Access America...and cruise insurance

[Cruise Amore]

Use caution when purchasing cruise trip insurance. We didn't and were just denied our claim.

We did not read the small print on a policy purchased through Access America - the part that stated the importantance of purchasing the policy within 14 days of the initial deposit to the cruise line for the cruise.

Due to a "pre-existing" medical condition we were hesitant in the first place to sign up for the cruise. However, our travel agent assured us our policy would cover us if we were unable to partake in the cruise.

We were unable to cruise - doctors orders; and, our claim was just denied by Access America. I thought it was a real cheap shot by Access America. We have done major cruising in the past and have given Access America 10's of thousands of dollars in business. Access America was in no way sympathetic to our situation and could care less in regards to the business we had given them in the past; and, we had never before filed a claim. We will NEVER PURCHASE CRUISE INSURANCE AGAIN! I think it is a fraud.

And, I am very saddened by Access America's unprofessional conduct.

[cruiseco]

Use caution when purchasing cruise trip insurance. We didn't and were just denied our claim.

We did not read the small print on a policy purchased through Access America - the part that stated the importantance of purchasing the policy within 14 days of the initial deposit to the cruise line for the cruise.

Due to a "pre-existing" medical condition we were hesitant in the first place to sign up for the cruise. However, our travel agent assured us our policy would cover us if we were unable to partake in the cruise.

We were unable to cruise - doctors orders; and, our claim was just denied by Access America. I thought it was a real cheap shot by Access America. We have done major cruising in the past and have given Access America 10's of thousands of dollars in business. Access America was in no way sympathetic to our situation and could care less in regards to the business we had given them in the past; and, we had never before filed a claim. We will NEVER PURCHASE CRUISE INSURANCE AGAIN! I think it is a fraud.

And, I am very saddened by Access America's unprofessional conduct.

 

Mistake #1: "We did not read the small print on a policy purchased through Access America - the part that stated the importance of purchasing the policy within 14 days of the initial deposit to the cruise line for the cruise."

 

Mistake #2: "However, our travel agent assured us our policy would cover us if we were unable to partake in the cruise." Sue your travel agent for the amount of the loss. Any travel agent that makes that type of statement should be sued for general stupidity.

 

Mistake #3: "Access America was in no way sympathetic to our situation and could care less in regards to the business we had given them in the past; and, we had never before filed a claim." Each claim is evaluated on its own merits with no regard to your past purchases. That's the law.

 

Have you contacted your state's department of insurance yet to have them take a look at your complaint as recommended previously? Until you do so and come back with a finding from the regulators that Access America did indeed engage in unprofessional conduct everything points to you not doing your due diligence and expecting Access America to act as some sort of charity -- they should pay your claim, regardless of its merits, just because?

[klfrodo]

I think it is a fraud.

And, I am very saddened by Access America's unprofessional conduct.

 

I think it was fraudulant and unprofessional on your part to know you have a pre-existing condition, cancel the cruise due to complications of the pre-existing conditions, and then try to recover any lost monies from the insurance company. On top of that, have the audacity to publicly throw the insurance company under the bus for your own lack of due diligence.

 

Having now vented myself,,,,, if you can PROVE that your TA said buy this and everythings covered,,, then go after your TA. That's why they have errors and omisions insurance coverage.

[Keith1010]

As they say the devil is in the details.

 

No matter how tedious it is, the lesson on this is one must read the entire insurance policy up front before purchasing insurance to ensure it meets their needs. Most of the private policies require one to purchase the insurance within the first two weeks or so to cover pre-existing conditions.

 

Again, the devil is in the details.

 

Keith

[Cruise Amore]

Okay - - a little more info to all you experts....

We never signed a contract with Access America - never. In fact we did not see the aggreement until our cruise tickets were sent to us three weeks prior to sailing. We were never informed of the 14 day window to cover pre-existing conditions.

[Cruise Amore]

I wasn't aware you knew all the facts. And, I have been vague with them. What is a pre-existing condigion? If one is on medication then he has a pre-existing condition!

We never signed a contract with Access America - one was never presented to us; we were never made aware of the 14 day pre-existing clause starting from the date you reserve the cruise (sometimes done while on board a cruise ship to receive the additional 5% discount); and, there are other issues.

