July 13, ? ? ? [redacted] Revdex.com NDelaware Street #Indianapolis, IN? 46204-? RE: Complaint ID:? [redacted] ? Dear Theresa Davis:? Seven Corners, Incis in receipt of the complainant’s rebuttal to our initial response regarding complaint [redacted] filed by [redacted] .? The complainant, [redacted] , advised new documentation was provided for further consideration of the claim submitted for Trip Cancellation for [redacted] .? Our office received the appeal from the insured on June 27, 2016.? The appeal is currently under review.? The analyst is obtaining further information from the treating physician, to determine if benefits will apply under the policy.? Once that information is obtained from the physician, a letter will be sent to the insured with the final appeal decision.? ? We hope this answers your concerns regarding this matter.? Should you have any further concerns, please contact this office? Sincerely, ? Seven Corners, Inc?
[redacted] Revdex.com NDelaware Street #Indianapolis, IN? 46204- RE: Complaint ID:? [redacted] Dear [redacted] ***:? Seven Corners, Incis in receipt of the complainant’s rebuttal to our initial response regarding complaint [redacted] filed by [redacted] .? The complainant, [redacted] , has expressed concerns that she has not received a letter regarding payment for [redacted] ***’s claim.? Payment was processed to [redacted] on March 14, 2016.? The attached payment letter was also mailed.? Once processed, our system takes up to business days for the check to be printed and mailed.? Her claim check #***, in the amount of $1,865.00, was printed and mailed on March 25, 2016.? ? ? We hope this answers your concerns regarding this matter.? Should you have any further concerns, please contact this office Sincerely, Seven Corners, Inc
Revdex.com: I have reviewed the? response made by the business in reference to complaint ID [redacted] , and have determined that the response? would not resolve my complaint.? For your reference, details of the offer I reviewed appear below.I am still waiting to be reimbursed by seven corners for multiple bills and reciepts that I have submitted? Regarding Wesley S***? The bill he obtained for me was not legible and was rejected by ***? He said he would get me another, that was months ago? I have repeatedly asked what the status is and he ignores my emails? After waiting over months, I emailed him again? NO RESPONSE? Then, even more frustrated, I emailed him asking if he had been fired for being so bad at his job? He responded in less than minutes, sarcastically thanking me for my question and informing me that yes he still works there? He did not update me on the status of the itemized bill? This guy needs help? He is also the one that left me in a hospital for extra days in Costa Rica until I MYSELF, FROM A HOSPITAL BED, called him directly and inquired why he would not approve an ambulance plane home? I have worked with [redacted] to get some of the bills refunded, I am still waiting on others.? ? Regards, [redacted]
Revdex.com: I have reviewed the? response made by the business in reference to complaint ID [redacted] , and have determined that the response? would not resolve my complaint.? For your reference, details of the offer I reviewed appear below.I realize they say that I am not covered for service after the trip but how do they think I was supposed to get service in a foreign countryI attached? both pages of their insurance document provided to me prior to the tripOn page two,? close to the bottom,? section e)it says -? dental care:$for emergency dental treatment.? it does not say anything about where the service had to be doneI had the emergency on day four of my tourI toughed through the next five days of the tour.? How was I to get my tooth fixed in a foreign country? Where was I to find a dentist? Was I to just pop into a dental office and expect to get in immediately? What about my tour? Was I just to fend for myself in Europe? How would I have caught up with my tour and gotten home? Why have the insurance if it is not usable to fix the problem (my broken tooth) as soon as I could get to a dentist? Trip ended on 6/14/and I was getting my tooth crowned on 6/15/because my dental office said it was an emergencyI totally feel? left holding the bag? by this insurance company Regards, [redacted]
October 2, [redacted] Revdex.comNDelaware Street #2020Indianapolis, IN 46204-RE: Complaint ID – [redacted] Insured: [redacted] *** Dear Ms [redacted] : Seven Corners, Incacknowledges receiving furthercorrespondence on compliant ID [redacted] , regarding [redacted] *** This office has issued a claim benefit payment in theamount of $USD to Ms [redacted] on two prior occasions; however the insuredparty has not received either payment at her address of record in Taiwan Seven Corners had proposed that we send a wire transferpayment to Ms***, however she declined that course of action and stated shewould prefer a check as a form of settlementOn September 30, 2015, Seven Corners reissued claim settlementto Ms [redacted] as requested and shipped the claim payment via United StatesCertified Mail to her address of record: [redacted] Taiwan Please note the USPS Tracking Number: [redacted] for tracking purposesWe hope this will resolve [redacted] ***’s concernsregarding her recent claimIf you should have any further questions or needfurther clarification of the above, please do not hesitate to contact usSincerely, Seven Corners, Inc Tell us why here
December 2, [redacted] Revdex.comRevdex.com of Central Indiana NDelaware StreetSuite # 2020Indianapolis, IN? 46204-2599RE: Complaint Number:? [redacted] ? ? ? ? ? ? ? Complainant(s): [redacted] ***? ? ? ? ? ? Insureds:? [redacted] (The Estate of [redacted] c/o [redacted] , ***)? ? ? ? ? ? ? Certificate Number:? [redacted] Dear Ms.? [redacted] :Seven Corners, Incis in receipt of Complaint ID Number [redacted] , 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 [redacted] ***.? 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 [redacted] ***; 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; [redacted] purchased an insurance policy from American Modern Home Insurance Company; through Online Vacation Center Plan (FL) for his Celebrity Cruises vacationOur investigation determined that [redacted] became ill during the cruise and required medical attention.? Mr [redacted] was medically required to discontinue his travel due to this medical issue Seven Corners secured medical records indicating on ship medical care and off ship medical care from December 5, till December 14, ? The named insured, [redacted] claimed medical expenses of $11,on their submitted Proof of Loss Form.? Mr [redacted] 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 [redacted] 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 [redacted] c/o [redacted] P [redacted] , ***at [redacted] ***, 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, [redacted] ***; concerns regarding the claim presented by The Estate of [redacted] c/o [redacted] P [redacted] , ***.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 [redacted] , and have determined that the response would not resolve my complaint For your reference, details of the offer I reviewed appear below.It is my understanding that, should you client seek treatment at your hospital, we would be better of collecting money up front as a self-pay patient and let your client handle insurance Regards, [redacted]
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that the response would not resolve my complaint For your reference, details of the offer I reviewed appear below Dr [redacted] is part of Seven Corners' networkI do not think I am responsible for mediating the payment process between Seven Corners and the doctors office as I made sure I go to a doctor who is part of the insurance network prior to going to the doctors' officeThe failure to communicate with the doctor should not make me a victim for harassing letters from [redacted] lab and their collection office and ruining my credit scoreI hope Seven Corners finds a better way for reaching the doctors' office Regards, [redacted]
November 29, [redacted] Revdex.com NDelaware Street #Indianapolis, IN? 46204- RE:? Complaint ID:? [redacted] ? ? ? ? ? ? Dear Ms***:? ? Seven Corners, Incis in receipt of the complainant’s rebuttal to our initial response regarding complaint [redacted] filed by [redacted] ***.? The complainant, [redacted] ***, has expressed concerns that he was provided with incorrect information regarding his policy benefits In 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 [redacted] states he was provided with benefit information from Mabel H [redacted] 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.? [redacted] 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 [redacted] 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 [redacted] 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 office Sincerely, Seven Corners, Inc ? ?
