Seven Corners, Inc.

RE: Revdex.com Complaint # ***Complainant:
*** * *** Our Certificate Number: ***Our
Insured: *** * *** Insurance Company: Nationwide Mutual Insurance Company Attn:
*** ***: Thank
you for your correspondence dated October 22, regarding *** *
***. Seven
Corners, Incis an
administrator for Nationwide Mutual Insurance Company and this response is in
reference to Revdex.com Complaint Number *** We have reviewed Ms***’s claim and case fileBased on the information
provided by Ms***, we are pleased to advise that a settlement check in the
amount of $has been issued, which represents the non-refunded prepaid
airfare expense.If
you have any further questions regarding this matter, please contact our
officeClaims Administered on Behalf of Nationwide Mutual Insurance
Company and affiliated companiess why here

December
7, 2015Ms
*** *** Revdex.com Revdex.com of Central Indiana NDelaware StreetSuite
# Indianapolis, IN 46204-RE: Complaint Number: *** Complainant(s): *** and *** *** 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 24,
2015. The complainants, *** *** and *** ***, are requesting
a refund of their airfare that was purchased on April 9, Upon further
review of their file, we are unable to make a final determination on their
claim as we still need medical information from Mr***’s physicianIn
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 the ***s. Seven Corners,
Inc(“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 from NMIC. One Travel is the Travel Provider from whom the
***s purchased their flight and other vacation accommodations fromOur
records show that on April 9, 2015, the complainants purchased airfare for a
scheduled trip to Washington D.Cand days later on May 22, 2015, purchased
their travel insurance policy The
travel insurance policy purchased by the ***s contains a pre-existing clause
which states that if travel insurance was not purchased within days of the
initial travel deposit, any claims are subject to the following:GENERAL DEFINITIONSSickness: means an illness or disease which is
diagnosed or treated by a Physician after the Effective Date of Insurance and
while You are covered under the Policy.Pre-Existing Condition
means an illness, disease, or other condition during the sixty (60) day period
immediately prior to the Effective Date for which You, a Traveling Companion, a
Family Member booked to travel with You: 1) exhibited symptoms that would have
caused one to seek care or treatment; or 2) received or received a
recommendation for a test, examination, or medical treatment; or 3) took or
received a prescription for drugs or medicineItem (3) of this definition does
not apply to a condition that is treated or controlled solely through the
taking of prescription drugs or medicine and remains treated or controlled
without any adjustment or change in the required prescription throughout the
sixty (60) day period before the Effective Date.The Pre-Existing
Conditions exclusion is waived if You (a) enroll in this Certificate at the
time You pay the deposit required for Your Trip (or within fourteen (14) days
of the initial Trip deposit); (b) purchase this Certificate for the full cost
of Your Trip; and (c) are medically able to travel on the Effective Date. LIMITATIONS AND
EXCLUSIONSThe following
exclusions apply to Trip Cancellation.Loss caused by or
resulting from:1. Pre-Existing Conditions, as defined in the
Definitions section.Per
their submitted trip cancellation claim form, the ***s requested reimbursement
in the amount of $for prepaid airfare expenses and $for the cost
of the insurance coverage premium. We
have reviewed the submitted documentation but since travel insurance was not
purchased within days of the initial travel deposit, this claim must be
investigated for a pre-existing medical conditionOn
August 28, 2015, correspondence was sent to the ***s requesting the names
and addresses of the physicians who may have treated Mr*** during the time
period of March 23, to May 22, 2015. In addition, Seven Corners requested a copy of the ***’s trip cancellation
notice with the date of cancellation, amount of any fees incurred, and the
amount of any refund / credit received from their travel provider. We have received information regarding the
***’s trip cancellation notice but as of today’s date, we have not received
the names and addresses of the doctors who have treated Mr***As soon as
this information is received, we will be able to continue our review of the
***’s claim.Should
you have any further questions involving this claim matter, please contact our
companySincerely, Seven
Corners