Infact, Access America has yet to contact us with any formal, via mail, or even an email that our claim has been denied. All information is coming only from our travel AGENT.

[klfrodo]

I wasn't aware you knew all the facts. And, I have been vague with them. What is a pre-existing condigion? If one is on medication then he has a pre-existing condition!

We never signed a contract with Access America - one was never presented to us; we were never made aware of the 14 day pre-existing clause starting from the date you reserve the cruise (sometimes done while on board a cruise ship to receive the additional 5% discount); and, there are other issues.

Infact, Access America has yet to contact us with any formal, via mail, or even an email that our claim has been denied. All information is coming only from our travel AGENT.

 

Then why in the world are you slamming the insurance company? The insurance company did their job.

Your problem is with your TA.

Have you gone back to them?

 

BTW: In my opinion, this still doesn't absolve you of all of the responsibility. You still have the responsibility of due diligence.

You indicated that you have given tens of thousands of dollars in the past to insurance companies which indicates to me that you are a very experienced traveller. No excuses.

[cherylandtk]

I wasn't aware you knew all the facts. And, I have been vague with them. No we don't have all the facts, just the ones you stated. Namely that you did not read/understand your policy details and that your husband had a Pre-existing condition that made you hesitant to book the cruise in the first place.What is a pre-existing condigion? If one is on medication then he has a pre-existing condition!Yes, you stated he had a PEC, and yes, being on medication can also mean a PEC if the medication is new or the condition is not stable and controlled. So can something as simple as going to the doctor for a new ailment. This is all defined within the DOC of the insurance policy.We never signed a contract with Access America - one was never presented to us; we were never made aware of the 14 day pre-existing clause starting from the date you reserve the cruise (sometimes done while on board a cruise ship to receive the additional 5% discount);The 14 day limit is listed in the policy DOC which is the 'fine print' you earlier stated you failed to read, and which you apparently did not understand formed the basis of your contract. (You say here that you never received a contract, but the fine print policy you referred to earlier means you did receive something) You do not have to 'sign' a contract to form one. If you truly think you did not have a contract with Access America, why on earth would you have bothered to file a claim with them? and, there are other issues. In fact, Access America has yet to contact us with any formal, via mail, or even an email that our claim has been denied. All information is coming only from our travel AGENT.Then how do you know it was denied if nothing has been received? Why are you going through your TA to file a claim? This involves medical statements that are none of your TA's business and which they may answer incorrectly or inadequately. YOU are the insured, not your TA, and YOU must sign the claim form. Did you do that? Do you have a copy of what the TA filed?

You did not say this in so many words, but it sounds to me like your TA has been selling you this same type of policy for all your past cruises without adequately explaining the coverage limits, the PEC exclusions, the 14 day waiver periods, or whether this was even the best policy for your situation. It is just now, when a claim was made, that all these things came to light. This should ALL have been clearly explained to you years ago when the first cruise was insured. Has your TA even told you that he or she earned a commission on your policies over the years? Has your TA told you that you are free to shop around for another policy that may better fit your needs? Did your TA tell you that CSA polices waive the PEC exclusion if you purchase them before final payment? (that would have been useful to you if you booked onboard and could not meet the 14 day limit of most other policies)

 

I know you are still upset. I am sorry for that and I don't hold out much hope for your situation. But nothing that you have written says anything unexpected or new or unusual about trip insurance. Every policy out there has a PEC exclusion and defines it. Most policies have a waiver of the PEC (not all) but only if you purchase within a defined period of time. This may be frightfully expensive news to you, but it is a well-documented, standard, normal trip insurance limitation. You may still want to be upset with Access America, but from what you have written, every other trip insurance provider would have also denied your claim given the same timing of events. I agree with others who said that if your TA made certain claims that proved to be untrue, then you should seek redress from them.

 

IN PARTICULAR, you should make certain that a claim was actually filed on your behalf by the TA, and that it was denied. ALL medical claims require a doctor's statement and signature, and I don't see how your TA could have obtained that. It may be possible that your reason for canceling is unrelated to your husband's PEC (unlikely based on your first post, but without medical details and dates we cannot tell for certain). All claim denials are made in writing, and have a specified reason for denial and are supposed to be sent to the policy owner/insured. Your claim is not denied until you receive that, so ask your TA to provide it. If he/she cannot, and cannot provide a copy of the original claim, then you have a real complaint against your TA and should seek legal assistance.

