We have reviewed *** ***s complaint regarding the processing of the claim for *** *** S*** for Trip Cancellation benefits. We are providing our response accordingly. We received a claim initiation advising that *** *** and MsS*** were attempting to change the
original airline ticket or cancel and repurchase a new ticket, indicating that they would advise us of the situation once they’d made their decision. We acknowledged receipt of the claim submission and the need for such documentation once available. *** *** later submitted documentation indicating that the original, insured airline ticket had been cancelled and a new ticket purchased. We then proceeded to provide the full refund of the original, cancelled, airline ticket for which the coverage had been purchased, in the amount of $233.29. Please understand that this is the maximum benefit available under this coverageThe plan states: In no event shall the amount reimbursed under Trip Cancellation or Trip Interruption exceed the amount you prepaid for your Flight While we understand that MsS*** purchased a new airline ticket for her new travel date, please understand that there is no coverage for any additional cost of such ticket over the cost of the original ticket purchased and reimbursed. The payment provided to MsS*** represents the maximum benefit to which she was entitled under the plan purchased. As full payment of this claim has been provided we have closed this matterWe trust that we have sufficiently responded to the concerns contained in *** ***’s complaintShould 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# 1***, and have determined that my complaint has NOT been resolved because: I have emailed them an official letter on letterhead that he was checked out and verified to be ill, like requested Last time I emailed the company, I never heard back Once I hear back from them about the letter I sent, verifying he was ill and what their response is, will determine if I accept the resolution. Thank you
In order for the Revdex.com to appropriately process your response, you MUST answer the question above
Sincerely,
*** ***
We have reviewed [redacted]’s complaint and are responding accordingly. The plan that [redacted] purchased on May **, 2017 does indeed offer coverage for a flight cancellation in the event of a job loss. However, the plan does specify that this coverage does not apply to “temporary...
employment, independent contractors or self-employed persons.” Based on the information received from [redacted] and her traveling companion, [redacted], the cancellation was due to [redacted]’ job loss. However, from the information submitted, [redacted] was a co-owner of the business that ceased operations on May **, 2017, two days after their purchase of the plan. As [redacted] was self-employed, his and [redacted]’s reason for cancellation is specifically excluded under the terms of the plan and we are unable to consider their request for reimbursement. Please note that the plan in its entirety is provided prior to purchase for review. Further, the confirmation provided to [redacted] and [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. 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 her complaint, [redacted] states that she submitted the information needed regarding her cancellation and we have not yet provided her refund. Please note that we spoke to [redacted] several times regarding her...
claim and advised her on September *, 2017 what information is needed in order to continue our review of her claim. We are currently awaiting such documentation. More particularly, when [redacted] submitted her claim form to us, she did not submit a completed Attending Physician Statement from her treating physician nor note any dates of treatment. Rather, she noted that she was an employee of a hospital and simply provided generic information regarding her medical condition As such, we were unable to consider the claim as verification of examination and treatment by a physician at the time of the cancellation, which is required under the plan, was not provided. As per our discussion with [redacted] on September *, 2017, we advised that in order for us to continue our review of her claim, sufficient medical documentation must be submitted to allow us to confirm that her reason for cancellation meets the plan’s terms and conditions. At that time [redacted] advised that she would have her physician complete the Attending Physician Statement and submit same to our office. To date we continue to await submission of this documentation. Please understand that until sufficient medical documentation has been submitted to allow us to continue our review of the claim, we will be unable to make any further determination on [redacted]s request for reimbursement. Upon receipt of same, we will give [redacted]s claim our immediate attention. We trust this has addressed the concerns raised in [redacted]s correspondence. Should you have any additional questions regarding this matter, 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:
It wasn't that I had to "fulfill job obligations" -- the place of business was closed entirely for the week, that was beyond my control. Furthermore the description of coverage says "e. your involuntary termination of employment or layoff which occurs after your effective date of coverage and was not under your control. You must have been continuously employed with the same employer for 3 years prior to the termination or layoff. This provision is not applicable to temporary employment, independent contractors or self-employed persons;"I was involuntarily laid off for a week, and it was not under my control. NOWHERE does it state how long the layoff has to be for.And: "g. a Natural Disaster occurs, which causes a complete cessation of travel services at point of departure and/or destination;" -- A large part of my neighborhood was destroyed by flooding and I am still have to take detours just to get around my normal routes to and from work.This company should not be allowed to scam people out of money, this was out of my control. I will be glad to contact any and all media to let them know that this company is trying to scam a flood victim out of insurance money. This is disgraceful and NOT ok.
