June 24, [redacted] Revdex.com N Delaware Street #Indianapolis IN 46204- RE: Complaint ID [redacted] Customer: [redacted] l Certificate # [redacted] Dear MsDavis: Seven Corners, Incis in receipt of the rebuttal to Complaint ID Number [redacted] and sent to the attention of Sureleen S [redacted] on June 21, We have again reviewed the file, which included a medical review of the complete medical records received from [redacted] *** As stated in our earlier response, the initial treatment was on July 23, and showed no acute injury or onset resulting in the visit Additional visits on August 13, September and October 20, were all shown as being follcare, with no indication on any of the visits that there was any onset of new, acute symptoms involving the condition Based on the medical records and the provisions and definitions contained in the policy, we can find no basis for allowing these claims under the Acute Onset of Pre-Existing Conditions benefit Therefore, we must uphold our denial of these claims in accordance with the provisions of the policy Thank you for your time and attention to this matter and should you have questions involving this claim matter, please contact this officeSincerely, Seven Corners, Inc
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 have already explained several times to several different employees of Seven Corners, when I initially purchased the travel insurance I was told that my TRIP would be covered only to find out when I filed the claim that the woman did not inform me that I had to make separate purchases to cover my tripNot only that but the amount of my trips equaled $302.90, which I was issued a check for $I am still owed $for the other portion of my tripThis company has scammed my husband and I out of over $and I have been fighting for it sinceI purchased the insurance on the 10th with the knowledge from the employee I purchased it through that my trip was coveredI then had to spend another $for more coverage which is why the day of he appointment is the day before coverageWe are being scammed out of our money by this companyI am fighting for my money back from this company.? 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 just sent a letter from the doctor's office about ongoing outpatient treatment for my sonThat should meet the insurance requirement for partial hospitalizationI hope they accept it Regards, [redacted]
June 3, Revdex.com NDelaware Street #Indianapolis, IN 46204-RE: Complaint ID – [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 concernsSeven Corners evaluated the documentation submitted by [redacted] regarding an emergency accident/sickness medical expense claimOur records show that Mr [redacted] sustained injury to his ankle on July 11, and sought out medical care at [redacted] (located in [redacted] ***, Costa Rica) on July 12, Due to injuries sustained by Mr [redacted] , Seven Corners arranged to have the insured party medically evacuated home to the United States, so he could be cared for by his familyThis office has received claim documentation from the treating medical facility, as well as from [redacted] for out of pocket costs he has incurred due to his injurySeven Corners has issued payment as follows: CLAIM NUMBER LOSS ITEM PAYMENT AMOUNT [redacted] Air Ambulance $28, [redacted] Guarantee of Payment to [redacted] Hospital $6, [redacted] Cost of EVAC Air Ticket for Escort $On July 15, 2016, this office received medical documentation from [redacted] Hospital regarding the Guarantee of Payment with the hospitalOn July 24, 2015, Seven Corners received a claim form and receipts from Mr [redacted] regarding his out-of-pocket medical costsOn August 13, 2015, Seven Corners sent via US Postal Service correspondence to [redacted] requesting additional informationThis office asked the insured to provide an Explanation of Benefits (EOB) form from his primary healthcare insurance carrier: [redacted] insuranceThis information is needed to evaluate his presented medical expense claim for his out of pocket medical expensesOn August 31, 2015, Mr [redacted] called Seven Corners and spoke to Amber J [redacted] and asked why this office needed information from [redacted] insurance, MsJ [redacted] explained that they are his primary insurance carrier and that Seven Corners provides secondary coverage, Mr [redacted] stated he understood this and would contact [redacted] regarding his overseas coverageOn August 31, 2015, Mr [redacted] contacted Wesley S [redacted] via email stating that [redacted] insurance would cover some of his Urgent and Emergency Care expenses, however [redacted] would need a copy of the itemized billThe insured asked Wesley S [redacted] if he could assist with obtaining a copy of his itemized medical bill from the treating hospital in Costa RicaMrS [redacted] indicated as a courtesy, he would assist Mr [redacted] in obtaining the document, even though the purchased travel plan provides excess coverage to [redacted] insuranceOn September 10, 2015, Seven Corners sent via US Postal Service a second written request of the insured party for an [redacted] insurance EOB and upon receipt of this document this office would conclude handling of his lossOn September 17, 2015, MrS [redacted] informed [redacted] via email (john [redacted] [email protected]) that he has obtained the medical records from [redacted] HospitalOn September 25, 2015, Wesley S [redacted] emailed Mr [redacted] the medical report and invoice to submit to [redacted] insuranceOn October 1, 2015, Wesley S [redacted] sent a follow up email to Mr [redacted] , asking for the insured to confirm receipt of the correspondence that contained the requested medical recordsMrS [redacted] did not receive a response to his inquiry to [redacted] Seven Corners communicated within our September 10, letter to Mr [redacted] that upon receipt of an Explanation of Benefits from [redacted] insurance his claim would be reopened for further processingAs of today’s date, this office has not received the requested document from [redacted] We hope this answers [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
Dear Ms***: Seven Corners, Incis in receipt of Complaint ID Number [redacted] and sent to the attention of Dennis Wood on May 18, 2016.? The complainant, [redacted] , has expressed concerns with the handling of recent travel medical insurance claims for insured [redacted] under the certificate # referenced aboveThis office has reviewed the file and the claims in question.? 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 policy a) 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 [redacted] 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 monthsA review of the medical records by medical staff determined that based on the medical records reviewed this member’s condition could be be stated with reasonable medical certainty to have existed or is related to a condition that existed at the time of application or prior to the effective date of the policy.? 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.? ?
