Seven Corners, Inc.

December
17, 2015***
***Revdex.com
of Central Indiana
NDelaware StreetSuite
# 2020Indianapolis,
IN 46204-2599RE: Complaint Number: ***Complainant:
*** ***Our
Insured’s Name: *** *** ***Certificate
Number: ***Policy:
Inbound USAUnderwriter: Certain Underwriters at Lloyd's, LondonDear
Ms***:We
are in receipt of your correspondence regarding the complainant’s rebuttal to
our response on the above referenced complaint.
The rebuttal complaint was received by Seven Corners on December 16,
2015. Seven Corners, Incis an
administrator for Certain Underwriters at Lloyd's, London (Underwriters)This
response is on behalf of Seven Corner’s, Incand Certain Underwriters at
Lloyd's, London (Underwriters) subscribing to the above referenced policy.Our
records show that the effective dates of the above captioned policy were from
November 14, to April 12, 2015.Seven
Corner’s, Incand Certain Underwriters at Lloyd's, London (Underwriters) had
an independent medical review completed by Medical Review Institute of America,
Inc.; of the medical records regarding *** *** ***’s condition The
findings of this independent medical review of the medical records revealed Ms
*** suffered from an acute manifestation of coronary artery disease and that
her coronary atherosclerosis was present for years preceding the event on
December 26, 2014. Her admission on
December 26, was determined to be due to a pre-existing medical condition,
by the independent medical reviewBased
upon the Policy’s Coverage Provisions specified in our December 9,
response and the independent medical review of the medical records,
Underwriters have determined there is no coverage for the claim submitted because
the condition existed prior to the effective date of the policyThe
reasons for this denial of coverage are not limited to those stated in this
letter, and Underwriters reserve the right to supplement this letter with
further legal and factual reasons as to why there is no coverage. Underwriters do not waive any rights under
the Policy or under applicable law. This
response is based upon the information you provided to Underwriters and
information Underwriters have obtained during their investigation and review of
your claim.We
hope this answers any outstanding questions in relation to *** *** ***’s
claim.If
you should have any further questions or need further clarification of the
above, please do not hesitate to contact us.Sincerely,Claims
DepartmentSeven
Corners, Inc

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
To Whom It May Concern,I am not in agreement with this settlement offer. The denial of this claim is based on my missed flight due to a delay on the way to my destinationI purchased another ticket for $to get to my school in a timely manner, which I do not expect to be reimbursed forI was not able to stay at the JFK airport for two days, which was required if I was to utilize my Etihad Airline ticketI have already agreed to give up one half of my ticket cost of $(one half of the original ticket price of $) based on the insurance company’s delay criteriaMy settlement claim for $fits into the category of cancellation ( not delay )The Etihad airline CANCELLED my return flight that I already paid for on 11/20/This was beyond my control and I was forced to purchase a new return ticket for $948.00. It is only fair and just that the travel insurance that I purchased in good faith cover this CANCELLED flight by the airline. The reason I bought the flight cancellation insurance, was to protect me in this type of situation
Regards,
*** ***

February 24, *** *** Revdex.com N Delaware Street #Indianapolis IN 46204-RE: Complaint ID *** Customer: *** *** Certificate #***
Policy Name: *** *** Dear Ms***: Seven Corners, Incis in receipt of Complaint ID Number *** and sent to the attention of Chelsi T*** on February 24, 2017. The complainant, *** ***, has expressed concerns with the handling of his mother’s travel medical insurance claims under the certificate # referenced aboveThis office has reviewed the file and the claims in question. We regret that Mr*** is not happy with our customer service or claim handling. This policy was purchased with an effective date of 9/20/16. Upon receipt and review of the medical records for services on 9/21/16, which indicated that illness had been present for days, the claims were denied under the exclusion in the policy for pre-existing conditions. This decision was made after medical review of the medical records received in connection with the insured’s illness. A detailed letter explaining the denial was sent to the insured on February 13, 2017. We do find that our protocols for timeliness in the processing of submitted information did not meet our established customer service protocols and for this we apologize. We have addressed the issues with the appropriate personnel. However, we are required to process claims in accordance with the policy provisions and no refund of premium can be made. Thank you for your time and attention to this matter and should you have questions involving this claim matter, please contact this officeSincerely, Seven Corners, Inc