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 accept the 45$ deductible for each physical therapy but there were sessions and I received only reimbursements of dollar each.Thanks]
Regards,
*** ***

December
9, 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 above referenced
complaint. The complaint was received by
Seven Corners on December 9, 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, 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 treatment received by *** *** ***, The findings of the
review revealed Ms*** suffered an acute manifestation of coronary artery
disease and that her coronary atherosclerosis was present for years preceding
the event on December 26, Her admission on December 26, was
determined to be due to a pre-existing medical conditionBelow
is the Policy language that is pertinent to this matter.DEFINITIONS“Acute
Onset of a Pre-existing Condition(s)” shall mean a sudden and unexpected
outbreak or recurrence of a Pre-existing Condition(s) which occurs
spontaneously and without advance warning either in the form of Physician
recommendations or symptoms and is of short duration, is rapidly progressive, and
requires urgent careThe Acute Onset of a Pre-existing Condition(s) must occur
after the effective date of the policyTreatment must be obtained within
hours of the sudden and unexpected outbreak or recurrenceA Pre-existing
Condition that is a chronic or congenital condition or that gradually becomes
worse over time will not be considered Acute OnsetThis benefit does not
include coverage for known, scheduled, required, or expected medical care,
drugs or Treatments existent or necessary prior to the Effective Date of
coverage."Pre-Existing
Condition" shall mean any medical condition, Sickness, Injury, illness,
disease, Mental Illness or Mental Nervous Disorder, regardless of the cause
including any congenital, chronic, subsequent, or recurring complications or
consequences related thereto or resulting therefrom that with reasonable
medical certainty existed at the time of application or within the one hundred
and eighty (180) days (three hundred and sixty five (365) days for Insured
Persons and older) immediately prior to the Insured Person’s Effective Date
under the policy, whether or not previously manifested, symptomatic, known,
diagnosed, treated or disclosedThis specifically includes but is not limited
to any medical condition, Sickness, Injury, illness, disease, Mental Illness or
Mental Nervous Disorder, for which medical advice, diagnosis, care or treatment
was recommended or received or for which a reasonably prudent person would have
sought treatment during the one hundred and eighty (180) days (three hundred
and sixty five (365) days for Insured Persons and older) immediately
preceding the effective date of coverage under this policy.GENERAL
EXCLUSIONS AND LIMITATIONSNo
benefits will be paid for loss or expense caused by, contributed to, or
resulting from:
Pre-existing Conditions, as defined hereinIf you are a non-U.Scitizen under
age 70, this exclusion is waived for eligible medical expenses for an Acute
Onset of a Pre-existing Condition(s) (as defined herein) as shown in the
Schedule of Benefits for your chosen plan (Plan A, B, C, or D)Benefits will
be administered as stated in section G, Acute Onset of a Pre-Existing
Condition(s), for eligible medical expenses incurred in the United States,
minus your Deductible and subject to the scheduled limits for benefits as
stated in the Schedule of BenefitsFor persons age and over, there is no
benefitThis benefit does not include coverage for known, scheduled, required,
or expected medical care, drugs, or treatments existent or necessary prior to
the effective date of this programAny exclusion specifically listed in
General Exclusions and Limitations, numbers through 35, as well as the
section entitled Additional Limitations and Exclusions for Elective Surgery and
Elective Treatment, will not receive benefits from this waiverBased
upon the Policy’s Coverage Provisions and 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 policy. The
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
claimIf
you should have any further questions or need further clarification of the
above, please do not hesitate to contact us.Sincerely,Claims
Department 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
[Provide details of why you are not satisfied with this resolution.]
Regards,*** ***I followed the guidelines according to their policy; I explained the reasoning why my primary care doctor did not feel comfortable providing some of the information on their form. She provided a letter from the department of Veterans Affairs Hospital. On Friday, I spoke with a representative from seven corners, requested a copy of their policy to review, and was told it would be emailed to me but I have received it. I tried to explain my health condition that comes unexpectedly and the reason why I did not go to a doctor in Europe for treatment but instead took necessary self-care for medical condition. I was told they would review any new documents I can provide but I have to make an appointment with my VA doctor. Since leaving the military with a disability, I use my own health insurance for most of my medical care and not the VA hospital as much because of convenience and experience