April 15, [redacted] Revdex.com N Delaware Street #Indianapolis IN? 46204- RE:? ? ? Complaint ID ?" [redacted] ? ? ? ? ? ? ? ? ? Complainant:? [redacted] ? ? ? ? ? ? ? ? Our Certificate Number [redacted] Dear Ms***, Seven Corners, Incis in receipt of Complaint ID Number:? [redacted] and sent to the attention of Dennis [redacted] on April 11, 2016.? The complainant, [redacted] , has expressed concerns with the handling of his recent travel medical insurance claim.? This office has reviewed the file and the claims in question.? Based on a thorough review of the file, it has been determined that the denial of the claims under the policy was incorrect as all information needed to process the claims was in our office.? ? ? The denial at this time is being overturned and the claims processed for payment in accordance with the policy benefits? ? We are also including interest payments totaling $in accordance with Massachusetts prompt payment laws.? We also find that inquiries and appeals by Mr [redacted] were not responded to in accordance with our established customer service procedures.? We apologize for this and have addressed this issue with the appropriate personnel.? 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
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 Regarding the [redacted] trip and the response from Seven Corners On the original claim form [redacted] 's physician selected the option provided for other in regards to the condition of cystic acne We completely understood it not being an illness and that is the reason the option provided "other" was selected Also the Dramended the date she first saw [redacted] for the condition in a letterhead from her office which was faxed to Seven Corners My daughter was looking forward to attending this trip but just was physically unable to do so due to this debilitating condition which left her with huge lumps on her face I ask you to remember being among High School peers during such an extreme condition and being on such harsh medication which requires monitoring from said physician It has not been easy and having to have cancelled such a great opportunity with [redacted] was beyond troubling for [redacted] I have an original copy from Dr [redacted] 's letter head submitted to Seven corners (to amend the date on the claim form) Regards, [redacted]
February 23, Revdex.com of Central Indiana N Delaware Street #Indianapolis, IN? 46204- RE: Complaint ID:? ? ? [redacted] ? ? ? ? ? ? Complainant:? ? ? J David [redacted] To Whom It May Concern: Seven Corners, Inc (“Seven Corners”) is in receipt of Complaint [redacted] which was filed by [redacted] on February 11, 2016.? ? ? ? We have reviewed the complaint and appreciate the opportunity to address Mr [redacted] ’s concerns In order to clarify the roles of the parties involved, Nationwide Mutual Insurance Company (“NMIC”) is the insuring company of the travel insurance policy purchased by Mr [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.? One Travel is the Travel Provider from whom Mr [redacted] purchased his flights Mr [redacted] ’s travel insurance policy has a Pre-Existing Conditions clause that requires a sixty day look back period from the effective date of the travel insurance policy Date trip was booked? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? November 10, Date travel insurance was purchased? ? ? ? ? ? ? January 20, Effective date of travel insurance ? ? ? ? ? ? ? ? ? ? ? ? ? January 21, Date trip was cancelled? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? March 17, While attempting to process Mr [redacted] ’s claim, it was necessary to request additional medical information from Mr [redacted] ’s physicians in light of the Pre-Existing Conditions clause.? We requested information from the physicians that treated Mr [redacted] during this sixty-day look back period, which would be his primary care physician and cardiologist.? To date, we have only received information from Mr [redacted] ’s primary care physician In order to appropriately evaluate Mr [redacted] ’s claim, it is necessary that our office receive the outstanding medical records from his cardiologist, Dr [redacted] , for dates of service November 21, ?" January 20, 2015.? Our office contacted Dr [redacted] ’s office on February 17, and spoke with a representative from Dr [redacted] ’s office who confirmed receipt of our medical record requests.? However, we were informed by that representative that our requests were not accepted as our medical authorization for release was not HIPAA compliant.? Unfortunately, our office was not notified of this fact prior to this telephone conversation.? As a result, we have sent Mr [redacted] a new medical authorization release form and will forward to Dr [redacted] ’s office upon receipt Policy language which is pertinent to Mr [redacted] ’s claim is as follows: LIMITATIONS AND EXCLUSIONS The following exclusions apply to Trip Cancellation & Trip Interruption, Trip Delay, Missed Connection, and Accidental Death & Dismemberment: Loss caused by or resulting from: Pre-Existing Conditions, as defined in the Definitions section unless the insurance is purchased within fourteen (14) days of the initial Covered Trip deposit Pre-Existing Condition: means any injury, sickness or condition of You, or Your Traveling Companion for which within the sixty (60) day period prior to the Effective Date of Trip Cancellation coverage under the Policy (a) first manifested itself or exhibited symptoms which would have caused one to seek diagnosis, care or treatment; (b) required taking prescribed drugs or medicine, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the required prescription; or (c) required medical treatment or treatment was recommended by a PhysicianThe Pre-Existing Conditions exclusion is waived for You if You enroll in the Plan at the time You pay the deposit required for the Covered Trip (or within fourteen (14) days of the initial deposit) and You purchase the coverage under the Plan for the full cost of the Covered Trip Mr [redacted] has also requested reimbursement of the insurance premium paid for the travel insurance policy.? ? The policy purchased has a 10-day review period and insurance premiums are non-refundable once fully earned Important Note: All protection plan costs and fees are non-refundable after a day review period We appreciate the opportunity to address Mr [redacted] ’s concerns and upon receipt of the medical records from Dr [redacted] , we will be able to finalize claim processing Sincerely, Seven Corners, Inc