October 17, *** *** Revdex.com N Delaware Street #Indianapolis IN 46204-RE: Complaint ID *** Customer: *** *** Certificate # *** Policy Name: Inbound Choice Claim #*** Dear Ms***: Seven Corners, Incis in receipt of the rebuttal by *** *** for Complaint ID Number *** and sent to the attention of Sureleen S*** on October 12, 2016. The complainant, *** ***, has further disagreed with our responses to this complaintWe have reviewed our records and find that only invoices were filed for physical therapy services, one for July 5, and one for July 15, 2016. Physical therapy notes have also been filed for only these two visits. In an effort to resolve this issue, we have reached out to the *** *** to confirm if there were any invoices we were missing. However, they have refused to provide us with any information, since they do not have authorization to discuss the insured’s account with us. If there are additional invoices that we are missing for physical therapy services, the customer can file the fully itemized bills with our office and we will be more than happy to review them for additional benefits. Thank you for your time and attention to this matter and should you have questions involving this claim matter, please contact this officeSincerely, Seven Corners, Inc.

Seven Corners,Incis in receipt of complaint ID # *** sent to Dennis *** on March 30,The complaint was filed by *** *** who objects to the claimhandling of her lost or stolen personal effects claim. Upon reevaluation of Ms*** claim, wemust uphold our original
decision that the travel policy purchased does notprovide coverage benefits for any loss or damage to the Apple iPad.On November 2,2014, *** *** purchased a Roundtrip travel insurance policy for travelfrom December 13-21, 2014. Our recordsshow that on December 17, 2014, Ms*** reported that she was the victim oftheft as an unknown party stole her bag and the contentsShe submitted acompleted proof of loss form and claim documents to Seven Corners for review Seven Corners evaluated the documents receivedand issued settlement per the policy terms and conditions in the amount of$on March 2, 2015.The Roundtrip policypurchased by Ms*** excludes coverage for personal computers and sunglasses.Ms*** appealed the coverage denial for the two Apple iPads as she assertsthat iPads are not computers or have computer hardware/software and thereforethe policy should afford coverage Correspondencewas mailed to the insured party explaining the coverage exclusion(s) and nofurther settlement was issued to Ms***.Policy languagewhich is pertinent to this matter:BAGGAGE/PERSONAL EFFECTSThe Company will reimburse You, up to themaximum shown on the Confirmation of Coverage, for Loss, theft or damage tobaggage and personal effects, provided You have taken all reasonable measuresto protect, save and/or recover Your property at all timesThe baggage andpersonal effects must be owned by and accompany You during the Trip.This coverage is secondary to any coverageprovided by a Common Carrier.There will be a per article limit of $300.There will be a combined maximum limit of$1,for the following: jewelry; watches; articles consisting in whole or inpart of silver, gold or platinum; furs; articles trimmed with or made mostly offur; cameras and their accessories and related equipment. The Company will pay the lesser of thefollowing:(a) Actual Cash Value at time of Loss,theft or damage to baggage and personal effects, less depreciation asdetermined by the Company; or (b) the cost of repair or replacementEXTENSION OF COVERAGE: If You checked Yourproperty with a Common Carrier and delivery is delayed, coverage forBaggage/Personal Effects will be extended until the Common Carrier delivers theproperty.LIMITATIONS AND EXCLUSIONSThe following exclusions apply toBaggage/Personal Effects, Baggage Delay: The Company will not provide benefits forany Loss or damage to:Eyeglasses, sunglasses or contactlenses;Professional or occupational equipmentor property, whether or not electronic business equipment;Personal computers, telephones,computer hardware or software; We appreciate theopportunity to address Ms***’ concerns, please contact this office shouldyou have any further questions regarding this matter

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
It has been a while since we spoke (I was hoping Seven Corners had covered the bills), but we just received a new bill from the ambulance service. We would like to reopen/reactivate our complaint against Seven Corners Insurance to have them cover the bills from our son's accident while he was on a service oriented retreat last March. We certainly feel that the bills should be covered as Seven Corners was the accident insurance that was purchased by the church to cover the participants of the retreat. *** fell ft off of a ladder onto a concrete pad, broke vertebrae, his wrist, and his elbow. It is clear that he needed ambulance servicesAttached are the two bills that have not been paidPlease let us know if you have any questions or need additional informationThank you, *** and *** ***

