediate family.   We responded to [redacted] on October **, 2016, advising that we must review the claim under the terms, conditions and definitions of the plan purchased, and as such, we were unable to consider the claim.   [redacted] then contacted our office again to advise that though the sufferer was his cousin, his parents had adopted her and therefore she was his sister.   [redacted] was advised to submit the documentation of this and we would gladly re-review his claim.     The documentation [redacted] submitted however, did not confirm that the individual listed on his claim form, [redacted], DOB 2/**/1999, was in fact adopted by his parents.  Rather, though the document [redacted] submitted was a Final Order of Adoption, the adoptee was one [redacted] DOB 7/**/2012, and was adopted by one [redacted].   As the individual listed on this adoption order was not the individual for whose death [redacted] had previously claimed to have cancelled his trip, we advised of this inconsistency in our correspondence of December **, 2016 and noted that we would be unable to consider his claim based on the documentation he submitted.   Should [redacted] have the appropriate documentation, namely the death certificate of [redacted], DOB [redacted], as well as the adoption order for [redacted], including confirmation that the adoptive parents were indeed [redacted]’s own parents, he should submit same to our office for our review.   However, until such time, we will be unable to consider [redacted]’s request for reimbursement and no payment shall be forthcoming.    We trust this has responded to the concerns 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] advises that he disagrees with our determination on his claim.   Please note that we have again reviewed [redacted]’s claim and have confirmed it was adjudicated...

correctly.  Please allow me to clarify that [redacted]’s reason for cancellation was due to his work schedule and his inability to take the time off work that he had originally planned for this trip of 11/**/15 through 11/**/15.   While we understand that [redacted] served jury duty on 10/**/15, several weeks before his travel dates, this jury service did not prevent him from making this trip, as is required under the plan.  Rather, the impact to his work schedule following the day of such jury service made [redacted] determine that he was unable to take the additional time off from work scheduled for this trip and subsequently cancelled this trip on the day of departure, 11/**/15.   While we certainly appreciate [redacted]’s decision to cancel his trip to attend to his business, such is not a specified reason for cancellation under the plan and we are unable to consider his request for reimbursement. We trust 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.   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 find that this resolution is satisfactory to me and the matter has been resolved.
Sincerely,
[redacted]

We have reviewed [redacted]’s complaint.  Please note that we have received this complaint from [redacted] in our office and we will be responding to him directly as well.    In his complaint, [redacted] is seeking a settlement due to his feelings regarding his emergency...

evacuation.   Please allow us to confirm that the evacuation was handled appropriately by the assistance company in accordance with the plan terms and in the best interests of the patient under the circumstances presented.  Please understand that an evacuation can only take place once a patient is deemed medically fit to fly by the treating physician, in conjunction with the medical staff of the assistance company.    While the assistance company attempted, there were no available rooms in the [redacted]’s preferred hospital in Orlando so alternate hospital arrangements were made in Ft. Lauderdale given his condition. As the evacuation costs exceeded the benefit limit, the assistance company had to confirm that the Berrongs were responsible for any overages to complete the evacuation arrangements. Finally, please be advised that the assistance company is presently reimbursing [redacted] for the portion of the evacuation expenses he paid out of pocket following recovery from his primary carrier’s for portion of the evacuation costs.     With regard to [redacted]’s settlement request, please understand that we are unable to entertain any such request and no settlement offer will be forthcoming.   We trust that we have addressed the concerns raised in [redacted]’s complaint.   Should you have any additional questions, please feel free to contact us.