In order for the Revdex.com to appropriately process your response, you MUST answer the question above.
Sincerely,
[redacted]
We are in receipt of the complaint submitted by [redacted] on behalf of his wife, [redacted] and are responding accordingly. As per the information received, [redacted] cancelled her trip to Costa Rica after discovering she was pregnant and due to concerns related to the...
Zika virus. The Plan [redacted] 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. 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 caused by or incurred resulting from:… 3. normal pregnancy, except if hospitalized;From the information received, there is 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 recent discovery of 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 her trip, unfortunately, as her reason for such cancellation, namely her 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. 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. 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]
We have reviewed [redacted]’s complaint and are responding accordingly. Please note that [redacted] states he canceled his scheduled flight due to his 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] contacted our office on October **, 2015, to advise that he was unable to take his scheduled flight on October **, 2015, due to his own medical condition and he wished to initiate a claim for the losses associated with the cancelation or change of this ticket. Contrary to [redacted]’s assertion that he was not advised at the time he initiated his claim that he would need to provide verification of the examination and treatment he received at the time of his cancellation, in fact this information was relayed to [redacted] during said conversation. More particularly, a review of this conversation confirmed that our representative advised [redacted] that the claim form contained a section that would need to be completed by his treating physician. [redacted] expressed his displeasure at this requirement as he advised it would cost him $100 to have his doctor complete the claim form. Our representative relayed her understanding of his concerns but reiterated that this was a plan requirement. Further, please note that the plan requirements, including the requirement of an examination and treatment at the time of a trip cancellation, are noted in the plan’s description of coverage. This description of coverage was provided to [redacted] prior to his purchase of the plan, with a link to an additional copy provided on the confirmation of his purchase. As such, [redacted] had ample notice of the plan requirements regarding a Trip Cancellation claim for a medical illness. With respect to [redacted]’s assertion that he was not sent a claim form for a number of weeks after initiating his claim, please note that a claim form was sent to [redacted] via email, at [redacted], concurrent with the claim initiation, at 5:17pm on October **, 2015. [redacted] then contacted our office again on November *, 2015 regarding receipt of the claim form and a second copy of the claim form was emailed to the same address at 12:07pm on November *, 2015. Within minutes of the sending of this second claim form, [redacted] again called our office and he again requested the claim form be emailed. A third copy of the claim form was then emailed to [redacted] at the same address at 3:19pm that same afternoon. Accordingly, every effort was made to provide [redacted] with a claim form for his completion. Though [redacted] has not yet submitted a completed claim form, based on the information he included in his complaint, he affirmed that he in fact did not see a physician at the time of his cancellation. As [redacted] does not meet the plan requirements indicated above, we are unable to consider his request for reimbursement and must decline coverage at this time and will notify him of this decision under separate cover. While we certainly understand [redacted]’s disappointment in the claims process, please understand that we must consider each claim under the terms and conditions of the Plan purchased. 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] complaint and we are responding accordingly. [redacted] had filed claims with our office for Trip Interruption benefits under two separate protection plans he and his wife had purchased in connection with their scheduled European tour. The [redacted] began their...
outbound flight to reach their tour but were unable to continue on as scheduled due to a carrier delay/cancellation. Due to this situation, the airline was unable to re-accommodate the [redacted]’ and they returned home. The [redacted] purchased a tour with Trafalgar and booked the airline tickets to reach the tour through Priceline. The Edmonds purchased the travel protection plans available in conjunction with both the travel bookings made. We processed the two claims submitted by the [redacted] in relation to the interruption of their trip. With regard to the claim the [redacted] filed under their Trafalgar plan, the reason for the interruption of the [redacted] travel plans was indeed a specified reason under the terms and conditions of the plan. As such, they were eligible for payment of their Trip Interruption benefits. Accordingly, we provided the payments to the [redacted] under their Trafalgar travel plan totaling $4,048.04. These payments were: $33.52 per person on August [redacted], for the additional expenses they incurred during the flight delay and $1,990.50 per person on August [redacted], for the full cost of their missed tour. Apparently upon receipt of that first payment, the [redacted] believed there was no additional payment forthcoming. We sincerely apologize for any such misunderstanding. With regard to the coverage the Edmonds purchased in conjunction with their airline tickets booked through Priceline, however, regrettably that plan does not contain coverage for a Trip Interruption as a result of a carrier delay or cancellation. As such, we were unable to consider the [redacted] request for reimbursement under this plan. Please allow me to advise further that, even if the [redacted] had interrupted their travel plans for one of the specified reasons contained in the plan, the losses for which they were seeking reimbursement, namely their original, partially used airline tickets, would not be eligible for refund as there is no coverage for original airfare under the Trip Interruption benefit but rather for any new airfare expenses incurred to return home. While we understand the [redacted] disappointment with the interruption of their travel plans, and the outcome of the claim for their airfare, we are pleased we were able to reimburse them for their missed tour. We trust this has provided clarification of the claims handling as well as an understanding that we must review each request in accordance with the terms and conditions of the specific plan purchased. Should you have any additional questions, please feel free to contact our office.