February 24, *** *** Revdex.com N Delaware Street #Indianapolis IN 46204-RE: Complaint ID *** Customer: *** *** Certificate #***
Policy Name: *** *** Dear Ms***: Seven Corners, Incis in receipt of Complaint ID Number *** and sent to the attention of Chelsi T*** on February 24, 2017. The complainant, *** ***, has expressed concerns with the handling of his mother’s travel medical insurance claims under the certificate # referenced aboveThis office has reviewed the file and the claims in question. We regret that Mr*** is not happy with our customer service or claim handling. This policy was purchased with an effective date of 9/20/16. Upon receipt and review of the medical records for services on 9/21/16, which indicated that illness had been present for days, the claims were denied under the exclusion in the policy for pre-existing conditions. This decision was made after medical review of the medical records received in connection with the insured’s illness. A detailed letter explaining the denial was sent to the insured on February 13, 2017. We do find that our protocols for timeliness in the processing of submitted information did not meet our established customer service protocols and for this we apologize. We have addressed the issues with the appropriate personnel. However, we are required to process claims in accordance with the policy provisions and no refund of premium can be made. Thank you for your time and attention to this matter and should you have questions involving this claim matter, please contact this officeSincerely, Seven Corners, Inc.

Seven Corners, Incis in receipt of complaint ID # *** andsent to the attention of Dennis W*** on August 14, 2015. The complainant, *** ***, is requestinga refund for premium paid to purchase a travel insurance policy on July 27,We appreciate the opportunity to address his
concerns.In order to clarify the role of the parties involved, One Travelis a travel provider of flight and other vacation accommodations, and SevenCorners, Inc(“Seven Corners”) is the third party administrator contracted toprovide claim adjudication services.Our records show that on July 27, 2015, *** *** made anonline purchase for travel insurance from One TravelMr*** paid $inpremium to the travel providerThe following day, (7/28/2015), Mr*** stateshe was directed to contact Seven Corners to cancel his travel insurancepurchase and receive a refund for his purchasePer Mr***’s concerns made to the Revdex.com of Central Indiana, hehas not received his requested refund and not received assistance in processinghis refundSeven Corners does not collect premium for the travel insurancepolicy purchased by the consumer; however upon our office being made aware ofMr***’s request to cancel his policy and refund his payment, Seven Cornerscontacted One Travel on his behalf and requested that they reimburse/refund hispurchaseOn August 17, 2015, Seven Corners received the following notificationfrom One Travel:“Pleasenote that a request for refund of the premium amount of $is submittedtoday (8/17/2015)This should be done on 'priority basis' which should takeabout 24-hrsOnce we process the refund, it typically takes about 7-10business days for the amount to reflect on the customer's credit card account (MasterCardending with *** ***).”Per One Travel, they are currently processing Mr***’s refundfor $74.65, and once that is completed, the refund will be reflected on hiscredit card within to business days.Please contact this office if you have any further questionsregarding this matter

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
I request Dr *** ***, ***-*** ***'s personal physician be contacted in France to give his personal report on the matter (***[email protected]), as well as Dr *** *** in Mount Forest, Ontario, Canada (***) whose report was recent and accurate, they alone can testify about her conditionI also want the detailed assessment (plus the hospital chart from Citrus Memorial Hospital, Inverness, Florida) cited by Seven Corners be sent to the above doctors, and one to myself to verify the veracity of their claimI will not be happy before this is settled correctly and ethicallyI will take further steps if necessaryI also find poor that no person responsible would sign the claim and assessment mentioned on behalf of Seven CornersLooking forward to some prompt and solid resolution
Regards,
*** ***

February 20, Revdex.com N Delaware Street #Indianapolis IN 46204-RE: Complaint ID *** Customer: *** *** Certificate #***
Insured: *** *** Policy Name: *** *** Seven Corners, Incis in receipt of Complaint ID Number *** and sent to the attention of Sureleen S*** on February 15, 2018. The complainant, *** ***, has expressed concerns with the handling of his travel medical insurance claim under the certificate # referenced aboveThis office has reviewed the file and the claim in question. The claims were denied under the exclusion in the policy for pre-existing conditions. Further review of the file shows that this claim was denied in error. The claim has now been processed for payment in accordance with the benefit provisions of the policy. Thank you for your time and attention to this matter and should you have questions involving this claim matter, please contact this officeSincerely, Seven Corners, Inc.

