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Is there recourse when insurance rejects claim?


RicoPaz

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I am awaiting a decision on a claim I submitted to Travelex and it could go either way. I am wondering if the claim is rejected do insurance companies have a mechanism to review the decision?

 

I understand I have the option to file a complaint with the insurance commission in my state, but I'm just wondering if there is a standard procedure for these situations.

 

Thanks in advance.

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Yes, you can appeal, but you're going to have to have a reason to do so. If your claim was correctly denied, filing a complaint with the Dept. of Insurance is a waste of everyone's time.

 

I had a claim rejected by Travelguard, because they were denying it for a pre-existing condition. This was a correct denial, but I also had cancel for any reason coverage. I had to point this out to them and ask them to reprocess for this reason; they did and they paid.

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In most states, in the case of a denial, the insurer is required to to give the insured something in writing stating what the insured's options are at that point. Here's from one Travelex policy:

 

"ARBITRATION

Notwithstanding anything in this Policy to the contrary, any claim arising out of or relating to this contract, or its breach, will be settled by arbitration administered by the American Arbitration Association in accordance with the Uniform Arbitration Act (710 ILCS 5/1 et seq.) except to the extent provided otherwise in this clause. Judgment upon the award rendered in such arbitration may be entered in any court having jurisdiction thereof. All fees and expenses of the arbitration shall be borne by the parties equally. However, each party will bear he expense of its own counsel, experts, witnesses, and preparation and presentation of proofs. The arbitrators are precluded from awarding punitive, treble or exemplary damages, however so denominated. If more than one Insured is involved in the same dispute arising out of the same Policy and relating to the same Loss or claim, all such Insureds will constitute and act as one party for the purposes of the arbitration. Such arbitration will be voluntary, will be by mutual consent by all parties, and may be binding upon all parties or non-binding on the Insured. Nothing in this clause will be construed to impair the rights of the Insureds to assert several, rather than joint, claims or defenses.

"

 

Please note that many states have their own procedures so there's a fair chance the wording will be different. But you should be given phone numbers or other contact information to get the ball rolling. But as 6rugrats said, many of these disputes arise from a simple mistake that when looked at by a claims supervisor eventually get handled correctly.

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Good info, thanks so much.

 

Hopefully it there won't be a problem but it's better to understand the process just in case. When it comes to insurance it always seems like "the tie goes to the insurer".

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  • 2 weeks later...

The claim I am filing is for a cruise in Japan that was scheduled a week after the earthquake/tsunami/nuclear problem. The insurance company cannot confirm that the cruise was cancelled and the cruise line, Compagnie Du Ponant, will not provide documentation that they cancelled the cruise.

 

Any advice from anyone?

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the cruise line, Compagnie Du Ponant, will not provide documentation that they cancelled the cruise.

 

Any advice from anyone?

 

I'd be all over those guys until they do. FYI, it is the customer's responsibility to provide the proof of loss. Don't expect the insurer to fight this battle for you.

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The claim I am filing is for a cruise in Japan that was scheduled a week after the earthquake/tsunami/nuclear problem. The insurance company cannot confirm that the cruise was cancelled and the cruise line, Compagnie Du Ponant, will not provide documentation that they cancelled the cruise.

 

Any advice from anyone?

Edited because I got the rest of the story from reading your other posts. Do you have the letter from the captain? It does not appear this cruise was cancelled; you chose to disembark early. This is different than an entirely cancelled cruise:

 

http://boards.cruisecritic.com/showthread.php?p=28534241&highlight=#post28534241

 

The itinerary was to head to Shanghai and on to Japan. The tragic earthquake/tsunami/nuclear plant caused the itinerary to end in Hong Kong, and most all the passengers not only approved but were relieved. The irritation came when the captain told everyone one thing, then the office sent a letter to each passenger that said another, the guest relations person said various things and the cruise director didn't even know what to say about where the ship would go next, how people were to get home and what the financial situation for the missed ports and altered itinerary would be resolved. Several times we heard that "it was the weekend so nobody's in the office". So while the personal service on board was outstanding, the company back home was out to lunch. A better response might have been for the cruise line to say, "be patient, don't worry and we will take care of each passenger". Didn't happen, and the result was a caucauphony of French expletives.