Seven Corners,Incis in receipt of Complaint ID Number: *** and sent to the attentionof Dennis W*** on August 25, The complaint was filed by *** *.*** and we appreciate the opportunity to address his concerns.*** *** purchased a RoundTrip Economy (AOS) travel insurance
policyand during his trip, he became ill and sought out medical treatmentSevenCorners received his claim documentation and determined the loss was coveredand proceeded to issue a claim payment check in the amount of $USDTheclaim check mailed to Mr***’s address of record in the United States. The customer,wished to deposit the check in the Philippines and not in the U.Sand couldnot deposit the check into a Philippine bank account. *** *** requested a wire payment besent to his banking institution in the PhilippinesMr*** provided SevenCorners with his banking information and this office accommodated theconsumers’ request for a wire transfer payment Cambridge MercantilePayment Reference: ***Currency and Amount: $USDBeneficiary: *** *** *** On August 24, 2015,Seven Corners completed a wire transfer payment in the amount of $USD.The payment was sent to the consumers banking institution and this office hasincluded a copy of the transaction confirmation affirming the wire transfer. Upon receiving Mr.***’s concerns made to the Revdex.com of Central Indiana, this officereevaluated his presented claim and found that there was a handling delayregarding the reissuance of his payment via wire transferSeven Cornersapologizes profusely for this delay as we aim to satisfy our internal andexternal customers We hope this willresolve Mr***’s concerns regarding his recent claimIf you should haveany further questions or need further clarification of the above, please do nothesitate to contact us. Enclosure

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,
*** ***

Revdex.com:
Please find attached the release per seven corner's request. Please ensure that it is received by the appropriate party as Ihave not had much luck with the inquires I have sent them.I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to me. Thank you for your assistance in this matter
Regards,
*** ***