June 24, *** *** Revdex.com N Delaware Street #Indianapolis IN 46204- RE: Complaint ID *** Customer: *** ***l Certificate #*** Dear MsDavis: Seven Corners, Incis in receipt of the rebuttal to Complaint ID Number *** and sent to the attention of Sureleen S*** on June 21, 2016. We have again reviewed the file, which included a medical review of the complete medical records received from *** *** *** ***. As stated in our earlier response, the initial treatment was on July 23, and showed no acute injury or onset resulting in the visit. Additional visits on August 13, September and October 20, were all shown as being follcare, with no indication on any of the visits that there was any onset of new, acute symptoms involving the condition. Based on the medical records and the provisions and definitions contained in the policy, we can find no basis for allowing these claims under the Acute Onset of Pre-Existing Conditions benefit. Therefore, we must uphold our denial of these claims in accordance with the provisions of the policy. Thank you for your time and attention to this matter and should you have questions involving this claim matter, please contact this officeSincerely, Seven Corners, Inc.

RE: Complaint ID: *** Complainant: * *** *** To Whom It May Concern: This is a follto our previous response regarding Complaint *** which was filed by * *** *** on February 11, 2016. Upon further receipt and review of all the necessary documentation, we determined that payment of $1,was due under Certificate Number *** and payment was issued on March 2, 2016. This payment was made as we were able to confirm that the medical condition that resulted in the cancelled trip is not pre-existing We appreciate the opportunity to address Mr***’s concernsPlease feel free to contact our office should you have any further questions regarding this matter Sincerely, Seven Corners, Inc

June 2, Revdex.com NDelaware Street #Indianapolis, IN 46204- RE: Complaint ID: *** Disputed Amount: $ Dear Sir or Madam: This office is in receipt of complaint number: *** that was sent to the attention of Seven Corners, IncThe complaint was
submitted by complainant: *** *** *** ***, who objects to the decision to deny his presented claim(s) Mr*** purchased an *** *** ** (Group) policy with effective dates: 1/1/to 2/28/The complainant sought out medical care on 1/10/from *** Health Services ***Medical records from that visit state that the patient’s symptoms began two weeks earlier. This statement would affirm that the member’s illness originated prior to the effective date of the purchased policy and would be considered a pre-existing condition, that is excluded from policy coverageSeven Corners communicated this determination via electronic correspondence sent to Mr*** via email on 5/19/ The complainant, states in his complaint that: “it is true that the symptoms started on December …”Based on this statement, Mr*** admits that his symptoms originated prior to the effective date of his coverage under the *** *** ** (Group) policy and therefore would be excluded from policy coverage In review of Mr***’s statements, the pre-existing condition definition included in his claims denial letter does indeed differ from the definition included within his purchased policyFor this error, we truly apologizeHowever, based upon the policy definition from the *** *** ** (Group) policy, the member’s illness would be considered a pre-existing condition The policy purchased by Mr*** contains the following pertinent policy wording: DEFINITIONS Pre-Existing Condition means: 1) the existence of symptoms which would cause an ordinarily prudent person to seek diagnosis, care or treatment within the months immediately prior to the Insured’s Effective Date under the policy; or, 2) any condition which originates, is diagnosed, treated or recommended for treatment within the months immediately prior to the Insured’s Effective Date under the policy We hope this answers any outstanding questions in relation *** *** *** *** ‘s claim. If you should have any further questions or need further clarification of the above, please do not hesitate to contact us. Seven Corners, Inc