We have reviewed [redacted]s additional comments regarding this claim and are responding accordingly. As advised previously, we show no record of the calls [redacted] contends she had with our office. If she maintains her position, she will need to supply the requested information to allow further research. However, at this time, as we have found no evidence to substantiate her contention, we consider that issue closed. With regard to the documentation requested and submitted, please note that this documentation was required in the normal course of the claims process to verify the basis of the claim, and to allow payment of the claim to Ms. S[redacted] for the applicable, maximum benefit. As advised, the appropriate and full payment of this claim has been provided to Ms. S[redacted]. The draft for said payment remains valid for a period of six months from date of issue, July *, 2017. We trust this matter is now concluded.
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]
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:
I have never received the automated answer they claim I did, but at this point it's my word again theirs. I have offered a screen shot of the last email I ever got from them. Also, I already had my doctor submit paper work, twice, and I am a bit reluctant to go back to her without knowing what exactly they want this time. I am afraid that it will still not meet their needs. Can they be very specific about the type of documentation they need, so I do not take so much of the doctor's time again? They can also call her directly.This is really starting to feel more and more like an excuse after another for not paying the claim.
We have reviewed [redacted]’s further comments advising of her submission of the physician form required for further claim review. Please note that we did indeed receive the Attending Physician Statement (“APS”) [redacted] had completed by Dr. Joycelyn D. M**. However, rather than affirming the date of examination performed by Dr. M** and treatment provided by Dr. M**, which was noted in our prior response as being required under the plan, Dr. M** in fact simply affirmed that she had performed no such examination and had provided no such treatment to [redacted], noting on the APS under the question of examination and treatment of [redacted], “None for this condition.” Further, Dr. M** indicates that she knows of no treatment received by [redacted] from any other physician for this condition. As the medical documentation submitted by [redacted] affirms that she underwent no examination and treatment by a physician during the coverage period and at the time of cancellation, we must maintain our original determination on this claim. Please note that correspondence was sent to [redacted] on October [redacted] advising of such determination. We trust this responds to [redacted]’s further inquiry and this matter is now concluded. Should you have any further questions regarding this matter, 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 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 the complaint filed by [redacted] and are responding accordingly. [redacted] initiated a claim with our office seeking reimbursement for Trip Interruption expenses for changes she made to her travel arrangements approximately two and a half weeks prior to her...
departure. As coverage for Trip Interruption had not yet incepted, as such coverage does not begin until the insured departs on the scheduled trip, we were unable to consider [redacted]’s request for reimbursement of her new airline ticket and additional expenses she incurred in the course of her early return. In accordance with this basis, and further that the medical condition prompting [redacted] to return home early from her trip was not a condition that began during her covered trip, as is required under the plan, the denial of such benefits was appropriate. However, we have reviewed [redacted]’s claim again and, though not as originally presented, based on the medical information reviewed, we have determined that we can consider [redacted]’s original airline ticket, which she cancelled when she changed her travel arrangements and return date, under the Trip Cancellation coverage of this plan. Accordingly, payment in the amount of $3,095.00, the cost of [redacted]’s original airline ticket, is presently being provided to her directly. While the amount being provided at this time may not be the full amount [redacted] sought when filing the claim, it is in fact the maximum benefit available to [redacted] based on the medical information received, coverage terms in place and plan language. 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.
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.