September 18, 2015 [redacted] Revdex.comNDelaware Street #2020Indianapolis, IN 46204-2599 RE: Complaint ID Number: [redacted] Certificate Number: [redacted] Dear Ms [redacted] : Seven Corners, Incis in receipt of Complaint ID: [redacted] and sent to the attention of Dennis W [redacted] on September 14, 2015regarding [redacted] We appreciate the opportunity to address herconcerns.Upon further review of the claim documents submitted on behalf of Ms [redacted] ,Seven Corners has determined the trip cancellation claim is eligiblefor payment and issued settlement in the amount of $ The settlement check was mailed to Ms [redacted] ’s addressof record: [redacted] R [redacted] *** Seven Corners apologizes for any miscommunication whichoccurred during the handling of her travel claim. We hope this answers [redacted] ’s concerns regarding herrecent travel claimShould you have any further questions involving this claimmatter, please contact me at the address listed below.Sincerely, Seven Corners, Inc. Enclosure
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 meFinally, I received my claim Thank you Revdex.com for helping me in this matter Regards, [redacted]
May 25, [redacted] ***Revdex.comN Delaware Street #2020Indianapolis IN 46204-RE: Complaint ID – [redacted] Complainant: *** [redacted] Our Certificate Number [redacted] Dear Ms***, Seven Corners, Incis in receipt of Complaint ID Number: [redacted] and sent to the attention of [redacted] on May 4, The complainant, [redacted] , has expressed concerns with the handling of his recent travel medical insurance claim This office has reviewed the file and the claims in question At issue was a review of his complex travel history as it applied to the eligibility provisions of the policy as well as review of his medical history as it pertained to the Pre-Existing Conditions exclusion of the policy It has been determined after thorough review by management that coverage for claims in the U.Sremained in effect for the dates of his treatment However, a medical review of the medical records received indicate that the condition in question is pre-existing based on the following definition in the policy: The term “Pre-Existing Condition” as used in this Policy 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 [redacted] 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 months Mr [redacted] ’s effective date under the purchased Liaison Majestic policy was March 16, According to the medical records reviewed for his medical visit on December 11, 2015, it was stated that the insured had experienced the problem for year prior to that visit Based on this information and the definition in the policy, the condition is pre-existing and therefore is not covered under the policy A letter detailing this denial is being mailed to Mr [redacted] today 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
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.The condition was acute exacerbation of chronic condition and would meet the criteria for treatment and coverageThis was indicated by my provider that I spoken to Regards, [redacted]
December 17, [redacted] Revdex.com of Central Indiana NDelaware StreetSuite # 2020Indianapolis, IN? 46204-2599RE:? Complaint Number:? [redacted] Complainant: [redacted] Our Insured’s Name:? ? [redacted] Certificate Number: [redacted] Policy: Liaison ContinentUnderwriter:? Certain Underwriters at Lloyd's, LondonDear Ms [redacted] :We are in receipt of your correspondence regarding the above referenced complaint.? The complaint was received by Seven Corners on December 17, 2015.? Seven Corners, Inc.; is 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 October 9, to December 9, The insured submitted a Proof of Loss Form stating she suffered from a skin rash with itching since arriving in the United States on August 27, ? Based upon the Policy’s Coverage Benefits, the coverage was not in effect until October 9, 2015.? Therefore, no coverage is afforded for the claim submitted because the condition existed prior to the effective date of the policyThe policy language that is pertinent to this matter:DESCRIPTION OF BENEFITSMedical Expenses: Only such expenses, incurred as the result of and within one hundred and eighty days (180) days from a Disablement, which are specifically enumerated in the following list of charges, and which are not excluded in EXCLUSIONS AND LIMITATIONS, shall be considered as Covered Expenses:EXCLUSIONS AND LIMITATIONSFor Medical benefits, this Insurance does not cover: 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 policy.a) 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 program.b) 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 program..PLAN DEFINITIONSPre-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 [redacted] months prior to the effective date of coverage under this policy, whether or not previously manifested, symptomatic, known, diagnosed, treated or disclosed This 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 months.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 [redacted] **’s claim.If you should have any further questions or need further clarification of the above, please do not hesitate to contact us.Sincerely,Claims DepartmentSeven Corners, Inc
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , 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, [redacted] There was no mention of what happens to the Policy until the ExpiryIs it still in force since the cancellation is rejected? [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 ? Please review the section I attached(Section IV trip cancellation/interruption (a))Also, there was no response to my complaint that I personally spoke to a representative from the company to assure me of my coverage prior to going on this trip (5/4) and well within the cancellation periodPlease have the company review the phone records of there employee to validate my claimI had, nor have I ever had a reason to purchase a claim such as this other that a potential medical emergency in which I was assured of the coverage forAgain, please address the employees assurances on 5/from a Mabel Harrera, as well as the email from a company representative that I have snipped inFurthermore, on 8/25/I received an email from Janet G***(Claims Manager) indicating "I apologize for the delay in a responseI do have the outcome of your claim and I don't agree with itI will be speaking with the account manager to see if there is anything to dispute this." This is an example of two individuals who assured me of my coverageI will be happy to send this email to anyone that would like to review it.? Regards, [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 belowNo where on the website does it state that coverage takes place hours after the premium is paid, and considering this was a last minute trip they should have never insured me, knowing that I wouldn't have coverageAnd what family member treated my child?? They are wrong again The attending doctor just happened to have the same name? How common is that in the Hispanic