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
Please review the section I attached(Section IV trip cancellation/interruption (a))Also, there was no response to my complaint that I personally spoke to a representative from the company to assure me of my coverage prior to going on this trip (5/4) and well within the cancellation periodPlease have the company review the phone records of there employee to validate my claimI had, nor have I ever had a reason to purchase a claim such as this other that a potential medical emergency in which I was assured of the coverage forAgain, please address the employees assurances on 5/from a Mabel Harrera, as well as the email from a company representative that I have snipped inFurthermore, on 8/25/I received an email from Janet G***(Claims Manager) indicating "I apologize for the delay in a responseI do have the outcome of your claim and I don't agree with itI will be speaking with the account manager to see if there is anything to dispute this." This is an example of two individuals who assured me of my coverageI will be happy to send this email to anyone that would like to review it.
Regards,
*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and am submitting my response to them as follows:We didn’t see the insurance offer on our screen earlier, as
soon as we saw it, realizing the health condition of *** ***, we opted
for it. If it were late, as it is claimed,
the payment should not have been accepted, instead the company should have
informed us about the lapse of time! The
company accepted the payment hoping that we will travel and they will get to
eat up our $without having to ever take any responsibility towards the
insured amount; a bogus offer which should be considered a spam!Nobody buys airfare to waste or claim back the amount s/he
paid from his/her pocket! Is insurance
company paying from their pocket more than we have already paid? So, this doubt that it might be claim
and a doctor has to confirm the sickness, or the treatment for the sickness
does not even make sense. Millions of
people buy insurance claims and the company digests them all without even a
burp but when there is a claim of reimbursement due to the genuine condition,
the insurance company starts coming up with unreasonable demands of proof of truthfulness
of the claim!In any case, doctor’s name and phone noand the report was
provided to seven corners on their demand, which they rejected on the pretext
that it was not within the time-frame they require! Another bluff! The very fact that *** *** is a patient
of osteoarthritis, high blood pressure, Lyme disease and diabetes, which is
proven by all the tests that were done on the request of seven corners and the
report was provided, is not enough to prove that she was not in the condition
of traveling due to the flare up of her condition!It is a very clear case of seven corners cutting of corners
whenever people have claimed the insurance they bought from them. You could check in reviews given about them;
most of them are unpaid or paid way below the insured amount if paid at all!
Regards,
*** & *** ***

June 10, *** *** Revdex.com N Delaware Street #Indianapolis IN 46204-RE: Complaint ID *** Customer: *** *** Certificate #***
Insured: * *** Dear Ms***: Seven Corners, Incis in receipt of Complaint ID Number *** and sent to the attention of Chelsi T*** on June 8, 2016. The complainant, *** *** with *** *** ***, has expressed concerns with the handling of recent travel medical insurance claims for insured * *** under the certificate # referenced aboveThis office has reviewed the file and the claims in question. The insured is covered under a Travel Medical policy which provides coverage for individuals traveling outside their home country. Seven Corners received the complainant’s claim on March 2, 2016, for services that were provided to the insured on February 16, 2016. In order to determine if benefits were payable under the policy, we required medical records from the hospital, as well as a Proof of Loss form fully completed by the insured and copy of the insured’s passport to verify eligibility under the policy. This information was requested on March 11, 2016. We did receive the copies of the requested medical records from the hospital, as well as a copy of the passport also provided by the hospital. However, we have received no response from the insured to our request for completed Proof of Loss formWe have checked our records and can find no record of any call from the complainant on the dates indicated in the complaint. Until the required Proof of Loss form is received from the insured, we will be unable to complete the processing of the claims. Thank you for your time and attention to this matter and should you have questions involving this claim matter, please contact this officeSincerely, Seven Corners, Inc.