November 29, *** *** Revdex.com NDelaware Street #Indianapolis, IN 46204-RE: Complaint ID: *** Dear Ms***: Seven Corners, Incis in receipt of the complainant’s rebuttal to our initial response regarding complaint *** filed by *** ***. The complainant, *** ***, has expressed concerns that he was provided with incorrect information regarding his policy benefitsIn order to clarify the role of the parties involved, American Modern Home Insurance Company is the insuring company of the travel insurance purchased. April Travel Protection is the agent that sells the travel insurance and provides customer assistance. Seven Corners Incis the third party administrator contracted by American Modern Home Insurance Company to provide claim adjudication services. The rebuttal response from Mr*** states he was provided with benefit information from Mabel H*** and Janet G***, and is requesting that phone records be obtained to verify any conversations. These individuals are employed with April Travel Protection, not Seven Corners Inc., and there we are unable to verify any phone conversations with these individuals. *** *** purchased a short term travel insurance policy on May 4, 2016, covering trip dates June 11, to June 18, 2016. On July 19, 2016, Seven Corners received a claim from Mr***, for additional airfare incurred when two members in his party had to return home early due to the death of a family memberThe insured group had driven to their vacation destination. Mr*** purchased two airline tickets in the amount of $for his wife and daughter to fly home following the death of the family member. The policy purchased provides Trip Interruption benefits only for the unused, non-refundable travel arrangements prepaid to the travel supplier. This benefit does not reimburse for additional airfare. A denial letter was sent to Mr*** on July 22, 2016, explaining the reason the loss was not covered under the policy. The policy language which is pertinent to this matter includes the following: “SECTION IVCOVERAGES TRIP INTERRUPTION We 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 for the unused, non-refundable travel arrangements prepaid to the Travel Supplier(s).” We are sorry we cannot respond more favorably at this time. We hope this answers your concerns regarding this matter. Should you have any further concerns, please contact this officeSincerely, 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
Hi *** and Revdex.com team,It's nice to see that Seven Corners replied Thank you Chelsi for replying. You say that you "reviewed the file and claim" and denied all the claims due to this "pre-existing condition." Can you please tell us what that is? what is the condition that you are saying is "pre-existing." We have asked this over and overFor many months we have been dealing with you guys trying to get an answer. You say that you did a "medical review..." Can you tell us if you got the Clarification Letters that we sent you on Dec 7, 2016? Both the Clarification Letters from the original doctors clearly state that what was causing *** to have the stabbing lower left pain was not any pre-existing conditionDid you get the Clarification Letters? Did you read them? You mention "extensive communication" between me and your claims departmentYes that is trueMostly us asking you the same questions again and again, and Kathy H*** ignoring, dodging, or replying with bad responses like, "the denial is firm..." We ask you what the "pre-existing condition" isYou ignore usWe ask you if you received the Clarification Letters from the doctorsThe Clarification Letters that your claims person Kathy H*** said would be nearly impossible to even getWell after months of hard work, we got two so farWe sent them to your Claims people with a new Appeal on Dec 7, And nothingNo reply to whether you got them or read themWe waited weeks, and we sent you another email asking if you got the Appeal. Also you continue to ignore our question about the "month look back period" which applies to "pre-existing conditions." Can you respond about that question?***, can you as the Revdex.com, ask Chelsi these questions and get a reply? That would be very appreciated.We have had to file a CA Commissioner of Insurance Complaint about Seven Corners.Hopefully Chelsi and the Seven Corners people decide to stop denying the claims, and reimburse *** for the bills she has already had to pay to stop them from going to collections, as well as pay the current claims. I have replied and attached the Clarification Letters from the original doctors in case you want to read them.thanks*** *** *** Regards,
*** ***

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
Dear Revdex.com; This is extension of my complain#***There are three providers need to be paid1) Doctor - $2) Quest - $3) Doctors Express- $Recently I got the letter from Seven corners and they agreed to pay doctor’s bill of only $out of $which I yet to get the confirmation from the doctor that they indeed paid the moneyThey 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, *** ***All the providers on the claim must be paid by Seven Corners Inc