world, EXTREMELY!!! They should have never insured me if coverage didn't start till hours later, if they can't insure me, I want my $backThey are liers and scammers, absolutely no where does it say any of that on the website when you are buying ticketsRegards, [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.Dear Sir or Madam, My name is [redacted] (***) ***I submitted a complain (ID [redacted] ) against Seven Corners, Inc(insurance company) to Revdex.com (of Central Indiana) on July 20, Through your assistance, Seven Corners, Increplied that they would re-mail me the check (225.91USD) again so my complaint was closed on July 24thHowever, I have not yet received any mail with the check from Seven Corners so far after one monthTherefore, I file the complaint againMy address is: Miss [redacted] I think the country name on Revdex.com’s website is incorrect/confusing (Taiwan, province of China)Nowadays, people just write “TAIWAN” because it is much clear and Taiwan does not belong to (Mainland) ChinaI have received many mails from other countries successfully without any problem via only using “TAIWAN.” Sometimes mails, through the name the same as Revdex.com’s website, will be sent to Mainland China and disappearTherefore, may I ask Seven Corners to mail the check to me again via only “TAIWAN” for the country name? Thank you very much for your precious assistanceBest regards, [redacted] (***) ***Please re-mail me the check through the right COUNTRY NAME (TAIWAN) Regards, [redacted] ***
Seven Corners,Incis in receipt of complaint ID # [redacted] and sent to the attention ofDennis W [redacted] on June 29, The complainant: [redacted] objects tothe claim handling of his trip cancellation claim.On March 8, 2015, [redacted] completed an online purchase for airfare and travel insurancefor a scheduled flight from Bordeaux, France to Miami, FloridaThe traveldates were: April 16, – May 5, 2015.Due to the deathof Mr [redacted] family member (sister-in-law), he cancelled his travel andpresented a trip cancellation claimSeven Corners adjudicated the loss anddetermined that Mr [redacted] claim was not eligible for payment, the reason isas follows:Per the purchasedtravel policy, there is no coverage provided under the trip cancellation benefitas Mr [redacted] deceased relative lived/resided in France (Europe) andtherefore does not meet the policy definition of family memberThe purchasedpolicy defines a family member as a person who resides in the United States, Canadaor MexicoThis office alsogave consideration to possibly provide coverage benefits for this loss underthe death of the host at destination provision, however our evaluation foundthat not applicable as Mr [redacted] was not sharing pre-arranged accommodationsat the usual principal place of residence of his sister in law/family member Based upon thepresented claim documentation, this office mailed a claim denial letter to [redacted] on June 16, Upon our receiptof the concerns presented to the Revdex.com of Central Indiana, Seven Corners re-evaluatedthe presented documentation [redacted] indicated within his complaintthat his trip cancellation claim was denied since he did not live in the UnitedStatesThis is not thecase, the travel insurance policy he purchased does not provide coverage forhis presented loss: travel cancellation due to the death of a family member whoresides outside of the United States, Mexico, or Canada.Due to the aboveinformation, this office must uphold our original decision that the claim isnot eligible for payment.Policy languagewhich is pertinent to this matter:BENEFITS TRIP CANCELLATION & TRIPINTERRUPTION The Company will pay a benefit, up to themaximum shown on the Confirmation of Coverage, if You are prevented from takingor unable to continue Your Covered Trip due to: (a)Sickness, Accidental Injury or death of You, Traveling Companion, or FamilyMember; which results in medically imposed restrictions as certified by aPhysician at the time of Loss preventing Your continued participation in theCovered TripA Physician must advise cancellation of the Covered Trip on orbefore the Scheduled Departure Date (d) The death or hospitalization ofYour Host at Destination.TRIP CANCELLATION The Company willreimburse You for the following: Non-refundable cancellation charges imposed bythe Travel Suppliers.In no event shall the amount reimbursedexceed the amount You prepaid for the Covered Trip up to the maximum benefitshown on the Confirmation of Coverage.SPECIAL CONDITIONS: You must advise theTravel Supplier and the Company as soon as possible in the event of a claim.The Company will not pay benefits for any additional charges incurred thatwould not have been charged had You notified the Travel Supplier as soon asreasonably possibleYou or Your: refers to all persons listed on theConfirmation of Coverage under the program purchased by the Insured.Family Member: means You or Your TravelingCompanion’s legal or common law spouse, ex-spouse, Domestic Partner, parent,legal guardian, step-parent, grandparent, parents-in-law, grandchild, naturalor adopted child, step-child, children-in-law, brother, sister, step-brother,step-sister, brother-in-law, sister-in-law, aunt, uncle, niece ornephew, or Business Partner who reside in the United States, Canada orMexico.Host at Destination: means a person withwhom You are sharing pre-arranged overnight accommodations at the host’susual principal place of residence.We apologize thatwe cannot respond more favorably at this time and hope this answers anyoutstanding questions in relation to [redacted] claimIf youshould have any further questions or need further clarification of the above,please do not hesitate to contact this office
February 3, [redacted] Revdex.com NDelaware Street #Indianapolis, IN 46204-RE: Complaint ID – [redacted] Complainant: [redacted] Dear Ms [redacted] : Seven Corners, Incis in receipt of Complaint ID Number: [redacted] and sent to the attention of Dennis Wood on February 1, The complainant: [redacted] has expressed concerns with the handling of a recent travel insurance claim on behalf of our insured, [redacted] ***, under certificate # [redacted] This office has reviewed the file and the claims in question and find that the denial of the claims as routine services was in error As of today’s date, we are in the process of issuing payment in accordance with the policy benefits Payment will be made to [redacted] Bukhara at the address on record and to Laboratory Corporation of AmericaThank 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
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]