December
2, 2015***
***RevDex.comRevdex.com
of Central Indiana
NDelaware StreetSuite
# 2020Indianapolis,
IN 46204-2599RE:
Complaint Number: *** Complainant(s): *** ***
Insureds: *** *** (The Estate of *** *** c/o
*** ***, ***) Certificate Number: ***Dear
Ms. ***:Seven
Corners, Incis in receipt of Complaint ID Number ***, forwarded to the
attention of Dennis W***, Seven Corners, Incvia email on November 30,
2015. In
order to clarify the roles of the parties involved, American Modern Home
Insurance Company is the insuring company of the travel insurance policy
purchased by *** ***. Seven
Corners, Inc(“Seven Corners”) is the third party administrator contracted by
American Modern Home Insurance Company to provide customer service
administration and claims adjudication services for individuals who purchase
travel insurance products from American Modern Home Insurance CompanyIn
the Complaint, the Complainant *** ***; is requesting full payment of the
claim amount of $15,000.00. No
supporting documentation was submitted with the Complaint confirming the
claimed expenses of $15,000.00. Our
records show that on July 18, 2013; *** *** purchased an insurance policy
from American Modern Home Insurance Company; through Online Vacation Center
Plan (FL) for his Celebrity Cruises vacationOur
investigation determined that *** *** became ill during the cruise and
required medical attention. Mr***
was medically required to discontinue his travel due to this medical issueSeven Corners secured medical records indicating on ship medical care and off
ship medical care from December 5, till December 14, The named insured, *** *** claimed medical
expenses of $11,on their submitted Proof of Loss Form. Mr*** later passed away on March 6,
2014. Seven
Corners secured the Online Vacation Center Booking Notice and Payment History
Confirmation Notice that indicated the insured’s total trip cost for the Cruise
(package) was $3822.94. Mr*** was
indicated to have missed ten (10) days of his thirty two (32) day cruise. At a rate of $per day, the unused
portion of the trip was determined to have been a non-refunded cost of
$Seven
Corners, Inc.; on behalf of American Modern Home Insurance Company, has issued
the following settlement payments to The Estate of *** *** c/o ***
P***, ***at *** *** *** *** *** ***, Delray Beach, Florida
***.$11,
for the medical expense claim.$1,
for the trip interruption claimThe
Policy language which is pertinent to this matter: SECTION
I - GENERAL DEFINITIONS“Sickness”
means an illness or disease which is diagnosed or treated by a Physician on or
after the Effective Date of insurance and while You are covered under the
Policy.SECTION
IV- COVERAGESWe
will provide the coverage described in this policy only if it is listed on the
Schedule of Benefits.TRIP
INTERRUPTIONWe
will pay a benefit, up to the maximum shown on the Schedule of Benefits, if You
are prevented from continuing or resuming Your Covered Trip due to any of the
Unforeseen events listed below.We
will pay You for the following:(a)
unused, non-refundable travel arrangements prepaid to the Travel Supplier(s);
or(b)
additional Transportation expenses incurred by You; or(c)
return air travel up to the lesser of the cost of an economy flight or the
amount shown in the Schedule of Benefits, less the value of applied credit from
an unused return travel ticket.In
no event shall the amount We pay exceed the lesser of the amount You prepaid
for the Covered Trip or the maximum benefit shown on the Schedule of Benefits.For
Trip Cancellation or Trip Interruption, Unforeseen Events Include:(a)
Accidental Injury, Sickness or death of You, Your Traveling Companion, Your
Family Member, Your children’s caregiver or Your Business Partner; which
results in medically imposed restrictions as certified by a Physician at the
time of loss preventing Your participation or continued participation in the
Covered TripA Physician must advise cancellation of the Covered Trip on or
before the Scheduled Departure Date.EMERGENCY
ACCIDENT AND EMERGENCY SICKNESS MEDICAL EXPENSEWe
will pay Reasonable and Customary Charges up to the maximum limit shown on the
Schedule of Benefits, subject to the Deductible, if You incur necessary Covered
Expenses while on your Covered Trip and as a result of an Accidental Injury or
Emergency Sickness which first manifests itself during the Covered Trip.Covered
Expenses are Medically Necessary services and supplies which are recommended by
the attending Physician.They
include but are not limited to:(a)
the services of a Physician;(b)
charges for Hospital confinement and use of operating rooms;(c)
Hospital or ambulatory medical-surgical center services (this may also include
expenses for a Cruise ship cabin or Hotel room, not already included in the
cost of Your Covered Trip, if recommended as a substitute for a Hospital room
for recovery from a Sickness);(d)
charges for anesthetics (including administration);(e)
x-ray examinations or treatments, and laboratory tests;(f)
ambulance service;(g)
drugs, medicines, prosthetics and therapeutic services and supplies;Insurance
With Other InsurersIf
there is other valid coverage, not with Us, providing benefits for the same
loss on a provision of service basis or on an expense incurred basis and of
which We have not been given written notice prior to the occurrence or
commencement of loss, the only liability under any expense incurred coverage of
this Policy shall be for such proportion of the loss as the amount which would
otherwise have been payable hereunder plus the total of the like amounts under
all such other valid coverages for the same loss for which We had notice bears
to the total like amounts under all valid coverages for such loss, and for the
return of such portion of the premiums paid as shall exceed the pro-rata portion
for the amount so determinedFor the purpose of applying this provision when
other coverage is on a provision of service basis, the “like amount” of such
other coverage shall be taken as the amount which the services rendered would
have cost in the absence of such coverage.We
hope this answers Complainant, *** ***; concerns regarding the claim
presented by The Estate of *** *** c/o *** P***, ***.Should
you have any further questions involving this claim matter, please contact our
companySincerely, Seven
Corners, Inc