Seven Corners, Incis in receipt of Complaint ID Number: and sent to the attention of Dennis W*** on January 12, The complainant: *** * *** has expressed concerns with the handling of her son’s recent travel insurance claimSeven Corners has reviewed the documentation provided
by Ms*** regarding her son’s Loss of Baggage claimIn order to evaluate *** ***’s claim, this office asked that all documents related to Mr***’s claim with airline, Air Lingus, be forwarded to this office for reviewThe initial evaluation of the claim receipts led to Seven Corners claim denial, as it appeared that the insured received reimbursement from the airline in excess of his presented claim documentationThe insured party appealed the claim denial and submitted additional documentation/receipts, as well as documentation from Air Lingus confirming the out-of-pocket purchases made as a result of *** ***’s lost luggageAt the time of the review, Seven Corners noted the policy coverage limit of $1,less the payment issued by the airline, $1,280.32, and proceeded to issue payment to the customer for the remaining $The customer contacted this office to again explain that her son’s total loss was $2,and that the airline paid her the limit of their coverage which was: $1,Ms*** was seeking reimbursement from Seven Corners in the amount of $1,Due to the fact that this office has issued a prior claim payment to *** *** in the amount of $219.68, Seven Corners has issued a claim payment to the insured party in the amount of $1,for *** ***’s Loss of baggage claimOur calculations are noted below: Total Loss Amount: $2,Less Reimbursement Received from Air Lingus: $1,Less Prior Claim Payment: $Total to be reimbursed to the insured: $1,Seven Corners profusely apologizes for any miscommunication that may have occurred during the handling of this claimThank 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 Number: *** sent to the attention of Dennis *** on February 16, The complainant, *** ***, has expressed concerns with the handling of his Trip interruption/Trip Delay claim
*** *** purchased a short term travel insurance policy covering his trip dates 11/02/to 11/25/Mr*** received notification from Philippine Airlines that his scheduled flight for 11/19/2015, had been changed to 11121/This change was the result of government authority runway closures, due to the arrival and departure of APEC leadersThe change in itinerary resulted in a Trip Delay loss for Mr***
On 12109/2015, Seven Corners received a claim for the additional expenses incurred as a result of the original cancelled flightThe policy purchased provides benefits for Trip Cancellation, Trip Interruption, and Trip Delay for specific named unforeseen events listed in the policyUnfortunately, the reason the flight was cancelled/delayed was not a covered peril under this policyA denial letter was sent to Mr*** on 1211612015, outlining the reason his loss was not covered under the policyThe denial letter quoted Trip Cancellation or Trip Interruption Unforeseen Events
On 01/11/2016, Seven Corners received an Appeal on this claimMr*** requested benefits apply under the Trip Delay benefits of the policyThis policy has the same named perils for Trip Cancellation, Trip Interruption, and Trip DelayNo benefits apply for the loss due to the runway or airport being closed by government authorityA denial of appeal letter was sent to Mr.*** on 02/02/The appeal analyst returned a call to Mr*** on 02/16/tofurther explain the policy benefitsFollowing that conversation, Mr*** was not pleased but understood that the policy did not provide benefits for his loss
The policy language which is pertinent to this matter includes the following:
"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
TRIP DELAYWe Will pay You for additional expenses on a one-time basis, up to the maximum shown in the Schedule of Benefits, if You are delayed en route to or from the CoverFor Trip Cancellation or Trip Interruption, Unforeseen Events Include:Accidental Injury, Sickness or death of You, Your Traveling Companion, Your Family Member, 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.The death or hospitalization of Your Host at Destination.Inclement weather, Natural Disasters, Terrorist Attacks, or mechanical breakdown of the common carrier which results in the complete cessation of travel services at the point of departure or destination for at least consecutive hours.Adverse weather or Natural Disasters resulting in the complete cessation of travel services.Natural Disaster or documented man-made disaster at the point of departure or Your destination which renders Your primary residence or the accommodations at Your destination uninhabitable.(t) Strike that causes complete cessation of services of Your Common Carrier for at least consecutive hours.Your transfer by the employer with whom You are employed on the Effective Date of insurance which requires Your principal residence to be relocated.You or Your Traveling Companion are terminated, or laid off from employment, from aplace of employment for which You have been employed for the past consecutive years(1) Your business operations are interrupted by fire, flood, burglary, vandalism, product recall, Bankruptcy, Natural Disaster, or financial Default.If within days of Your departure, a politically motivated Terrorist Attack occurs within a mile radius of the territorial City limits of the City to be visited as shown in Youritinerary and the United States government issues a travel advisory indicating that Americans should not travel to a City named on the itinerary.Bankruptcy and/or Default of Your Travel Supplier which occurs more than days following Your Effective DateYour Scheduled Departure Date must be no more than months beyond Your Effective DateBenefits will be paid due to Bankruptcy or Default of an airline only if no alternate Transportation is availableIf alternate Transportation is available, benefits will be limited to the change fee charged to allow You to transfer to another airline in order to get to Your intended destinationThis coverage only applies if the Policy was purchased within calendar days of the initial Trip payment.(I) A documented theft of passports or visasDocumented means that You have reported the theft to the local authorities.(m) You and/or Your Traveling Companion are hijacked, quarantined, required to serve on a jury, subpoenaed, required to appear as a witness in a legal action, provided You are or Your Traveling Companion are not a party to the legal action or appearing as a law enforcement officer.SEVEN CORNERSYou and/or Your Traveling Companion are the victim of felonious assault; have Your principal place of residence made uninhabitable by fire, flood or other Natural Disaster, or burglary of Your principal place of residence within days of departure.You or Your Traveling Companion being directly involved in or delayed due to a traffic Accident substantiated by a police report, while en route to departure.You or Your Traveling Companion who are military personnel, are called to emergency duty for a disaster other than war or are called to active military duty, have their leave revoked or are reassigned for reasons other than War.A cancellation of Your Covered Trip if Your arrival on the Covered Trip is delayed and causes You to lose 51% or more of the scheduled Covered Trip duration due to the reasons covered under the Trip Delay benefit."
We are sorry we cannot respond more favorably at this timeWe hope this answers your concerns regarding this matterShould you have any further concerns, please contact this office
Sincerely,
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,
*** ***