February 12, [redacted] Revdex.com N Delaware Street #Indianapolis, IN 46204- RE: Complaint ID – [redacted] Complainant: [redacted] Dear Ms***: Seven Corners, Inc is in receipt of Complaint ID Number [redacted] and sent to the attention of Dennis W [redacted] on January 6, The complainant, [redacted] , has expressed concerns with the handling of his father’s recent travel medical insurance claim This office has reviewed the file and the claims in question and find that the denial of the claims under the policy exclusion for pre-existing conditions was correct based on the medical information we received We also find that we did receive several inquiries from Mr [redacted] requesting more specific medical information on the determination that was made It appears that our responses to these inquiries did not provide the detailed information that was requested in order for Mr [redacted] to understand our determination By separate letter directly to Mr [redacted] , we will respond with the medical details he has requested Thank you for your time and attention to this matter and should you have questions involving this claim matter, please contact this office Sincerely, Seven Corners, Inc
Seven Corners, Incis in receipt of Complaint ID Number: [redacted] and sent to the attention of Dennis W [redacted] on August 13, Thecomplaint was filed by [redacted] and we appreciate the opportunity toaddress her concerns[redacted] purchased a Peter's Way travel insuranceplan for travel dates: 4/12/to 4/21/On the date of departure, April12th, [redacted] states she was removed from the flight toIsrael by the British Airways Cabin Service DirectorThe insured noted incorrespondence, that the airline staff “did not like the way I was breathing”.Emergency Medical Technicians attempted to assist Ms [redacted] , however she wasnot comfortable with the medical attention and she elected to return to her home.Ms [redacted] then departed Logan Airport by cab and incurred car fare chargesto return to her residence [redacted] presented a claim to Seven Corners forreviewThis office evaluated the claim documentation presented by Ms [redacted] and determined the loss was not eligible for payment and the reason(s) are asfollows: Ms [redacted] was not medically restricted from participatingin her covered trip by a Legally Qualified Physician, a coverage requirement.Per documentation dated: 4/13/from Cheshire Medical Center EmergencyDepartment physician, Dr [redacted] ***; states “ [redacted] is medicallyclear to fly on an airplaneShe gets short of breath when she exerts herself.This is for her and should not be a problem while flying”[redacted] ’s travel insurance included an optionalcoverage provision, “Cancel for Any Reason.” This office evaluated theapplication of the optional coverage benefit and again, Seven Corners found theloss did not qualify for coverage as Ms [redacted] did not cancel her trip twodays or more before her scheduledtrip departure date? On June 29, 2015, aclaim denial letter was mailed to [redacted] ’s address of record.Policy language which is pertinent to this matter:COVERAGE D - TRIPCANCELLATION This Coverage D ismade a part of the policyIt is subject to all the provisions of this CoverageDBenefits will be paid up to the Maximum Benefit Amount purchased to cover Youfor the Published Penalties and unused non-refundable prepaid expenses forTravel Arrangements when You are prevented from taking Your Covered Trip dueto:A covered Sicknessor Injury involving You, Your Traveling Companion or Business Partner, or Your FamilyMember or You or Your Traveling Companions Family member which necessitates MedicalTreatment at the time of cancellation and results in medically imposedrestrictions, as certified by a Legally Qualified Physician, which prevents an Insured’sparticipation in the Covered Trip;OPTIONAL PURCHASE ?"CANCEL FOR ANY REASONIf You cancel Your Trip for any reason not otherwise covered by this policy, Wewill reimburse You for 75% of the prepaid, forfeited, non-refundable paymentsor deposits paid for Your Trip provided:Your premiumpayment is received within days of the initial deposit/payment for YourTrip; andYou insure 100% ofall prepaid Trip costs that are subject to cancellation penalties orrestrictions by the Travel Supplier; andYou cancel YourTrip two (2) days or more before Your Scheduled Trip Departure Date.We hope this answers any outstanding questions in relationto [redacted] ’s claimIf you should have any further questions or needfurther clarification of the above, please do not hesitate to contact us
March 16, Revdex.com of Central Indiana N Delaware Street #Indianapolis, IN? 46204- RE: ? ? ? ? Complaint ID:? ? ? ? [redacted] ? ? ? ? ? ? ? ? ? ? Complainant: ? ? ? ? [redacted] To Whom It May Concern: Seven Corners, Inc(“Seven Corners”) is in receipt of the rebuttal to Complaint [redacted] which was filed by [redacted] 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 benefits As 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 [redacted] 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 [redacted] has any additional receipts relating to her Trip Delay, we encourage her to submit them for further review Please 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 reserved We appreciate the opportunity to address Ms***’s concerns.? Please contact this office should you have any further questions regarding this matter Sincerely, Seven Corners, Inc
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this proposed action 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.]The response is the same reason they churned out to us for rejection beforeThey have even stated in their response that the claim was rejected on the basis that the iPads supposedly fell into the category of PCs and Computer Hardware and SoftwareThis is completely as pointed out in our original complaintA tablet is not a PC (A Desktop or Laptop PC) and is not considered Computer Hardware (A printer, scanner, mouse, keyboard etc) or Software (It's not a CD/DVD containing a program to install)In order for the policy to avoid reimbursing for a media tablet such as an iPad they would have to define it in the policyThey can not make up their own definitions to meet their own financial gainsIt is like them having an exception for specifically a motorcar and then saying they will not cover a bicycleTheir reasoning is preposterous and insulting, much like their communication or lack there of Revdex.com Please see the attached evidence previously issued to the company for your examination as part of this rebuttal Regards, [redacted]