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to me.
Regards,
*** ***

Dear Revdex.com;This is extension of my complain#***There are three providers need to be paid.1) Doctor - $18052) Quest - $6243) Doctors Express- $293Recently I got the letter from Seven corners and they agreed to pay doctor’s bill of only $out of $They denied request for the Quest bill and no word yet on Doctors Express billThey denied or underpaid my providers with a remark that “DENIAL: Charges EXCEED Maximum allowed”My insurance coverage is $45,Medical Maximum per Injury/SicknessHow these bills are over $45,000? Does this really make sense? We didn’t even ask for the medicine cost and not even asking them to pay anything for medicine but they must pay all three providers as these are over months old billsThank you, *** ***Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
Regards,
*** ***

March 18, Revdex.com of Central Indiana N Delaware Street #Indianapolis, IN 46204-RE: Complaint ID: *** Complainant: *** *** To Whom It May Concern: Seven Corners, Inc(“Seven
Corners”) is in receipt of Complaint *** which was filed by *** *** on March 10, 2016. Mr*** purchased the Nationwide Travel Protection Plan, Certificate Number 30958242, for his November 18-28, trip. We have reviewed the complaint and the claim file and have confirmed that the claim is not eligible for trip cancellation coverage benefits. The reasoning for our decision is explained belowIn order to clarify the roles of the parties involved, Nationwide Mutual Insurance Company (“NMIC”) is the insuring company of the travel insurance policy purchased by Mr***. Seven Corners is the third party administrator contracted by NMIC to provide customer service administration and claims adjudication services for individuals who purchase travel insurance products underwritten by NMIC. OneTravel is the Travel Provider from whom Mr*** purchased his flightsDue to medical reasons, Mr*** submitted a trip cancellation claim. The medical documentation submitted did not indicate treatment dates for the condition that resulted in the cancelled trip. On December 16, 2015, a fax was sent directly to Mr***’s treating physician requesting clarification of the treatment dates. An items needed letter was also sent to Mr***, on this same date, advising him that we had written to his physician requesting additional informationOn February 18, 2016, we received a physician’s statement from Mr*** indicating he received treatment on September 14, for the medical condition that resulted in the cancelled trip, which is prior to the October 21, trip cancellation coverage effective date. Based on this information, he would not satisfy the purchased policy’s definition of sickness, which states “sickness” is (1) an illness that requires a physical examination and medical treatment by a physician and (2) commences while the coverage is in effect.” On February 26, 2016, we sent an e-mail to Mr*** requesting additional information. The physician’s statement provided on February 18, did not confirm whether Mr*** sought any treatment between October 21, (the effective date of trip cancellation coverage) and November 18, (scheduled departure date). Mr*** informed our office that he did not seek treatment during the specified period, October 21, to November 18, 2015, for the condition that resulted in his cancelled tripBased on the information provided by Mr***, he would not satisfy the policy’s definition of sickness in order for trip cancellation benefits to apply. As a result, his claim was denied. Due to the failure of Mr*** to present evidence to meet the definition of “sickness,” a denial letter was mailed to Mr*** on March 8, We appreciate the opportunity to address Mr***’s concerns. Please contact this office should you have any further questions regarding this matterSincerely, Seven Corners, Inc