We have reviewed [redacted] further comments and respond accordingly. [redacted] found our prior response, most notably regarding the request for specific information related to the telephone discussions he advised he had with our office and of which we found no record, unacceptable.   Please understand our request for this information was prompted by [redacted] prior response wherein he asserted he had spoken to our office twice before initiating his claim via our self-serve website. Should [redacted] not wish to provide this information, we must proceed with the information and documentation at hand.   Accordingly, as previously advised, the plan [redacted] purchased was provided to him for review prior to such purchase.   The plan specifically advises of the terms and conditions, as well as the requirements, for eligibility of coverage. Further, as previously advised, [redacted] was also provided with an additional copy of the plan with his booking confirmation for reference at any time.   As such, [redacted] had ample opportunity to review the requirements for a cancellation due to an illness and he did not meet such plan requirements.   As [redacted] did not meet these plan requirements, having not undergone an examination and received treatment from a physician at the time of his cancellation, we are unable to consider his request for reimbursement and no payment shall be provided.   Please note that should [redacted] wish to have us further investigate any telephone calls he asserts he made to our office prior to his claim initiation, as previously advised, we would be more than happy to do so.  He should provide to us the information noted in our prior response.   However, until such time, the determination made on [redacted] claim is hereby upheld and we consider this matter closed.

We have reviewed [redacted]’ additional comments and we are responding accordingly.  We note that [redacted] indicates in her complaint that she emailed our office to advise that if we require documentation from a physician, she can provide a letter from her cousin with whom she stayed during her trip.     Please note that the email [redacted] sent to our office advised that as she was out of town, her only option was to bring her son to the emergency room in the middle of the night and that she decided against doing so.     If [redacted] did in fact have her son undergo an examination by her cousin, a physician, at the time of the interruption of their trip, and received treatment from that physician, she can certainly have the physician send a letter to our office, on letterhead, confirming the examination, the diagnosis made and the date of the examination, as well as indicating the treatment provided.    Upon receipt of such documentation, we would be happy to again review [redacted]’ claim. Attached is a copy of [redacted]’ email for your reference.   We trust this has responded to the additional comments from [redacted].   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:

 
 
 
 
In order for the Revdex.com to appropriately process your response, you MUST answer the question above.
Sincerely,
[redacted]

We have reviewed [redacted] complaint and the email correspondence received directly from him, and we are responding accordingly.  In his complaint, [redacted] advised that he was unable to travel due to work obligations.   Unfortunately, this is not one of the covered reasons for...

cancellation under the plan.  Rather, the plan specifically excludes coverage for a cancellation due to a business obligation.    As such, we are unable to consider [redacted] request for reimbursement.   While we certainly appreciate the disappointment [redacted] demonstrates in his correspondence, 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 additional comments and are responding accordingly.  [redacted] is arguing that his temporary inability to attend his place of employment constitutes a layoff.   However, there is no evidence that at the time in question [redacted] was contacted by his employer and advised that his employment was no longer needed and he was being terminated or laid off.   Rather, from the letter which [redacted] submitted with his claim form, dated October [redacted], from the South Carolina Department of Health and Environmental Control,  at which he works, it was advised that the office was temporarily closed Octobe** [redacted] due to extensive flooding in the area.   It goes on to say that all compensation and leave time has not been approved and advises that any prior time off requests must be used to cover the days during which the office was closed.  Further, from [redacted]’s own explanation provided with his claim form, as a result of the time away from work due to this temporary office closure, the time off that he had requested for this trip now must be used to cover the days of the office closure.   He concludes by saying that because of this, as well as no longer being financially able to afford this trip, he regretfully requests cancellation.  Accordingly, the denial of [redacted]’s claim was appropriate as his reasons for cancellation, the loss of his time off requested and any subsequent financial constraints, do not qualify him for coverage under the plan.   Finally, as evidenced by the letter from [redacted]’s employer, he was neither terminated nor laid off from his employment and as such, we are unable to consider his request on such basis. With regard to [redacted]’s mention of the definition of Natural Disaster, please note that as there was no shutdown of all local airports for a period greater than 72 hours at the time of his scheduled flight, nor was [redacted]’s own home made uninhabitable at that time, we are unable to consider his request on this basis. While we certainly understand [redacted]’s disappointment with the outcome of his request for reimbursement, we must review each claim in accordance with the terms and conditions of the plan.   We trust that we have provided the requested additional clarification of the handling of this claim and this matter is now closed.  Should you have any additional questions, please feel free to contact our office.