April 25, Revdex.com NDelaware Street #Indianapolis, IN 46204-RE: Complaint ID – [redacted] Dear Ms [redacted] : Seven Corners, Incis in receipt of Revdex.com Complaint ID Number: [redacted] from [redacted] We have reviewed the complaint and appreciate the opportunity to address your concernsIn order to clarify the role of the parties involved, One Travel is a travel provider of flight and other vacation accommodations, and Seven Corners, Inc(“Seven Corners”) is the third party administrator contracted to provide claim adjudication services for travel insurance policies issued by Nationwide Mutual Insurance CompanySeven Corners evaluated the documentation submitted by Mr [redacted] regarding a trip cancellation claimMr [redacted] noted he cancelled his scheduled travel due to illness (autism and paranoid schizophrenia)Claim documentation presented to this office did not indicate that [redacted] was hospitalized for his illnessThe purchased policy requires that for mental or emotional disorders, the client must be hospitalized to be eligible for coverage benefitsBased upon the above plan language, his claim is not eligible for reimbursement and a denial letter was mailed to his address of record on December 30, On February 16, 2016, this office received a claim appeal from the insured party disputing the initial decision and providing a different reason for cancellationMr [redacted] indicated within his claim appeal, that his travel cancellation resulted from the death of his grandmother who passed away on December 1, The purchased policy provided plan coverage from February 15, to March 9, In order for trip cancellation coverage to be applicable the presented loss must take place after the effective date of his policyHis family member’s death occurred after his policy coverage expired and therefore is ineligible for reimbursementFurther documentation was mailed to the insured’s address of record confirming that his losses were not covered under the purchased travel insurance policyShould Mr [redacted] provide documentation from his treating doctor that he was hospitalized for his illness during the policy effective dates, we will gladly give his claim further considerationBased upon the above information, [redacted] ‘s trip cancellation claim is ineligible for payment due to a policy exclusionThe policy language pertinent to this matter is as follows: BENEFITS TRIP CANCELLATION The Company will reimburse You, up to the Maximum Benefit shown on the Confirmation of Coverage, if You are prevented from taking Your Trip for any of the following reasons that are Unforeseen and takes place after the Effective Date: Sickness, Accidental Injury or death of a non-traveling Family Member; LIMITATIONS AND EXCLUSIONS The following exclusions apply to Trip Cancellation & Trip Interruption, Trip Delay, Missed Connection, And Accidental Death & Dismemberment: Mental or emotional disorders, unless hospitalized; We hope this answers Mr [redacted] ‘s concerns regarding his recent travel claimShould you have any further questions involving this claim matter, please contact me at the address listed belowSincerely, Seven Corners, Inc
Revdex.com: I have reviewed the? response made by the business in reference to complaint ID [redacted] , and have determined that the response? would not resolve my complaint.? For your reference, details of the offer I reviewed appear below I will not accept this offer because it is not an offerI got an health insurance covered up to and all I got back is a bill $tothat nobody wants to payI am totally broke because I wanted to be saveIf I had known that I'm only covered up to and need to pay that company on top, why would I have needed an insurance? I paid them more in the coverage time then they paid for the billThat shouldn't be right! ? I would need to go times to the hospital room in one month to even get to - totally fraud in my eyesI paid a monthly payment for that $coverage and now they have to pay for itEven the Airforce lawyer couldn't belive thatAnd I didn't go to the hospital because I like it there, I went there because I did have a serious problem.? This is a fraud and shouldn't be allowedNobody else should get into thisIf necessary, I will open more cases across the country and also write recommendations across the country about that coverageThis won't help me but it will help others since it is an immigration insurance.? Regards, [redacted]
March 18, 2016Revdex.com of Central Indiana N Delaware Street #Indianapolis, IN 46204-2599RE: Inquiry ID: [redacted] Complainant: [redacted] To Whom It May Concern:Seven Corners, Inc(“Seven Corners”) is in receipt of Inquiry [redacted] which was filed by [redacted] on March 10, Ms [redacted] purchased the Nationwide Travel Protection Plan under Certificate Number [redacted] , for her July 14, – August 2, trip We have reviewed the inquiry and the claim file and have confirmed that all eligible expenses have been reimbursed according to the trip delay benefit listed in the policyPayment was issued to Ms [redacted] on November 19, and we will explain below how this benefit was calculatedIn 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 Ms [redacted] 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 Ms [redacted] purchased her flightsMs [redacted] submitted a claim for her travel, which was received by Seven Corners on October 29, On the claim form submitted, Ms [redacted] did not clearly indicate the amount she was seeking for reimbursement and did not submit any receipts to support her claimOn November 5, 2015, a request was sent to Ms [redacted] requesting the following information:Original receipts for expenses incurred due to the delay;Confirmation of the amount being sought for reimbursement, and;Other insurance information, if applicableAccording to the documentation provided by Ms [redacted] , Ms [redacted] incurred approximately $in out of pocket expensesUnder the Nationwide Travel Protection Plan, the trip delay benefit reimburses for meal, lodging, local transportation, and essential phone call expenses incurred due to the delay If these items are provided by the airlines free of charge, they are not subject to reimbursement under the Travel Protection Plan As a result, payment of $was issued to Ms [redacted] , since American Airlines did not cover this expense In her inquiry, Ms [redacted] mentioned that she should be reimbursed more than $and on the claim form she submitted, she indicated reimbursement of $1,was appropriate because of several appointments she missed as a result of the trip delay While it was unfortunate that Ms [redacted] was inconvenienced due to the trip delay, the Nationwide Travel Protection Plan does not provide compensation for loss of time As of this date, Ms [redacted] mentioned that she has not received our $check and this could be attributed to her address outside of the United StatesIn order to get the funds to her as quickly as possible, we encourage Ms [redacted] to complete the attached Payment Authorization Form so payment can be wired to her bank Ms [redacted] should send the completed form to the following email for prompt handling: [email protected] language that is pertinent to this matter is as follows: TRIP DELAY Covered expenses: (a) Any Additional Expenses incurredAdditional Expenses means any reasonable expenses for meals and lodging as well as local transportation and essential phone calls that were necessarily incurred as the result of a Hazard and that were not provided by the Common Carrier or other party free of charge.We appreciate the opportunity to address Ms [redacted] ’ concerns Please contact this office should you have any further questions regarding this matter.Sincerely,Seven Corners, Inc