We are in receipt of the complaint filed by [redacted] and are responding accordingly. [redacted] began their cruise vacation but disembarked from the sailing the following day. They submitted a claim to our office seeking reimbursement of their Trip Interruption...
benefits. However, from the information received, it indicated that [redacted], who uses a C-Pap machine while sleeping, discovered that his machine was not functioning and the couple decided to disembark due to such mechanical issue. Please understand that a mechanical issue with the machine alone would not be a specified reason for interruption under the plan and as such we were unable to consider the couple’s request for reimbursement. However, based on the clarification provided in [redacted]’ complaint, as well as additional medical information regarding the circumstances surrounding the decision to end their participation on the cruise early, we were able to re-review the claim. More particularly, we have affirmed that due to the mechanical issue with [redacted]’ C-Pap machine, he experienced an exacerbation of the underlying medical condition which requires the use of this machine. That exacerbation was confirmed by the ship’s physician who in fact recommended the [redacted]’ disembark the cruise at the first port of call as a result of [redacted]’ medical condition. I am pleased to advise based on the additional information reviewed, we have been able to reverse our original determination on the [redacted]’ claim. Accordingly, on April *, 2016 we sent payment to the [redacted]es in the amount of $770.85 per person for their missed cruise portion and the additional transportation expenses for their early return. However, additional charges incurred for a hotel stay before their return flight was not eligible for reimbursement under the terms of the plan. 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.
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.
We have reviewed [redacted] complaint and we are responding accordingly. In her complaint, [redacted] explains that upon her and her parents’ return trip following their cruise, her parents, who are citizens of Trinidad and Tobago, were denied boarding onto the return flight as they did not...
have the required travel documentation for such passage. As such, [redacted] and her parents remained in Barcelona for two nights while making alternate travel arrangements. It is reimbursement for the expenses associated with this stay and the family’s new travel expenses which [redacted] requested. Unfortunately, as the reason for the family’s delayed return is not one covered under the plan, lack of proper travel documents, we are unable to consider their request for reimbursement of the expenses incurred in connection with such delay. Please note that we cannot address any issues [redacted] indicates regarding information received pertaining to travel document requirements. While we understand [redacted] disappointment at the outcome of this claim, we hope she can understand that we must review each request in accordance with the terms and conditions of the plan purchased.
We have reviewed *** ***s complaint regarding the processing of the claim for *** *** S*** for Trip Cancellation benefits. We are providing our response accordingly. We received a claim initiation advising that *** *** and MsS*** were attempting to change the
original airline ticket or cancel and repurchase a new ticket, indicating that they would advise us of the situation once they’d made their decision. We acknowledged receipt of the claim submission and the need for such documentation once available. *** *** later submitted documentation indicating that the original, insured airline ticket had been cancelled and a new ticket purchased. We then proceeded to provide the full refund of the original, cancelled, airline ticket for which the coverage had been purchased, in the amount of $233.29. Please understand that this is the maximum benefit available under this coverageThe plan states: In no event shall the amount reimbursed under Trip Cancellation or Trip Interruption exceed the amount you prepaid for your Flight While we understand that MsS*** purchased a new airline ticket for her new travel date, please understand that there is no coverage for any additional cost of such ticket over the cost of the original ticket purchased and reimbursed. The payment provided to MsS*** represents the maximum benefit to which she was entitled under the plan purchased. As full payment of this claim has been provided we have closed this matterWe trust that we have sufficiently responded to the concerns contained in *** ***’s complaintShould 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# 1***, and have determined that my complaint has NOT been resolved because: I have emailed them an official letter on letterhead that he was checked out and verified to be ill, like requested Last time I emailed the company, I never heard back Once I hear back from them about the letter I sent, verifying he was ill and what their response is, will determine if I accept the resolution. Thank you
In order for the Revdex.com to appropriately process your response, you MUST answer the question above
Sincerely,
*** ***
We have reviewed [redacted]’s complaint and are responding accordingly. The plan that [redacted] purchased on May **, 2017 does indeed offer coverage for a flight cancellation in the event of a job loss. However, the plan does specify that this coverage does not apply to “temporary...
employment, independent contractors or self-employed persons.” Based on the information received from [redacted] and her traveling companion, [redacted], the cancellation was due to [redacted]’ job loss. However, from the information submitted, [redacted] was a co-owner of the business that ceased operations on May **, 2017, two days after their purchase of the plan. As [redacted] was self-employed, his and [redacted]’s reason for cancellation is specifically excluded under the terms of the plan and we are unable to consider their request for reimbursement. Please note that the plan in its entirety is provided prior to purchase for review. Further, the confirmation provided to [redacted] and [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. 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 her complaint, [redacted] states that she submitted the information needed regarding her cancellation and we have not yet provided her refund. Please note that we spoke to [redacted] several times regarding her...