 

Long story short, many of us made our own arrangements to disembark as soon as we could on our own and let travel insurance sort it out.

 

It isn't clear from your post (quoted above). Did the cruise actually go on with an altered itinerary, and you chose to get off, or did the cruise just end in Hong Kong, and passengers had to debark? Just curious, what are you expecting to receive from your travel insurance?

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Edited because I got the rest of the story from reading your other posts. Do you have the letter from the captain? It does not appear this cruise was cancelled; you chose to disembark early. This is different than an entirely cancelled cruise:

 

http://boards.cruisecritic.com/showthread.php?p=28534241&highlight=#post28534241

 

 

 

It isn't clear from your post (quoted above). Did the cruise actually go on with an altered itinerary, and you chose to get off, or did the cruise just end in Hong Kong, and passengers had to debark? Just curious, what are you expecting to receive from your travel insurance?

 

So the cruise wasn't cancelled? That certainly explains why the cruise line won't supply documentation that it was.

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So the cruise wasn't cancelled? That certainly explains why the cruise line won't supply documentation that it was.

 

OP will have to come back and clarify. I am guessing he was on a B2B and the second portion of his cruise, departing Shanghai on 23 March to Tokyo was cancelled, but I also can find no information confirming cancellation.

 

If this was the case, and an alternate itinerary was offered and you didn't choose to sail, you can't claim on your insurance, can you? Sounds like a mess.

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If this was the case, and an alternate itinerary was offered and you didn't choose to sail, you can't claim on your insurance, can you? Sounds like a mess.

 

In every passenger contract I've ever read, the cruise line has the right to modify itineraries at will. By signing the contract, the passenger states that that's fine. An insurer is not going to pay you for something the cruise line does that you have previously told the cruise line was perfectly OK to do.

 

If the cruise was indeed cancelled some policies will cover the cost of the cancellation including and non-refundable airfare, if one of the covered reasons is natural disasters. For example, with the Iceland volcano situation of last year many allowed cancellations because of that because the passengers physically could not get to the ship. But an itinerary change? I can't think of any that will allow a passenger to cancel because of that. If the ship is still sailing you'd better be on it. But some policies may cover the cost of returning home is there is now a new final destination.

 

I can certainly better understand why the OP is worried about his claim being denied.

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Yes, I was on back to back with separate policies for each. The first was interrupted, no problem. The second never happened and we were given the option to stay on board and go back the way we came (why would anyone do that?) or take a credit towards a future cruise with additional expense. But it was chaos because of the situation and no choice was made. Meanwhile I asked for a letter and kept asking and nothing was provided.

 

Then this morning I received notice from claims folks that they can do nothing because no evidence that the cruise was cancelled was provided.

 

Taking the above advice yesterday from cruiseco, I started rattling cages and received a letter via email written in bad english that gives me a choice to stay aboard (a month later?) which I forwarded to the insurance company.

 

The drama continues. Thanks for input.

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In every passenger contract I've ever read, the cruise line has the right to modify itineraries at will. By signing the contract, the passenger states that that's fine. An insurer is not going to pay you for something the cruise line does that you have previously told the cruise line was perfectly OK to do.

 

If the cruise was indeed cancelled some policies will cover the cost of the cancellation including and non-refundable airfare, if one of the covered reasons is natural disasters. For example, with the Iceland volcano situation of last year many allowed cancellations because of that because the passengers physically could not get to the ship. But an itinerary change? I can't think of any that will allow a passenger to cancel because of that. If the ship is still sailing you'd better be on it. But some policies may cover the cost of returning home is there is now a new final destination.