Seven Corners,Incis in receipt of Complaint ID Number: [redacted] and sent to the attentionof Dennis W [redacted] on August 25, The complaint was filed by [redacted] *[redacted] and we appreciate the opportunity to address his concerns[redacted] 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 [redacted] ’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.? [redacted] requested a wire payment besent to his banking institution in the PhilippinesMr [redacted] provided SevenCorners with his banking information and this office accommodated theconsumers’ request for a wire transfer payment? Cambridge MercantilePayment Reference: [redacted] Currency and Amount: $USDBeneficiary: [redacted] ? 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[redacted] ’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 [redacted] ’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 [redacted] , and have determined that the response? would not resolve my complaint.? For your reference, details of the offer I reviewed appear below [redacted] ***/Revdex.com team, ? ? Thank you for getting a reply from Jennifer/ Seven CornersJennifer/Seven Corners,We can confirm that we got Jennifer's letter in reply to the Complaint that we had to file with the CA? CommissionerAnd thank you for finally replying to our Revdex.com reply from Feb Seems like a very very long? time to wait for a reply from you guys.? Unfortunately? you still have not answered the questions.In our Revdex.com Message from Feb 2017, we asked you very specific questionsWe were hoping that you would? have answered them in this new message from you that we got on March You state below that your letter? replying to our CA? Commissioner? Complaint addresses the questionsThat is not trueYour letter did not address? or answer the questions.We got your March letter replying to the CA? Commissioner? investigation.Thanks for apologizing for not? replying to the many many questions that we asked Kathy H [redacted] over the past monthsI guess you are also? apologizing for you and Chelsi T [redacted] not answering our questions to you directly to you, via the Revdex.com Complaint,? and via the CA Insurance CommissionerThe irony is that even though you are apologizing for not answering the? questions, it seems like you are still not answering the questions.Lets just focus on just one or two questions:First Question:The biggest question you still have not answered is, what is the "pre-existing condition"? Can you reply to this?? What is this "pre-existing condition" that apparently [redacted] has? And also what medical certainty do you have? that she had this "pre-existing condition" during the look-back period? This look-back period seems pretty? important, as it basically means that if someone once upon a time had some "pre-existing condition" but was? stable (meaning: had no new medical condition and no prescription medication changes) during the look-back? period, then a denial based on a "pre-existing condition" can't be usedIn this new reply letter from March 2017,? you say "[redacted] 's illnesses were pre-existing" Can you please tell us what these "illnesses" are? Since you are? telling us that with "medical certainty" they are "pre-existing," you should be able to tell us what they areAlso? please can you provide the evidence you are using to determine that the "illnesses" are "pre-existing"That would? be quite helpfulFor instance, what information, facts, or evidence are you using to determine that [redacted] 's? ovarian cyst was "pre-existing." ?? Second Question:Also can you confirm that you got the Clarification Letters that we sent you directly in December Did you? read them? We also attached them to the Revdex.com reply on Feb 2017.If you read Tina B***'s original office visit report and her Clarification Letter you asked for, Tina B [redacted] clearly? states that:"Her non-chronic more recent change in abdominal pain and menses required further evaluation to address her? complaint." and "The more acute problem including diagnosis or irregular menstrual cycle (N92.6,) female pelvic? pain (N94.9) required further evaluation and was not chronic in nature."? If you read Rahul C [redacted] 's Clarification letter he clearly states:"...acute onset abdominal pain and heartburnThis was the first time she had experienced such pain and? heartburn and so came to see me for consultation." he continues "While her bloating was a pre-existing? condition, her abdominal pain and heartburn were new medical problems that led to her seek Gl consultationIn? my professional opinion, her abdominal pain and heartburn were not pre-existing conditions and not related to her? prior history of bloating..."? Lets start with that, and hopefully a reply from you will come faster than the days we have waited patiently for? basically a non replyHopefully Chelsi or Jennifer and the Seven Corners people decide to stop denying the? claims, and reimburse [redacted] for the bills she has already had to pay to stop them from going to collections, as? well as pay the current claims.Regards, [redacted] ? [redacted] Regards, [redacted] ***
Revdex.com: I have reviewed the? response made by the business in reference to complaint ID [redacted] , and find that this resolution would be satisfactory to me.? Regards, [redacted] And [redacted]
July 13, [redacted] Revdex.com NDelaware Street #Indianapolis, IN 46204- RE: Complaint ID: [redacted] Dear Theresa Davis: Seven Corners, Incis in receipt of the complainant’s rebuttal to our initial response regarding complaint [redacted] filed by [redacted] The complainant, [redacted] , advised new documentation was provided for further consideration of the claim submitted for Trip Cancellation for [redacted] Our office received the appeal from the insured on June 27, The appeal is currently under review The analyst is obtaining further information from the treating physician, to determine if benefits will apply under the policy Once that information is obtained from the physician, a letter will be sent to the insured with the final appeal decision We hope this answers your concerns regarding this matter Should you have any further concerns, please contact this office Sincerely, Seven Corners, Inc
July 13, ? ? ? [redacted] Revdex.com NDelaware Street #Indianapolis, IN? 46204-? RE: Complaint ID:? [redacted] ? Dear Theresa Davis:? Seven Corners, Incis in receipt of the complainant’s rebuttal to our initial response regarding complaint [redacted] filed by [redacted] .? The complainant, [redacted] , advised new documentation was provided for further consideration of the claim submitted for Trip Cancellation for [redacted] .? Our office received the appeal from the insured on June 27, 2016.? The appeal is currently under review.? The analyst is obtaining further information from the treating physician, to determine if benefits will apply under the policy.? Once that information is obtained from the physician, a letter will be sent to the insured with the final appeal decision.? ? We hope this answers your concerns regarding this matter.? Should you have any further concerns, please contact this office? Sincerely, ? Seven Corners, Inc?