July 29, *** *** Revdex.com NDelaware Street #Indianapolis, IN 46204- RE: Complaint ID: *** Dear *** ***: Seven Corners, Incis in receipt of the complainant’s rebuttal to our prior response regarding complaint *** filed by *** ***. The complainant, *** ***, advised they have not yet received a response regarding the Appeal documentation provided for the claim. Our office received the appeal from the insured on June 27, The appeal was reviewed, and additional information was requested from the treating physician. Additional information was obtained, and the claim was processed for payment in the amount of $2,on July 28, 2016. A letter advising the payment is being processed was sent to the insured, *** *** via email. We hope this answers your concerns regarding this matter. Should you have any further concerns, please contact this office Sincerely, Seven Corners, Inc

March 16, 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 the rebuttal to Complaint *** which was filed by *** *** on March 11, 2016. We have reviewed Ms***’s additional comments and our position is unchanged from our response of March 2, 2016. We have confirmed that the claim is not eligible for trip cancellation coverage benefitsAs explained in our March 10, letter, trip cancellation benefits are available if the insured is prevented from taking the scheduled tripBased on the documentation presented by Ms***, she left on her trip as planned. Since Ms*** was able to depart on her trip as scheduled and only experienced a delay on the second leg of her trip, we looked to her trip delay benefits for coverageUnfortunately, additional airfare expenses are not a covered expense under the trip delay benefit. If Ms*** has any additional receipts relating to her Trip Delay, we encourage her to submit them for further reviewPlease understand that our action at this time should not be construed as a waiver of any and all rights and defenses which Nationwide Mutual Insurance Company may have under the policy in question, and any applicable statutory or common law, all of where are hereby expressly reservedWe appreciate the opportunity to address Ms***’s concerns. Please contact this office should you have any further questions regarding this matterSincerely, 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
[I am not satisfied with this resolution because during the initial request I was getting very different information from the representatives I spoke withThe last time I spoke with a representative, I was told if I provided more information to support my claim they would review it Although, the way the representative made this statement seemed as if no new information will be reviewed with the intention of reconsidering the circumstances why I was unable to fly that day I am a 80% disabled veteran, I don't use the VA health care that often because I use my employer's health care benefitsWhen I do see the VA it is for routine visits and to reevaluate the condition of my disabilities I explained this in every call and was told that I can provide further information when I see my VA doctor I can provide medical history from my private doctors to support my claim but they are not the primary doctors If they want tosee this medical history I can submit sooner
Regards,
*** ***

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 the above referenced complaint filed by *** *** on March 22, 2017. Upon further review of Mr***’s claim file and the circumstances surrounding this matter, trip cancellation coverage will be allowed for Mr***’s claim Although the policy purchased by Mr*** does not provide coverage for trip cancellation due to a travel ban, given the circumstances of the situation, we are issuing payment in the amount of $1,($per passenger) which is the cancellation fee charged by *** AirlinesMr*** will received payment under separate correspondence.We appreciate the opportunity to address Mr***’s concerns. Please contact our office at the number provided above should you have any further questions regarding this matterSincerely, Sherry O*** Seven Corners, Inc