June 24, [redacted] Revdex.com N Delaware Street #Indianapolis IN 46204- RE: Complaint ID [redacted] Customer: [redacted] l Certificate # [redacted] Dear MsDavis: Seven Corners, Incis in receipt of the rebuttal to Complaint ID Number [redacted] and sent to the attention of Sureleen S [redacted] on June 21, We have again reviewed the file, which included a medical review of the complete medical records received from [redacted] *** As stated in our earlier response, the initial treatment was on July 23, and showed no acute injury or onset resulting in the visit Additional visits on August 13, September and October 20, were all shown as being follcare, with no indication on any of the visits that there was any onset of new, acute symptoms involving the condition Based on the medical records and the provisions and definitions contained in the policy, we can find no basis for allowing these claims under the Acute Onset of Pre-Existing Conditions benefit Therefore, we must uphold our denial of these claims in accordance with the provisions of the policy Thank you for your time and attention to this matter and should you have questions involving this claim matter, please contact this officeSincerely, Seven Corners, Inc
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 have already explained several times to several different employees of Seven Corners, when I initially purchased the travel insurance I was told that my TRIP would be covered only to find out when I filed the claim that the woman did not inform me that I had to make separate purchases to cover my tripNot only that but the amount of my trips equaled $302.90, which I was issued a check for $I am still owed $for the other portion of my tripThis company has scammed my husband and I out of over $and I have been fighting for it sinceI purchased the insurance on the 10th with the knowledge from the employee I purchased it through that my trip was coveredI then had to spend another $for more coverage which is why the day of he appointment is the day before coverageWe are being scammed out of our money by this companyI am fighting for my money back from this company.? 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 just sent a letter from the doctor's office about ongoing outpatient treatment for my sonThat should meet the insurance requirement for partial hospitalizationI hope they accept it Regards, [redacted]
June 3, Revdex.com NDelaware Street #Indianapolis, IN 46204-RE: Complaint ID – [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 concernsSeven Corners evaluated the documentation submitted by [redacted] regarding an emergency accident/sickness medical expense claimOur records show that Mr [redacted] sustained injury to his ankle on July 11, and sought out medical care at [redacted] (located in [redacted] ***, Costa Rica) on July 12, Due to injuries sustained by Mr [redacted] , Seven Corners arranged to have the insured party medically evacuated home to the United States, so he could be cared for by his familyThis office has received claim documentation from the treating medical facility, as well as from [redacted] for out of pocket costs he has incurred due to his injurySeven Corners has issued payment as follows: CLAIM NUMBER LOSS ITEM PAYMENT AMOUNT [redacted] Air Ambulance $28, [redacted] Guarantee of Payment to [redacted] Hospital $6, [redacted] Cost of EVAC Air Ticket for Escort $On July 15, 2016, this office received medical documentation from [redacted] Hospital regarding the Guarantee of Payment with the hospitalOn July 24, 2015, Seven Corners received a claim form and receipts from Mr [redacted] regarding his out-of-pocket medical costsOn August 13, 2015, Seven Corners sent via US Postal Service correspondence to [redacted] requesting additional informationThis office asked the insured to provide an Explanation of Benefits (EOB) form from his primary healthcare insurance carrier: [redacted] insuranceThis information is needed to evaluate his presented medical expense claim for his out of pocket medical expensesOn August 31, 2015, Mr [redacted] called Seven Corners and spoke to Amber J [redacted] and asked why this office needed information from [redacted] insurance, MsJ [redacted] explained that they are his primary insurance carrier and that Seven Corners provides secondary coverage, Mr [redacted] stated he understood this and would contact [redacted] regarding his overseas coverageOn August 31, 2015, Mr [redacted] contacted Wesley S [redacted] via email stating that [redacted] insurance would cover some of his Urgent and Emergency Care expenses, however [redacted] would need a copy of the itemized billThe insured asked Wesley S [redacted] if he could assist with obtaining a copy of his itemized medical bill from the treating hospital in Costa RicaMrS [redacted] indicated as a courtesy, he would assist Mr [redacted] in obtaining the document, even though the purchased travel plan provides excess coverage to [redacted] insuranceOn September 10, 2015, Seven Corners sent via US Postal Service a second written request of the insured party for an [redacted] insurance EOB and upon receipt of this document this office would conclude handling of his lossOn September 17, 2015, MrS [redacted] informed [redacted] via email (john [redacted] [email protected]) that he has obtained the medical records from [redacted] HospitalOn September 25, 2015, Wesley S [redacted] emailed Mr [redacted] the medical report and invoice to submit to [redacted] insuranceOn October 1, 2015, Wesley S [redacted] sent a follow up email to Mr [redacted] , asking for the insured to confirm receipt of the correspondence that contained the requested medical recordsMrS [redacted] did not receive a response to his inquiry to [redacted] Seven Corners communicated within our September 10, letter to Mr [redacted] that upon receipt of an Explanation of Benefits from [redacted] insurance his claim would be reopened for further processingAs of today’s date, this office has not received the requested document from [redacted] We hope this answers [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
Dear Ms***: Seven Corners, Incis in receipt of Complaint ID Number [redacted] and sent to the attention of Dennis Wood on May 18, 2016.? The complainant, [redacted] , has expressed concerns with the handling of recent travel medical insurance claims for insured [redacted] under the certificate # referenced aboveThis office has reviewed the file and the claims in question.? 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 policy a) 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 [redacted] 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 monthsA review of the medical records by medical staff determined that based on the medical records reviewed this member’s condition could be be stated with reasonable medical certainty to have existed or is related to a condition that existed at the time of application or prior to the effective date of the policy.? 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.? ?