[redacted] Revdex.com NDelaware Street #Indianapolis, IN? 46204- RE: Complaint ID:? [redacted] Dear [redacted] ***:? Seven Corners, Incis in receipt of the complainant’s rebuttal to our initial response regarding complaint [redacted] filed by [redacted] .? The complainant, [redacted] , has expressed concerns that she has not received a letter regarding payment for [redacted] ***’s claim.? Payment was processed to [redacted] on March 14, 2016.? The attached payment letter was also mailed.? Once processed, our system takes up to business days for the check to be printed and mailed.? Her claim check #***, in the amount of $1,865.00, was printed and mailed on March 25, 2016.? ? ? We hope this answers your concerns regarding this matter.? Should you have any further concerns, please contact this office Sincerely, Seven Corners, Inc
Revdex.com: I have reviewed the? response made by the business in reference to complaint ID [redacted] , and have determined that the response? would not resolve my complaint.? For your reference, details of the offer I reviewed appear below.I am still waiting to be reimbursed by seven corners for multiple bills and reciepts that I have submitted? Regarding Wesley S***? The bill he obtained for me was not legible and was rejected by ***? He said he would get me another, that was months ago? I have repeatedly asked what the status is and he ignores my emails? After waiting over months, I emailed him again? NO RESPONSE? Then, even more frustrated, I emailed him asking if he had been fired for being so bad at his job? He responded in less than minutes, sarcastically thanking me for my question and informing me that yes he still works there? He did not update me on the status of the itemized bill? This guy needs help? He is also the one that left me in a hospital for extra days in Costa Rica until I MYSELF, FROM A HOSPITAL BED, called him directly and inquired why he would not approve an ambulance plane home? I have worked with [redacted] to get some of the bills refunded, I am still waiting on others.? ? Regards, [redacted]
Revdex.com: I have reviewed the? response made by the business in reference to complaint ID [redacted] , and have determined that the response? would not resolve my complaint.? For your reference, details of the offer I reviewed appear below.I realize they say that I am not covered for service after the trip but how do they think I was supposed to get service in a foreign countryI attached? both pages of their insurance document provided to me prior to the tripOn page two,? close to the bottom,? section e)it says -? dental care:$for emergency dental treatment.? it does not say anything about where the service had to be doneI had the emergency on day four of my tourI toughed through the next five days of the tour.? How was I to get my tooth fixed in a foreign country? Where was I to find a dentist? Was I to just pop into a dental office and expect to get in immediately? What about my tour? Was I just to fend for myself in Europe? How would I have caught up with my tour and gotten home? Why have the insurance if it is not usable to fix the problem (my broken tooth) as soon as I could get to a dentist? Trip ended on 6/14/and I was getting my tooth crowned on 6/15/because my dental office said it was an emergencyI totally feel? left holding the bag? by this insurance company Regards, [redacted]
October 2, [redacted] Revdex.comNDelaware Street #2020Indianapolis, IN 46204-RE: Complaint ID – [redacted] Insured: [redacted] *** Dear Ms [redacted] : Seven Corners, Incacknowledges receiving furthercorrespondence on compliant ID [redacted] , regarding [redacted] *** This office has issued a claim benefit payment in theamount of $USD to Ms [redacted] on two prior occasions; however the insuredparty has not received either payment at her address of record in Taiwan Seven Corners had proposed that we send a wire transferpayment to Ms***, however she declined that course of action and stated shewould prefer a check as a form of settlementOn September 30, 2015, Seven Corners reissued claim settlementto Ms [redacted] as requested and shipped the claim payment via United StatesCertified Mail to her address of record: [redacted] Taiwan Please note the USPS Tracking Number: [redacted] for tracking purposesWe hope this will resolve [redacted] ***’s concernsregarding her recent claimIf you should have any further questions or needfurther clarification of the above, please do not hesitate to contact usSincerely, Seven Corners, Inc Tell us why here
December 2, [redacted] Revdex.comRevdex.com of Central Indiana NDelaware StreetSuite # 2020Indianapolis, IN? 46204-2599RE: Complaint Number:? [redacted] ? ? ? ? ? ? ? Complainant(s): [redacted] ***? ? ? ? ? ? Insureds:? [redacted] (The Estate of [redacted] c/o [redacted] , ***)? ? ? ? ? ? ? Certificate Number:? [redacted] Dear Ms.? [redacted] :Seven Corners, Incis in receipt of Complaint ID Number [redacted] , 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 [redacted] ***.? 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 [redacted] ***; 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; [redacted] purchased an insurance policy from American Modern Home Insurance Company; through Online Vacation Center Plan (FL) for his Celebrity Cruises vacationOur investigation determined that [redacted] became ill during the cruise and required medical attention.? Mr [redacted] was medically required to discontinue his travel due to this medical issue Seven Corners secured medical records indicating on ship medical care and off ship medical care from December 5, till December 14, ? The named insured, [redacted] claimed medical expenses of $11,on their submitted Proof of Loss Form.? Mr [redacted] 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 [redacted] 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 [redacted] c/o [redacted] P [redacted] , ***at [redacted] ***, 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, [redacted] ***; concerns regarding the claim presented by The Estate of [redacted] c/o [redacted] P [redacted] , ***.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 [redacted] , and have determined that the response would not resolve my complaint For your reference, details of the offer I reviewed appear below.It is my understanding that, should you client seek treatment at your hospital, we would be better of collecting money up front as a self-pay patient and let your client handle insurance Regards, [redacted]
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that the response would not resolve my complaint For your reference, details of the offer I reviewed appear below Dr [redacted] is part of Seven Corners' networkI do not think I am responsible for mediating the payment process between Seven Corners and the doctors office as I made sure I go to a doctor who is part of the insurance network prior to going to the doctors' officeThe failure to communicate with the doctor should not make me a victim for harassing letters from [redacted] lab and their collection office and ruining my credit scoreI hope Seven Corners finds a better way for reaching the doctors' office Regards, [redacted]
November 29, [redacted] Revdex.com NDelaware Street #Indianapolis, IN? 46204- RE:? Complaint ID:? [redacted] ? ? ? ? ? ? Dear Ms***:? ? Seven Corners, Incis in receipt of the complainant’s rebuttal to our initial response regarding complaint [redacted] filed by [redacted] ***.? The complainant, [redacted] ***, has expressed concerns that he was provided with incorrect information regarding his policy benefits In 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 [redacted] states he was provided with benefit information from Mabel H [redacted] 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.? [redacted] 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 [redacted] 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 [redacted] 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 office Sincerely, Seven Corners, Inc ? ?