Seven Corners is in receipt of Complaint ID ***, filed September 9, and sent to the attention of *** ***. The complaint was filed by *** *** who objects to the handling of a family member’s claim
On July 29, 2013, an Inbound Immigrant policy was purchased by the
customer, with effective coverage dates: July 30, to May 30, 2014. On January 25, 2014, *** *** sought medical assistance at *** *** Park Hospital Emergency RoomClaims were later presented to Seven Corners, Incon behalf of Mr*** seeking reimbursement for medical treatment.
Per the presented medical records, *** *** was treated for myocardial infarction, initial episode of care and coronary atherosclerosis of native coronary arteryThe medical review completed by Seven Corners, Incmedical staff, indicated that the patient's coronary artery disease had been present for quite some time based on the degree of occlusions and the amount of collateral circulation that was present in the cardiology reportsThe myocardial infarction was found to be a "complication related thereto or resulting therefrom" the atherosclerotic cardiovascular disease. Based on the above, the presented claim documents, and medical records, the presented claims were not covered not due to the policy’s pre-existing condition exclusion
Our records show that a claim denial letter was mailed to Mr*** in care of *** ***, on May 2, The customer appealed the claim denial in writing and requested that Seven Corners, Increconsider his request for reimbursement for the presented claim(s)Mr*** was mailed an appeal denial of benefit letter on August 25,
Language which is pertinent to this matter:
GENERAL EXCLUSIONS AND LIMITATIONS
No benefits will be paid for loss or expense caused by, contributed to, or resulting from:
1) Pre-Existing Conditions as defined hereinIf you are a non-U.Scitizen under age 70, this exclusion is waived for eligible medical expenses for an Acute Onset of a Pre-existing Condition(s) (as defined herein) as shown in the Schedule of Benefits for your chosen plan (Plan A or B)Benefits will be administered as stated in section F, Acute Onset of a Pre-Existing Condition(s), for eligible medical expenses incurred in the United States, minus your Deductible and subject to the scheduled limits for benefits as stated in the Schedule of BenefitsFor persons age and over, there is no benefitThis benefit does not include coverage for known, scheduled, required, or expected medical care, drugs, or treatments existent or necessary prior to the effective date of this programAny exclusion specifically listed in General Exclusions and Limitations, numbers through 44, as well as the section entitled Additional Limitations and Exclusions for Elective Surgery and Elective Treatment, will not receive benefits from this waiver;
DEFINITIONS
“PRE-EXISTING CONDITION” shall mean any medical condition, sickness, Injury, Illness, disease, Mental Illness or Mental Nervous Disorder, regardless of the cause including any congenital, chronic, subsequent, or recurring complications or consequences related thereto or resulting therefrom that with reasonable medical certainty existed at the time of application or within the one hundred and eighty (180) days (three hundred and sixty five (365) days for Insured Persons and older) immediately prior to the Insured Person’s Effective Date under the policy, whether or not previously manifested, symptomatic, known, diagnosed, treated or disclosedThis specifically includes but is not limited to any medical condition, sickness, Injury, Illness, disease, Mental Illness or Mental Nervous Disorder, for which medical advice, diagnosis, care or treatment was recommended or received or for which a reasonably prudent person would have sought treatment during the one hundred and eighty (180) days (three hundred and sixty five (365) days for Insured Persons and older) immediately preceding the effective date of coverage under this policy
“ACUTE ONSET OF A PRE-EXISTING CONDITION(S)” shall mean a sudden and unexpected outbreak or recurrence of a Pre-existing Condition(s) which occurs spontaneously and without advance warning either in the form of Physician recommendations or symptoms and is of short duration, is rapidly progressive, and requires urgent careThe Acute Onset of a Pre-existing Condition(s) must occur after the effective date of the policyTreatment must be obtained within hours of the sudden and unexpected outbreak or recurrenceA Pre-existing Condition that is a chronic or congenital condition or that gradually becomes worse over time will not be considered Acute OnsetThis benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or Treatments existent or necessary prior to the Effective Date of coverage
We hope this answers any outstanding questions in relation to *** ***’s claims. If you should have any further questions or need further clarification of the above, please do not hesitate to contact us