claim and advised her on September *, 2017 what information is needed in order to continue our review of her claim. We are currently awaiting such documentation. More particularly, when [redacted] submitted her claim form to us, she did not submit a completed Attending Physician Statement from her treating physician nor note any dates of treatment. Rather, she noted that she was an employee of a hospital and simply provided generic information regarding her medical condition As such, we were unable to consider the claim as verification of examination and treatment by a physician at the time of the cancellation, which is required under the plan, was not provided. As per our discussion with [redacted] on September *, 2017, we advised that in order for us to continue our review of her claim, sufficient medical documentation must be submitted to allow us to confirm that her reason for cancellation meets the plan’s terms and conditions. At that time [redacted] advised that she would have her physician complete the Attending Physician Statement and submit same to our office. To date we continue to await submission of this documentation. Please understand that until sufficient medical documentation has been submitted to allow us to continue our review of the claim, we will be unable to make any further determination on [redacted]s request for reimbursement. Upon receipt of same, we will give [redacted]s claim our immediate attention. We trust this has addressed the concerns raised in [redacted]s correspondence. Should you have any additional questions regarding this matter, 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:
It wasn't that I had to "fulfill job obligations" -- the place of business was closed entirely for the week, that was beyond my control. Furthermore the description of coverage says "e. your involuntary termination of employment or layoff which occurs after your effective date of coverage and was not under your control. You must have been continuously employed with the same employer for 3 years prior to the termination or layoff. This provision is not applicable to temporary employment, independent contractors or self-employed persons;"I was involuntarily laid off for a week, and it was not under my control. NOWHERE does it state how long the layoff has to be for.And: "g. a Natural Disaster occurs, which causes a complete cessation of travel services at point of departure and/or destination;" -- A large part of my neighborhood was destroyed by flooding and I am still have to take detours just to get around my normal routes to and from work.This company should not be allowed to scam people out of money, this was out of my control. I will be glad to contact any and all media to let them know that this company is trying to scam a flood victim out of insurance money. This is disgraceful and NOT ok.
In order for the Revdex.com to appropriately process your response, you MUST answer the question above.
Sincerely,
[redacted]
We are in receipt of the complaint submitted by [redacted] on behalf of his wife, [redacted] and are responding accordingly. As per the information received, [redacted] cancelled her trip to Costa Rica after discovering she was pregnant and due to concerns related to the...
Zika virus. The Plan [redacted] 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. 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 caused by or incurred resulting from:… 3. normal pregnancy, except if hospitalized;From the information received, there is 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 recent discovery of 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 her trip, unfortunately, as her reason for such cancellation, namely her 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. 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. 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]
We have reviewed [redacted]’s complaint and are responding accordingly. Please note that [redacted] states he canceled his scheduled flight due to his 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] contacted our office on October **, 2015, to advise that he was unable to take his scheduled flight on October **, 2015, due to his own medical condition and he wished to initiate a claim for the losses associated with the cancelation or change of this ticket. Contrary to [redacted]’s assertion that he was not advised at the time he initiated his claim that he would need to provide verification of the examination and treatment he received at the time of his cancellation, in fact this information was relayed to [redacted] during said conversation. More particularly, a review of this conversation confirmed that our representative advised [redacted] that the claim form contained a section that would need to be completed by his treating physician. [redacted] expressed his displeasure at this requirement as he advised it would cost him $100 to have his doctor complete the claim form. Our representative relayed her understanding of his concerns but reiterated that this was a plan requirement. Further, please note that the plan requirements, including the requirement of an examination and treatment at the time of a trip cancellation, are noted in the plan’s description of coverage. This description of coverage was provided to [redacted] prior to his purchase of the plan, with a link to an additional copy provided on the confirmation of his purchase. As such, [redacted] had ample notice of the plan requirements regarding a Trip Cancellation claim for a medical illness. With respect to [redacted]’s assertion that he was not sent a claim form for a number of weeks after initiating his claim, please note that a claim form was sent to [redacted] via email, at [redacted], concurrent with the claim initiation, at 5:17pm on October **, 2015. [redacted] then contacted our office again on November *, 2015 regarding receipt of the claim form and a second copy of the claim form was emailed to the same address at 12:07pm on November *, 2015. Within minutes of the sending of this second claim form, [redacted] again called our office and he again requested the claim form be emailed. A third copy of the claim form was then emailed to [redacted] at the same address at 3:19pm that same afternoon. Accordingly, every effort was made to provide [redacted] with a claim form for his completion. Though [redacted] has not yet submitted a completed claim form, based on the information he included in his complaint, he affirmed that he in fact did not see a physician at the time of his cancellation. As [redacted] does not meet the plan requirements indicated above, we are unable to consider his request for reimbursement and must decline coverage at this time and will notify him of this decision under separate cover. While we certainly understand [redacted]’s disappointment in the claims process, please understand that we must consider each claim under the terms and conditions of the Plan purchased. 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] complaint and we are responding accordingly. [redacted] had filed claims with our office for Trip Interruption benefits under two separate protection plans he and his wife had purchased in connection with their scheduled European tour. The [redacted] began their...