February 12, [redacted] Revdex.com N Delaware Street #Indianapolis, IN 46204- RE: Complaint ID – [redacted] Complainant: [redacted] Dear Ms***: Seven Corners, Inc is in receipt of Complaint ID Number [redacted] and sent to the attention of Dennis W [redacted] on January 6, The complainant, [redacted] , has expressed concerns with the handling of his father’s recent travel medical insurance claim This office has reviewed the file and the claims in question and find that the denial of the claims under the policy exclusion for pre-existing conditions was correct based on the medical information we received We also find that we did receive several inquiries from Mr [redacted] requesting more specific medical information on the determination that was made It appears that our responses to these inquiries did not provide the detailed information that was requested in order for Mr [redacted] to understand our determination By separate letter directly to Mr [redacted] , we will respond with the medical details he has requested Thank you for your time and attention to this matter and should you have questions involving this claim matter, please contact this office Sincerely, Seven Corners, Inc
Seven Corners, Incis in receipt of Complaint ID Number: [redacted] and sent to the attention of Dennis W [redacted] on August 13, Thecomplaint was filed by [redacted] and we appreciate the opportunity toaddress her concerns[redacted] purchased a Peter's Way travel insuranceplan for travel dates: 4/12/to 4/21/On the date of departure, April12th, [redacted] states she was removed from the flight toIsrael by the British Airways Cabin Service DirectorThe insured noted incorrespondence, that the airline staff “did not like the way I was breathing”.Emergency Medical Technicians attempted to assist Ms [redacted] , however she wasnot comfortable with the medical attention and she elected to return to her home.Ms [redacted] then departed Logan Airport by cab and incurred car fare chargesto return to her residence [redacted] presented a claim to Seven Corners forreviewThis office evaluated the claim documentation presented by Ms [redacted] and determined the loss was not eligible for payment and the reason(s) are asfollows: Ms [redacted] was not medically restricted from participatingin her covered trip by a Legally Qualified Physician, a coverage requirement.Per documentation dated: 4/13/from Cheshire Medical Center EmergencyDepartment physician, Dr [redacted] ***; states “ [redacted] is medicallyclear to fly on an airplaneShe gets short of breath when she exerts herself.This is for her and should not be a problem while flying”[redacted] ’s travel insurance included an optionalcoverage provision, “Cancel for Any Reason.” This office evaluated theapplication of the optional coverage benefit and again, Seven Corners found theloss did not qualify for coverage as Ms [redacted] did not cancel her trip twodays or more before her scheduledtrip departure date? On June 29, 2015, aclaim denial letter was mailed to [redacted] ’s address of record.Policy language which is pertinent to this matter:COVERAGE D - TRIPCANCELLATION This Coverage D ismade a part of the policyIt is subject to all the provisions of this CoverageDBenefits will be paid up to the Maximum Benefit Amount purchased to cover Youfor the Published Penalties and unused non-refundable prepaid expenses forTravel Arrangements when You are prevented from taking Your Covered Trip dueto:A covered Sicknessor Injury involving You, Your Traveling Companion or Business Partner, or Your FamilyMember or You or Your Traveling Companions Family member which necessitates MedicalTreatment at the time of cancellation and results in medically imposedrestrictions, as certified by a Legally Qualified Physician, which prevents an Insured’sparticipation in the Covered Trip;OPTIONAL PURCHASE ?"CANCEL FOR ANY REASONIf You cancel Your Trip for any reason not otherwise covered by this policy, Wewill reimburse You for 75% of the prepaid, forfeited, non-refundable paymentsor deposits paid for Your Trip provided:Your premiumpayment is received within days of the initial deposit/payment for YourTrip; andYou insure 100% ofall prepaid Trip costs that are subject to cancellation penalties orrestrictions by the Travel Supplier; andYou cancel YourTrip two (2) days or more before Your Scheduled Trip Departure Date.We hope this answers any outstanding questions in relationto [redacted] ’s claimIf you should have any further questions or needfurther clarification of the above, please do not hesitate to contact us
March 16, Revdex.com of Central Indiana N Delaware Street #Indianapolis, IN? 46204- RE: ? ? ? ? Complaint ID:? ? ? ? [redacted] ? ? ? ? ? ? ? ? ? ? Complainant: ? ? ? ? [redacted] To Whom It May Concern: Seven Corners, Inc(“Seven Corners”) is in receipt of the rebuttal to Complaint [redacted] which was filed by [redacted] 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 benefits As 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 [redacted] 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 [redacted] has any additional receipts relating to her Trip Delay, we encourage her to submit them for further review Please 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 reserved We appreciate the opportunity to address Ms***’s concerns.? Please contact this office should you have any further questions regarding this matter Sincerely, Seven Corners, Inc
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this proposed action 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.]The response is the same reason they churned out to us for rejection beforeThey have even stated in their response that the claim was rejected on the basis that the iPads supposedly fell into the category of PCs and Computer Hardware and SoftwareThis is completely as pointed out in our original complaintA tablet is not a PC (A Desktop or Laptop PC) and is not considered Computer Hardware (A printer, scanner, mouse, keyboard etc) or Software (It's not a CD/DVD containing a program to install)In order for the policy to avoid reimbursing for a media tablet such as an iPad they would have to define it in the policyThey can not make up their own definitions to meet their own financial gainsIt is like them having an exception for specifically a motorcar and then saying they will not cover a bicycleTheir reasoning is preposterous and insulting, much like their communication or lack there of Revdex.com Please see the attached evidence previously issued to the company for your examination as part of this rebuttal Regards, [redacted]