June 13, *** *** Revdex.com N Delaware Street #Indianapolis IN 46204-RE: Complaint ID *** Customer: *** *** Certificate #*** Dear
Ms***: Seven Corners, Incis in receipt of Complaint ID Number *** and sent to the attention of Dennis W*** on June 11, 2016. The complainant, *** ***, has expressed concerns with the handling of recent travel medical insurance claims under the certificate # referenced aboveThis office has reviewed the file and the claims in question. *** *** was covered a Liaison Continent policy effective from June 16, through September 15, 2015. This policy contains the following exclusion: Pre-existing Conditions which are excluded under this policyThis means that any claims for Pre-existing Conditions will not be covered for the duration of this policya) If You are a United States resident under age 70, this exclusion is waived for the first $25,in eligible medical expenses incurred outside the United States and Canada (for persons age and over, the amount is $5,000), minus Your Deductible and selected Coinsurance option (Plan E or F)This waiver does not include coverage for known, scheduled, required, or expected medical care, drugs, or treatments existent or necessary prior to the effective date of this programb) If you are a non-U.Sresident under age 70, this exclusion is waived for eligible medical expenses for an Acute Onset of a Pre-existing Condition(s) (as defined herein) up to $45,(Ages 65-limited to $2,000) for eligible medical expenses incurred in the United States, minus Your Deductible and selected Coinsurance option (Plan A or B)For persons age and over, there is no benefitThis benefit does not include coverage for known, scheduled, required, or expected medical care, drugs, or treatments existent or necessary prior to arrival in the United States and prior to the effective date of this programPre-existing Condition(s) shall mean any medical condition, sickness, Injury, Illness, disease, Mental Illness or Mental Nervous Disorder, regardless of the cause including any congenital, chronic, subsequent, or recurring complications or consequences related thereto or resulting therefrom that with reasonable medical certainty existed at the time of application or any time during the 36* months prior to the effective date of coverage under this policy, whether or not previously manifested, symptomatic, known, diagnosed, treated or disclosedThis specifically includes but is not limited to any medical condition, sickness, Injury , Illness, disease, Mental Illness or Mental Nervous Disorder, for which medical advice, diagnosis, care or treatment was recommended or received or for which a reasonably prudent person would have sought treatment during the month period immediately preceding the effective date of coverage under this policy*For Insured Persons traveling outside the United States and Canada, the period is months instead of monthsAcute Onset of a Pre-Existing Condition(s) shall mean a sudden and unexpected outbreak or recurrence of a Pre-existing Condition(s) which occurs spontaneously and without advance warning either in the form of Physician recommendations or symptoms and requires urgent careThe Acute Onset of a Pre-existing Condition(s) must occur after the effective date of the policyTreatment must be obtained within hours of the sudden and unexpected outbreak or recurrenceA Pre-existing Condition that is a Congenital condition or that gradually becomes worse over time will not be considered Acute OnsetA Pre-existing Condition will not be considered an Acute Onset if during the days prior to the acute event You had a change in prescription or treatment for a diagnosis related to the acute eventThis benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or Treatments existent or necessary prior to arrival in the United States and prior to the Effective Date of coverageThe insured sought treatment on July 23, 2015. The medical records received from the medical provider indicate that the insured’s condition had developed gradually and been ongoing for a period of six months. The records do not indicate any acute injury or onset of this condition, and in fact states that the patient denied any injury relating to the problem. Based on the medical records and the definition in the policy, the condition is pre-existing. This member did not present within hours of acute onset of symptoms and therefore the Acute Onset Benefit would not apply for this occurrenceThank 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