 

I can certainly better understand why the OP is worried about his claim being denied.

 

The first segment was "interrupted" and the insurer agreed to pay return airfare although the limit that they pay is only 1/3 of what it cost. It wasn't an evacuation per se but because of the situation the airlines were swamped. The second segment wasn't an itinerary change, it was cancelled due to the earthquake/tsunami disaster. But whether they agree to cover it under the classification of "weather" remains to be seen.

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Yes, I was on back to back with separate policies for each. The first was interrupted, no problem. The second never happened and we were given the option to stay on board and go back the way we came (why would anyone do that?) or take a credit towards a future cruise with additional expense. But it was chaos because of the situation and no choice was made. Meanwhile I asked for a letter and kept asking and nothing was provided.

 

Then this morning I received notice from claims folks that they can do nothing because no evidence that the cruise was cancelled was provided.

 

Taking the above advice yesterday from cruiseco, I started rattling cages and received a letter via email written in bad english that gives me a choice to stay aboard (a month later?) which I forwarded to the insurance company.

 

The drama continues. Thanks for input.

 

So, did the ship actually sail on this reverse itinerary? If so, I am wondering if your insurance company will say the cruise wasn't cancelled; it was just a change in itinerary.

 

The first segment was "interrupted" and the insurer agreed to pay return airfare although the limit that they pay is only 1/3 of what it cost. It wasn't an evacuation per se but because of the situation the airlines were swamped. The second segment wasn't an itinerary change, it was cancelled due to the earthquake/tsunami disaster. But whether they agree to cover it under the classification of "weather" remains to be seen.

 

On what day of your cruise was it interrupted? The schedule shows the ship arriving in Hong Kong on 19 March. Did you skip ports after the earthquake, and just go to Hong Kong? I guess I don't really understand why the first cruise was interrupted, as it did not go to Japan.

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The insurance company denied my claim. The only covered reason under the policy that might apply says, "Weather that causes complete cessation of services of your common carrier for at least 24 hours."

 

Unfortunately they don't consider an earthquake nor a tsunami as "weather". There are only 8 situations where they would cover a cancellation.

 

If there is a lesson in all this it's this:

Travel insurance: a good business to invest in.

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The first cruise was cut short, so you will receive reimbursement for that, correct? This denial was for the second cruise? I still am not sure I'm understanding the story, but if the cruise did sail, even with a reverse itinerary, and you didn't board, I understand why insurance denied it. Cruiselines retain the right to change itineraries.

 

Is there anyway the cruiseline might reimburse you? This is a somewhat unusual circumstance; there seemed to be lots of confusion about what was going on.

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That's correct. The first was reimbursed for airfare only, to the limit of the policy with covered only 1/3 of the airfare. The second was denied completely and it is at the discretion of the cruise company which I'm still working on.

 

My question now is this. With so many consumer protections for the traveling public with airlines, why are cruise lines left to their own devices? If a cruise lines cancels you for their own reason why can they refund, credit or substitute another itinerary at their own whim? Somehow it doesn't seem right. Too many people spend too much money in this industry.

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You might be able to pursue a claim if the embarkation and/or debarkation ports changed on your second itinerary, but not if the interim ports were the only different ports. You need to re-read your cruise contract and your insurance contract to see what is covered for origination and destination.

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My question now is this. With so many consumer protections for the traveling public with airlines, why are cruise lines left to their own devices? If a cruise lines cancels you for their own reason why can they refund, credit or substitute another itinerary at their own whim? Somehow it doesn't seem right. Too many people spend too much money in this industry.

 

It's simple. They can do this because you sign a contract saying they can do it. Don't like it? Don't sign it. Spend your money elsewhere. Airlines are vital to moving people around and vital to the economy so they get a higher level of regulation. Cruising is pretty much for recreation only so consumers are left to make their own decisions and to accept the consequences of those decisions.

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