April 25, Revdex.com NDelaware Street #Indianapolis, IN 46204-RE: Complaint ID – [redacted] Dear Ms [redacted] : Seven Corners, Incis in receipt of Revdex.com Complaint ID Number: [redacted] from [redacted] We have reviewed the complaint and appreciate the opportunity to address your concernsIn order to clarify the role of the parties involved, One Travel is a travel provider of flight and other vacation accommodations, and Seven Corners, Inc(“Seven Corners”) is the third party administrator contracted to provide claim adjudication services for travel insurance policies issued by Nationwide Mutual Insurance CompanySeven Corners evaluated the documentation submitted by Mr [redacted] regarding a trip cancellation claimMr [redacted] noted he cancelled his scheduled travel due to illness (autism and paranoid schizophrenia)Claim documentation presented to this office did not indicate that [redacted] was hospitalized for his illnessThe purchased policy requires that for mental or emotional disorders, the client must be hospitalized to be eligible for coverage benefitsBased upon the above plan language, his claim is not eligible for reimbursement and a denial letter was mailed to his address of record on December 30, On February 16, 2016, this office received a claim appeal from the insured party disputing the initial decision and providing a different reason for cancellationMr [redacted] indicated within his claim appeal, that his travel cancellation resulted from the death of his grandmother who passed away on December 1, The purchased policy provided plan coverage from February 15, to March 9, In order for trip cancellation coverage to be applicable the presented loss must take place after the effective date of his policyHis family member’s death occurred after his policy coverage expired and therefore is ineligible for reimbursementFurther documentation was mailed to the insured’s address of record confirming that his losses were not covered under the purchased travel insurance policyShould Mr [redacted] provide documentation from his treating doctor that he was hospitalized for his illness during the policy effective dates, we will gladly give his claim further considerationBased upon the above information, [redacted] ‘s trip cancellation claim is ineligible for payment due to a policy exclusionThe policy language pertinent to this matter is as follows: BENEFITS TRIP CANCELLATION The Company will reimburse You, up to the Maximum Benefit shown on the Confirmation of Coverage, if You are prevented from taking Your Trip for any of the following reasons that are Unforeseen and takes place after the Effective Date: Sickness, Accidental Injury or death of a non-traveling Family Member; LIMITATIONS AND EXCLUSIONS The following exclusions apply to Trip Cancellation & Trip Interruption, Trip Delay, Missed Connection, And Accidental Death & Dismemberment: Mental or emotional disorders, unless hospitalized; We hope this answers Mr [redacted] ‘s concerns regarding his recent travel claimShould you have any further questions involving this claim matter, please contact me at the address listed belowSincerely, Seven Corners, Inc
Revdex.com: I have reviewed the? response made by the business in reference to complaint ID [redacted] , and have determined that the response? would not resolve my complaint.? For your reference, details of the offer I reviewed appear below I will not accept this offer because it is not an offerI got an health insurance covered up to and all I got back is a bill $tothat nobody wants to payI am totally broke because I wanted to be saveIf I had known that I'm only covered up to and need to pay that company on top, why would I have needed an insurance? I paid them more in the coverage time then they paid for the billThat shouldn't be right! ? I would need to go times to the hospital room in one month to even get to - totally fraud in my eyesI paid a monthly payment for that $coverage and now they have to pay for itEven the Airforce lawyer couldn't belive thatAnd I didn't go to the hospital because I like it there, I went there because I did have a serious problem.? This is a fraud and shouldn't be allowedNobody else should get into thisIf necessary, I will open more cases across the country and also write recommendations across the country about that coverageThis won't help me but it will help others since it is an immigration insurance.? Regards, [redacted]
March 18, 2016Revdex.com of Central Indiana N Delaware Street #Indianapolis, IN 46204-2599RE: Inquiry ID: [redacted] Complainant: [redacted] To Whom It May Concern:Seven Corners, Inc(“Seven Corners”) is in receipt of Inquiry [redacted] which was filed by [redacted] on March 10, Ms [redacted] purchased the Nationwide Travel Protection Plan under Certificate Number [redacted] , for her July 14, – August 2, trip We have reviewed the inquiry and the claim file and have confirmed that all eligible expenses have been reimbursed according to the trip delay benefit listed in the policyPayment was issued to Ms [redacted] on November 19, and we will explain below how this benefit was calculatedIn 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 Ms [redacted] 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 Ms [redacted] purchased her flightsMs [redacted] submitted a claim for her travel, which was received by Seven Corners on October 29, On the claim form submitted, Ms [redacted] did not clearly indicate the amount she was seeking for reimbursement and did not submit any receipts to support her claimOn November 5, 2015, a request was sent to Ms [redacted] requesting the following information:Original receipts for expenses incurred due to the delay;Confirmation of the amount being sought for reimbursement, and;Other insurance information, if applicableAccording to the documentation provided by Ms [redacted] , Ms [redacted] incurred approximately $in out of pocket expensesUnder the Nationwide Travel Protection Plan, the trip delay benefit reimburses for meal, lodging, local transportation, and essential phone call expenses incurred due to the delay If these items are provided by the airlines free of charge, they are not subject to reimbursement under the Travel Protection Plan As a result, payment of $was issued to Ms [redacted] , since American Airlines did not cover this expense In her inquiry, Ms [redacted] mentioned that she should be reimbursed more than $and on the claim form she submitted, she indicated reimbursement of $1,was appropriate because of several appointments she missed as a result of the trip delay While it was unfortunate that Ms [redacted] was inconvenienced due to the trip delay, the Nationwide Travel Protection Plan does not provide compensation for loss of time As of this date, Ms [redacted] mentioned that she has not received our $check and this could be attributed to her address outside of the United StatesIn order to get the funds to her as quickly as possible, we encourage Ms [redacted] to complete the attached Payment Authorization Form so payment can be wired to her bank Ms [redacted] should send the completed form to the following email for prompt handling: [email protected] language that is pertinent to this matter is as follows: TRIP DELAY Covered expenses: (a) Any Additional Expenses incurredAdditional Expenses means any reasonable expenses for meals and lodging as well as local transportation and essential phone calls that were necessarily incurred as the result of a Hazard and that were not provided by the Common Carrier or other party free of charge.We appreciate the opportunity to address Ms [redacted] ’ concerns Please contact this office should you have any further questions regarding this matter.Sincerely,Seven Corners, Inc