April 15, [redacted] Revdex.com N Delaware Street #Indianapolis IN? 46204- RE:? ? ? Complaint ID ?" [redacted] ? ? ? ? ? ? ? ? ? Complainant:? [redacted] ? ? ? ? ? ? ? ? Our Certificate Number [redacted] Dear Ms***, Seven Corners, Incis in receipt of Complaint ID Number:? [redacted] and sent to the attention of Dennis [redacted] on April 11, 2016.? The complainant, [redacted] , has expressed concerns with the handling of his recent travel medical insurance claim.? This office has reviewed the file and the claims in question.? Based on a thorough review of the file, it has been determined that the denial of the claims under the policy was incorrect as all information needed to process the claims was in our office.? ? ? The denial at this time is being overturned and the claims processed for payment in accordance with the policy benefits? ? We are also including interest payments totaling $in accordance with Massachusetts prompt payment laws.? We also find that inquiries and appeals by Mr [redacted] were not responded to in accordance with our established customer service procedures.? We apologize for this and have addressed this issue with the appropriate personnel.? 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
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 Regarding the [redacted] trip and the response from Seven Corners On the original claim form [redacted] 's physician selected the option provided for other in regards to the condition of cystic acne We completely understood it not being an illness and that is the reason the option provided "other" was selected Also the Dramended the date she first saw [redacted] for the condition in a letterhead from her office which was faxed to Seven Corners My daughter was looking forward to attending this trip but just was physically unable to do so due to this debilitating condition which left her with huge lumps on her face I ask you to remember being among High School peers during such an extreme condition and being on such harsh medication which requires monitoring from said physician It has not been easy and having to have cancelled such a great opportunity with [redacted] was beyond troubling for [redacted] I have an original copy from Dr [redacted] 's letter head submitted to Seven corners (to amend the date on the claim form) Regards, [redacted]
February 23, Revdex.com of Central Indiana N Delaware Street #Indianapolis, IN? 46204- RE: Complaint ID:? ? ? [redacted] ? ? ? ? ? ? Complainant:? ? ? J David [redacted] To Whom It May Concern: Seven Corners, Inc (“Seven Corners”) is in receipt of Complaint [redacted] which was filed by [redacted] on February 11, 2016.? ? ? ? We have reviewed the complaint and appreciate the opportunity to address Mr [redacted] ’s concerns In order to clarify the roles of the parties involved, Nationwide Mutual Insurance Company (“NMIC”) is the insuring company of the travel insurance policy purchased by Mr [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.? One Travel is the Travel Provider from whom Mr [redacted] purchased his flights Mr [redacted] ’s travel insurance policy has a Pre-Existing Conditions clause that requires a sixty day look back period from the effective date of the travel insurance policy Date trip was booked? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? November 10, Date travel insurance was purchased? ? ? ? ? ? ? January 20, Effective date of travel insurance ? ? ? ? ? ? ? ? ? ? ? ? ? January 21, Date trip was cancelled? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? March 17, While attempting to process Mr [redacted] ’s claim, it was necessary to request additional medical information from Mr [redacted] ’s physicians in light of the Pre-Existing Conditions clause.? We requested information from the physicians that treated Mr [redacted] during this sixty-day look back period, which would be his primary care physician and cardiologist.? To date, we have only received information from Mr [redacted] ’s primary care physician In order to appropriately evaluate Mr [redacted] ’s claim, it is necessary that our office receive the outstanding medical records from his cardiologist, Dr [redacted] , for dates of service November 21, ?" January 20, 2015.? Our office contacted Dr [redacted] ’s office on February 17, and spoke with a representative from Dr [redacted] ’s office who confirmed receipt of our medical record requests.? However, we were informed by that representative that our requests were not accepted as our medical authorization for release was not HIPAA compliant.? Unfortunately, our office was not notified of this fact prior to this telephone conversation.? As a result, we have sent Mr [redacted] a new medical authorization release form and will forward to Dr [redacted] ’s office upon receipt Policy language which is pertinent to Mr [redacted] ’s claim is as follows: LIMITATIONS AND EXCLUSIONS The following exclusions apply to Trip Cancellation & Trip Interruption, Trip Delay, Missed Connection, and Accidental Death & Dismemberment: Loss caused by or resulting from: Pre-Existing Conditions, as defined in the Definitions section unless the insurance is purchased within fourteen (14) days of the initial Covered Trip deposit Pre-Existing Condition: means any injury, sickness or condition of You, or Your Traveling Companion for which within the sixty (60) day period prior to the Effective Date of Trip Cancellation coverage under the Policy (a) first manifested itself or exhibited symptoms which would have caused one to seek diagnosis, care or treatment; (b) required taking prescribed drugs or medicine, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the required prescription; or (c) required medical treatment or treatment was recommended by a PhysicianThe Pre-Existing Conditions exclusion is waived for You if You enroll in the Plan at the time You pay the deposit required for the Covered Trip (or within fourteen (14) days of the initial deposit) and You purchase the coverage under the Plan for the full cost of the Covered Trip Mr [redacted] has also requested reimbursement of the insurance premium paid for the travel insurance policy.? ? The policy purchased has a 10-day review period and insurance premiums are non-refundable once fully earned Important Note: All protection plan costs and fees are non-refundable after a day review period We appreciate the opportunity to address Mr [redacted] ’s concerns and upon receipt of the medical records from Dr [redacted] , we will be able to finalize claim processing Sincerely, Seven Corners, Inc