outbound flight to reach their tour but were unable to continue on as scheduled due to a carrier delay/cancellation. Due to this situation, the airline was unable to re-accommodate the [redacted]’ and they returned home. The [redacted] purchased a tour with Trafalgar and booked the airline tickets to reach the tour through Priceline. The Edmonds purchased the travel protection plans available in conjunction with both the travel bookings made. We processed the two claims submitted by the [redacted] in relation to the interruption of their trip. With regard to the claim the [redacted] filed under their Trafalgar plan, the reason for the interruption of the [redacted] travel plans was indeed a specified reason under the terms and conditions of the plan. As such, they were eligible for payment of their Trip Interruption benefits. Accordingly, we provided the payments to the [redacted] under their Trafalgar travel plan totaling $4,048.04. These payments were: $33.52 per person on August [redacted], for the additional expenses they incurred during the flight delay and $1,990.50 per person on August [redacted], for the full cost of their missed tour. Apparently upon receipt of that first payment, the [redacted] believed there was no additional payment forthcoming. We sincerely apologize for any such misunderstanding. With regard to the coverage the Edmonds purchased in conjunction with their airline tickets booked through Priceline, however, regrettably that plan does not contain coverage for a Trip Interruption as a result of a carrier delay or cancellation. As such, we were unable to consider the [redacted] request for reimbursement under this plan. Please allow me to advise further that, even if the [redacted] had interrupted their travel plans for one of the specified reasons contained in the plan, the losses for which they were seeking reimbursement, namely their original, partially used airline tickets, would not be eligible for refund as there is no coverage for original airfare under the Trip Interruption benefit but rather for any new airfare expenses incurred to return home. While we understand the [redacted] disappointment with the interruption of their travel plans, and the outcome of the claim for their airfare, we are pleased we were able to reimburse them for their missed tour. We trust this has provided clarification of the claims handling as well as an understanding that we must review each request in accordance with the terms and conditions of the specific plan purchased. Should you have any additional questions, please feel free to contact our office.
We have reviewed [redacted]s additional comments regarding this claim and are responding accordingly. As advised previously, we show no record of the calls [redacted] contends she had with our office. If she maintains her position, she will need to supply the requested information to allow further research. However, at this time, as we have found no evidence to substantiate her contention, we consider that issue closed. With regard to the documentation requested and submitted, please note that this documentation was required in the normal course of the claims process to verify the basis of the claim, and to allow payment of the claim to Ms. S[redacted] for the applicable, maximum benefit. As advised, the appropriate and full payment of this claim has been provided to Ms. S[redacted]. The draft for said payment remains valid for a period of six months from date of issue, July *, 2017. We trust this matter is now concluded.
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]
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:
I have never received the automated answer they claim I did, but at this point it's my word again theirs. I have offered a screen shot of the last email I ever got from them. Also, I already had my doctor submit paper work, twice, and I am a bit reluctant to go back to her without knowing what exactly they want this time. I am afraid that it will still not meet their needs. Can they be very specific about the type of documentation they need, so I do not take so much of the doctor's time again? They can also call her directly.This is really starting to feel more and more like an excuse after another for not paying the claim.