Seven Corners,Incis in receipt of Complaint ID Number: [redacted] and sent to the attentionof Dennis W [redacted] on August 25, The complaint was filed by [redacted] *[redacted] and we appreciate the opportunity to address his concerns[redacted] 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 [redacted] ’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.? [redacted] requested a wire payment besent to his banking institution in the PhilippinesMr [redacted] provided SevenCorners with his banking information and this office accommodated theconsumers’ request for a wire transfer payment? Cambridge MercantilePayment Reference: [redacted] Currency and Amount: $USDBeneficiary: [redacted] ? 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[redacted] ’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 [redacted] ’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 [redacted] , and have determined that the response? would not resolve my complaint.? For your reference, details of the offer I reviewed appear below [redacted] ***/Revdex.com team, ? ? Thank you for getting a reply from Jennifer/ Seven CornersJennifer/Seven Corners,We can confirm that we got Jennifer's letter in reply to the Complaint that we had to file with the CA? CommissionerAnd thank you for finally replying to our Revdex.com reply from Feb Seems like a very very long? time to wait for a reply from you guys.? Unfortunately? you still have not answered the questions.In our Revdex.com Message from Feb 2017, we asked you very specific questionsWe were hoping that you would? have answered them in this new message from you that we got on March You state below that your letter? replying to our CA? Commissioner? Complaint addresses the questionsThat is not trueYour letter did not address? or answer the questions.We got your March letter replying to the CA? Commissioner? investigation.Thanks for apologizing for not? replying to the many many questions that we asked Kathy H [redacted] over the past monthsI guess you are also? apologizing for you and Chelsi T [redacted] not answering our questions to you directly to you, via the Revdex.com Complaint,? and via the CA Insurance CommissionerThe irony is that even though you are apologizing for not answering the? questions, it seems like you are still not answering the questions.Lets just focus on just one or two questions:First Question:The biggest question you still have not answered is, what is the "pre-existing condition"? Can you reply to this?? What is this "pre-existing condition" that apparently [redacted] has? And also what medical certainty do you have? that she had this "pre-existing condition" during the look-back period? This look-back period seems pretty? important, as it basically means that if someone once upon a time had some "pre-existing condition" but was? stable (meaning: had no new medical condition and no prescription medication changes) during the look-back? period, then a denial based on a "pre-existing condition" can't be usedIn this new reply letter from March 2017,? you say "[redacted] 's illnesses were pre-existing" Can you please tell us what these "illnesses" are? Since you are? telling us that with "medical certainty" they are "pre-existing," you should be able to tell us what they areAlso? please can you provide the evidence you are using to determine that the "illnesses" are "pre-existing"That would? be quite helpfulFor instance, what information, facts, or evidence are you using to determine that [redacted] 's? ovarian cyst was "pre-existing." ?? Second Question:Also can you confirm that you got the Clarification Letters that we sent you directly in December Did you? read them? We also attached them to the Revdex.com reply on Feb 2017.If you read Tina B***'s original office visit report and her Clarification Letter you asked for, Tina B [redacted] clearly? states that:"Her non-chronic more recent change in abdominal pain and menses required further evaluation to address her? complaint." and "The more acute problem including diagnosis or irregular menstrual cycle (N92.6,) female pelvic? pain (N94.9) required further evaluation and was not chronic in nature."? If you read Rahul C [redacted] 's Clarification letter he clearly states:"...acute onset abdominal pain and heartburnThis was the first time she had experienced such pain and? heartburn and so came to see me for consultation." he continues "While her bloating was a pre-existing? condition, her abdominal pain and heartburn were new medical problems that led to her seek Gl consultationIn? my professional opinion, her abdominal pain and heartburn were not pre-existing conditions and not related to her? prior history of bloating..."? Lets start with that, and hopefully a reply from you will come faster than the days we have waited patiently for? basically a non replyHopefully Chelsi or Jennifer and the Seven Corners people decide to stop denying the? claims, and reimburse [redacted] for the bills she has already had to pay to stop them from going to collections, as? well as pay the current claims.Regards, [redacted] ? [redacted] Regards, [redacted] ***
Revdex.com: I have reviewed the? response made by the business in reference to complaint ID [redacted] , and find that this resolution would be satisfactory to me.? Regards, [redacted] And [redacted]
July 13, [redacted] Revdex.com NDelaware Street #Indianapolis, IN 46204- RE: Complaint ID: [redacted] Dear Theresa Davis: Seven Corners, Incis in receipt of the complainant’s rebuttal to our initial response regarding complaint [redacted] filed by [redacted] The complainant, [redacted] , advised new documentation was provided for further consideration of the claim submitted for Trip Cancellation for [redacted] Our office received the appeal from the insured on June 27, The appeal is currently under review The analyst is obtaining further information from the treating physician, to determine if benefits will apply under the policy Once that information is obtained from the physician, a letter will be sent to the insured with the final appeal decision We hope this answers your concerns regarding this matter Should you have any further concerns, please contact this office Sincerely, Seven Corners, Inc