September 18, 2015 [redacted] Revdex.comNDelaware Street #2020Indianapolis, IN 46204-2599 RE: Complaint ID Number: [redacted] Certificate Number: [redacted] Dear Ms [redacted] : Seven Corners, Incis in receipt of Complaint ID: [redacted] and sent to the attention of Dennis W [redacted] on September 14, 2015regarding [redacted] We appreciate the opportunity to address herconcerns.Upon further review of the claim documents submitted on behalf of Ms [redacted] ,Seven Corners has determined the trip cancellation claim is eligiblefor payment and issued settlement in the amount of $ The settlement check was mailed to Ms [redacted] ’s addressof record: [redacted] R [redacted] *** Seven Corners apologizes for any miscommunication whichoccurred during the handling of her travel claim. We hope this answers [redacted] ’s concerns regarding herrecent travel claimShould you have any further questions involving this claimmatter, please contact me at the address listed below.Sincerely, Seven Corners, Inc. Enclosure
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 meFinally, I received my claim Thank you Revdex.com for helping me in this matter Regards, [redacted]
May 25, [redacted] ***Revdex.comN Delaware Street #2020Indianapolis IN 46204-RE: Complaint ID – [redacted] Complainant: *** [redacted] Our Certificate Number [redacted] Dear Ms***, Seven Corners, Incis in receipt of Complaint ID Number: [redacted] and sent to the attention of [redacted] on May 4, The complainant, [redacted] , has expressed concerns with the handling of his recent travel medical insurance claim This office has reviewed the file and the claims in question At issue was a review of his complex travel history as it applied to the eligibility provisions of the policy as well as review of his medical history as it pertained to the Pre-Existing Conditions exclusion of the policy It has been determined after thorough review by management that coverage for claims in the U.Sremained in effect for the dates of his treatment However, a medical review of the medical records received indicate that the condition in question is pre-existing based on the following definition in the policy: The term “Pre-Existing Condition” as used in this Policy 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 [redacted] 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 months Mr [redacted] ’s effective date under the purchased Liaison Majestic policy was March 16, According to the medical records reviewed for his medical visit on December 11, 2015, it was stated that the insured had experienced the problem for year prior to that visit Based on this information and the definition in the policy, the condition is pre-existing and therefore is not covered under the policy A letter detailing this denial is being mailed to Mr [redacted] today 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
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.The condition was acute exacerbation of chronic condition and would meet the criteria for treatment and coverageThis was indicated by my provider that I spoken to Regards, [redacted]
December 17, [redacted] Revdex.com of Central Indiana NDelaware StreetSuite # 2020Indianapolis, IN? 46204-2599RE:? Complaint Number:? [redacted] Complainant: [redacted] Our Insured’s Name:? ? [redacted] Certificate Number: [redacted] Policy: Liaison ContinentUnderwriter:? Certain Underwriters at Lloyd's, LondonDear Ms [redacted] :We are in receipt of your correspondence regarding the above referenced complaint.? The complaint was received by Seven Corners on December 17, 2015.? Seven Corners, Inc.; is 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 October 9, to December 9, The insured submitted a Proof of Loss Form stating she suffered from a skin rash with itching since arriving in the United States on August 27, ? Based upon the Policy’s Coverage Benefits, the coverage was not in effect until October 9, 2015.? Therefore, no coverage is afforded for the claim submitted because the condition existed prior to the effective date of the policyThe policy language that is pertinent to this matter:DESCRIPTION OF BENEFITSMedical Expenses: Only such expenses, incurred as the result of and within one hundred and eighty days (180) days from a Disablement, which are specifically enumerated in the following list of charges, and which are not excluded in EXCLUSIONS AND LIMITATIONS, shall be considered as Covered Expenses:EXCLUSIONS AND LIMITATIONSFor Medical benefits, this Insurance does not cover: 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 policy.a) 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 program.b) 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 program..PLAN DEFINITIONSPre-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 [redacted] months prior to the effective date of coverage under this policy, whether or not previously manifested, symptomatic, known, diagnosed, treated or disclosed This 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 months.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 [redacted] **’s claim.If you should have any further questions or need further clarification of the above, please do not hesitate to contact us.Sincerely,Claims DepartmentSeven Corners, Inc
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , 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, [redacted] There was no mention of what happens to the Policy until the ExpiryIs it still in force since the cancellation is rejected? [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 ? Please review the section I attached(Section IV trip cancellation/interruption (a))Also, there was no response to my complaint that I personally spoke to a representative from the company to assure me of my coverage prior to going on this trip (5/4) and well within the cancellation periodPlease have the company review the phone records of there employee to validate my claimI had, nor have I ever had a reason to purchase a claim such as this other that a potential medical emergency in which I was assured of the coverage forAgain, please address the employees assurances on 5/from a Mabel Harrera, as well as the email from a company representative that I have snipped inFurthermore, on 8/25/I received an email from Janet G***(Claims Manager) indicating "I apologize for the delay in a responseI do have the outcome of your claim and I don't agree with itI will be speaking with the account manager to see if there is anything to dispute this." This is an example of two individuals who assured me of my coverageI will be happy to send this email to anyone that would like to review it.? Regards, [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 belowNo where on the website does it state that coverage takes place hours after the premium is paid, and considering this was a last minute trip they should have never insured me, knowing that I wouldn't have coverageAnd what