[redacted]
We have reviewed [redacted]’s further comments advising of her submission of the physician form required for further claim review. Please note that we did indeed receive the Attending Physician Statement (“APS”) [redacted] had completed by Dr. Joycelyn D. M**. However, rather than affirming the date of examination performed by Dr. M** and treatment provided by Dr. M**, which was noted in our prior response as being required under the plan, Dr. M** in fact simply affirmed that she had performed no such examination and had provided no such treatment to [redacted], noting on the APS under the question of examination and treatment of [redacted], “None for this condition.” Further, Dr. M** indicates that she knows of no treatment received by [redacted] from any other physician for this condition. As the medical documentation submitted by [redacted] affirms that she underwent no examination and treatment by a physician during the coverage period and at the time of cancellation, we must maintain our original determination on this claim. Please note that correspondence was sent to [redacted] on October [redacted] advising of such determination. We trust this responds to [redacted]’s further inquiry and this matter is now concluded. Should you have any further questions regarding this matter, 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 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 the complaint filed by [redacted] and are responding accordingly. [redacted] initiated a claim with our office seeking reimbursement for Trip Interruption expenses for changes she made to her travel arrangements approximately two and a half weeks prior to her...
departure. As coverage for Trip Interruption had not yet incepted, as such coverage does not begin until the insured departs on the scheduled trip, we were unable to consider [redacted]’s request for reimbursement of her new airline ticket and additional expenses she incurred in the course of her early return. In accordance with this basis, and further that the medical condition prompting [redacted] to return home early from her trip was not a condition that began during her covered trip, as is required under the plan, the denial of such benefits was appropriate. However, we have reviewed [redacted]’s claim again and, though not as originally presented, based on the medical information reviewed, we have determined that we can consider [redacted]’s original airline ticket, which she cancelled when she changed her travel arrangements and return date, under the Trip Cancellation coverage of this plan. Accordingly, payment in the amount of $3,095.00, the cost of [redacted]’s original airline ticket, is presently being provided to her directly. While the amount being provided at this time may not be the full amount [redacted] sought when filing the claim, it is in fact the maximum benefit available to [redacted] based on the medical information received, coverage terms in place and plan language. 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.
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.
We are in receipt of the complaint filed by [redacted] and are responding accordingly. [redacted] began their cruise vacation but disembarked from the sailing the following day. They submitted a claim to our office seeking reimbursement of their Trip Interruption...
benefits. However, from the information received, it indicated that [redacted], who uses a C-Pap machine while sleeping, discovered that his machine was not functioning and the couple decided to disembark due to such mechanical issue. Please understand that a mechanical issue with the machine alone would not be a specified reason for interruption under the plan and as such we were unable to consider the couple’s request for reimbursement. However, based on the clarification provided in [redacted]’ complaint, as well as additional medical information regarding the circumstances surrounding the decision to end their participation on the cruise early, we were able to re-review the claim. More particularly, we have affirmed that due to the mechanical issue with [redacted]’ C-Pap machine, he experienced an exacerbation of the underlying medical condition which requires the use of this machine. That exacerbation was confirmed by the ship’s physician who in fact recommended the [redacted]’ disembark the cruise at the first port of call as a result of [redacted]’ medical condition. I am pleased to advise based on the additional information reviewed, we have been able to reverse our original determination on the [redacted]’ claim. Accordingly, on April *, 2016 we sent payment to the [redacted]es in the amount of $770.85 per person for their missed cruise portion and the additional transportation expenses for their early return. However, additional charges incurred for a hotel stay before their return flight was not eligible for reimbursement under the terms of the plan. 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.
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.
We have reviewed [redacted] complaint and we are responding accordingly. In her complaint, [redacted] explains that upon her and her parents’ return trip following their cruise, her parents, who are citizens of Trinidad and Tobago, were denied boarding onto the return flight as they did not...
have the required travel documentation for such passage. As such, [redacted] and her parents remained in Barcelona for two nights while making alternate travel arrangements. It is reimbursement for the expenses associated with this stay and the family’s new travel expenses which [redacted] requested. Unfortunately, as the reason for the family’s delayed return is not one covered under the plan, lack of proper travel documents, we are unable to consider their request for reimbursement of the expenses incurred in connection with such delay. Please note that we cannot address any issues [redacted] indicates regarding information received pertaining to travel document requirements. While we understand [redacted] disappointment at the outcome of this claim, we hope she can understand that we must review each request in accordance with the terms and conditions of the plan purchased.