family member treated my child?? They are wrong again The attending doctor just happened to have the same name? How common is that in the Hispanic world, EXTREMELY!!! They should have never insured me if coverage didn't start till hours later, if they can't insure me, I want my $backThey are liers and scammers, absolutely no where does it say any of that on the website when you are buying ticketsRegards, [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.Dear Sir or Madam, My name is [redacted] (***) ***I submitted a complain (ID [redacted] ) against Seven Corners, Inc(insurance company) to Revdex.com (of Central Indiana) on July 20, Through your assistance, Seven Corners, Increplied that they would re-mail me the check (225.91USD) again so my complaint was closed on July 24thHowever, I have not yet received any mail with the check from Seven Corners so far after one monthTherefore, I file the complaint againMy address is: Miss [redacted] I think the country name on Revdex.com’s website is incorrect/confusing (Taiwan, province of China)Nowadays, people just write “TAIWAN” because it is much clear and Taiwan does not belong to (Mainland) ChinaI have received many mails from other countries successfully without any problem via only using “TAIWAN.” Sometimes mails, through the name the same as Revdex.com’s website, will be sent to Mainland China and disappearTherefore, may I ask Seven Corners to mail the check to me again via only “TAIWAN” for the country name? Thank you very much for your precious assistanceBest regards, [redacted] (***) ***Please re-mail me the check through the right COUNTRY NAME (TAIWAN) Regards, [redacted] ***
Seven Corners,Incis in receipt of complaint ID # [redacted] and sent to the attention ofDennis W [redacted] on June 29, The complainant: [redacted] objects tothe claim handling of his trip cancellation claim.On March 8, 2015, [redacted] completed an online purchase for airfare and travel insurancefor a scheduled flight from Bordeaux, France to Miami, FloridaThe traveldates were: April 16, – May 5, 2015.Due to the deathof Mr [redacted] family member (sister-in-law), he cancelled his travel andpresented a trip cancellation claimSeven Corners adjudicated the loss anddetermined that Mr [redacted] claim was not eligible for payment, the reason isas follows:Per the purchasedtravel policy, there is no coverage provided under the trip cancellation benefitas Mr [redacted] deceased relative lived/resided in France (Europe) andtherefore does not meet the policy definition of family memberThe purchasedpolicy defines a family member as a person who resides in the United States, Canadaor MexicoThis office alsogave consideration to possibly provide coverage benefits for this loss underthe death of the host at destination provision, however our evaluation foundthat not applicable as Mr [redacted] was not sharing pre-arranged accommodationsat the usual principal place of residence of his sister in law/family member Based upon thepresented claim documentation, this office mailed a claim denial letter to [redacted] on June 16, Upon our receiptof the concerns presented to the Revdex.com of Central Indiana, Seven Corners re-evaluatedthe presented documentation [redacted] indicated within his complaintthat his trip cancellation claim was denied since he did not live in the UnitedStatesThis is not thecase, the travel insurance policy he purchased does not provide coverage forhis presented loss: travel cancellation due to the death of a family member whoresides outside of the United States, Mexico, or Canada.Due to the aboveinformation, this office must uphold our original decision that the claim isnot eligible for payment.Policy languagewhich is pertinent to this matter:BENEFITS TRIP CANCELLATION & TRIPINTERRUPTION The Company will pay a benefit, up to themaximum shown on the Confirmation of Coverage, if You are prevented from takingor unable to continue Your Covered Trip due to: (a)Sickness, Accidental Injury or death of You, Traveling Companion, or FamilyMember; which results in medically imposed restrictions as certified by aPhysician at the time of Loss preventing Your continued participation in theCovered TripA Physician must advise cancellation of the Covered Trip on orbefore the Scheduled Departure Date (d) The death or hospitalization ofYour Host at Destination.TRIP CANCELLATION The Company willreimburse You for the following: Non-refundable cancellation charges imposed bythe Travel Suppliers.In no event shall the amount reimbursedexceed the amount You prepaid for the Covered Trip up to the maximum benefitshown on the Confirmation of Coverage.SPECIAL CONDITIONS: You must advise theTravel Supplier and the Company as soon as possible in the event of a claim.The Company will not pay benefits for any additional charges incurred thatwould not have been charged had You notified the Travel Supplier as soon asreasonably possibleYou or Your: refers to all persons listed on theConfirmation of Coverage under the program purchased by the Insured.Family Member: means You or Your TravelingCompanion’s legal or common law spouse, ex-spouse, Domestic Partner, parent,legal guardian, step-parent, grandparent, parents-in-law, grandchild, naturalor adopted child, step-child, children-in-law, brother, sister, step-brother,step-sister, brother-in-law, sister-in-law, aunt, uncle, niece ornephew, or Business Partner who reside in the United States, Canada orMexico.Host at Destination: means a person withwhom You are sharing pre-arranged overnight accommodations at the host’susual principal place of residence.We apologize thatwe cannot respond more favorably at this time and hope this answers anyoutstanding questions in relation to [redacted] claimIf youshould have any further questions or need further clarification of the above,please do not hesitate to contact this office
February 3, [redacted] Revdex.com NDelaware Street #Indianapolis, IN 46204-RE: Complaint ID – [redacted] Complainant: [redacted] Dear Ms [redacted] : Seven Corners, Incis in receipt of Complaint ID Number: [redacted] and sent to the attention of Dennis Wood on February 1, The complainant: [redacted] has expressed concerns with the handling of a recent travel insurance claim on behalf of our insured, [redacted] ***, under certificate # [redacted] This office has reviewed the file and the claims in question and find that the denial of the claims as routine services was in error As of today’s date, we are in the process of issuing payment in accordance with the policy benefits Payment will be made to [redacted] Bukhara at the address on record and to Laboratory Corporation of AmericaThank 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
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]