[cruiseco]

What is a pre-existing condition? If one is on medication then he has a pre-existing condition!

 

Maybe, Maybe not. "Pre-existing condition" is not a term that has a standard definition across the travel insurance industry. Take 10 different travel insurers and it's possible to get 10 different definitions of that term -- all legal, all valid, but all different. That's why it's so important to read the fine print.

 

Also, you're going to have to decide on your next course of action. #1: You feel you do have a binding contract with Access America and should have your claim honored, or #2 you feel you don't have a valid contract with Access America and want your premium refunded. You can't argue both of those being true.

[Cruise Amore]

Boy, there some truly savvy cruisers on this board - I'm am impressed by your intelligence, and appreciate all of the feedback we have received!

To answer some of the questions and respond to comments: yes, the primary doctor has provided a statement and it has been submitted to Access America. He has also spoken directly with Access America and is surprised that this claim has been denied. As has the cruise line. In fact the cruise line has offered us a 50% credit toward a future cruise if we fail in our litigation.

We do have a case against Access America - at least law firms believe we do. And, yes maybe a more substantial case against our travel agent.

We will keep all of you advised! Thanks again for your input.

Much will be decided over the next three days.

[happy cruzer]

Infact, Access America has yet to contact us with any formal, via mail, or even an email that our claim has been denied. All information is coming only from our travel AGENT.

 

This sounds very strange. You have no formal denial yet you are talking to lawyers about a case and you are here blasting Access America?? Maybe just start doing things in writing directly with the insurance company? Then you can have something in writing to send to your state insurance board. How can anyone give you an opinion when you do not know for sure that you are denied or why.

[6rugrats]

To answer some of the questions and respond to comments: yes, the primary doctor has provided a statement and it has been submitted to Access America. He has also spoken directly with Access America and is surprised that this claim has been denied. As has the cruise line. In fact the cruise line has offered us a 50% credit toward a future cruise if we fail in our litigation.

We do have a case against Access America - at least law firms believe we do. And, yes maybe a more substantial case against our travel agent.

We will keep all of you advised! Thanks again for your input.

Much will be decided over the next three days.

I remain totally confused by this thread.

 

As I understand it, someone had a pre-existing condition (PEC), your insurance policy required purchase within 14 days of the first deposit on your cruise to cover this PEC, but you purchased outside of this window.

 

You don't "sign a contract" for insurance, you pay your money and get a copy of your policy. You are agreeing to this contract when you make your payment; signature not required. You can't have it both ways; you can't argue that you didn't sign a contract, as if that means you had no contract! If so, this would all be a moot point. No contract = no coverage. No coverage = no payment for lost cruise fare.

 

You didn't read your policy, though you appear to be very experienced with dealing with cruise insurance since you state:

.. have given Access America 10's of thousands of dollars in business

 

You go on to state your TA assured you that you would be covered. A "he said, she said" situation. No one was there, so impossible to comment. In any case, it's always your responsibility to actually read what you purchased.

 

It's really not clear who filed the claim, or if you have an actual written denial, but you state your doctor completed the necessary paperwork, and "was surprised this claim was denied". A future tip for you, doctors know very litte about how insurance works. Did he read the terms of the policy? His opinion is irrelevant.

 

What is relevant is that if your insurance policy had a "purchase within 14 days of initial deposit" clause to cover a PEC, you didn't take this cruise because of this condition, and you filed an insurance claim, which was denied, that Access America simply correctly denied the claim. Each claim is considered on its own merit and has nothing to do with how many policies you have or have not purchased in the past. If it's not covered, and this is specified in each policy, its not covered. End of story.

 

I have absolutely no idea why you are dealing with any law firms at this moment. Why? You first step, and I believe this has already been explained to you, is if you feel your claim was incorrectly denied, to either file an appeal with Access America, or to start a case with your state's Department of Insurance.

 

After that avenue is exhausted, if you feel you have a claim with your TA, you start there. They should be covered by their errors and omissions insurance, but I feel, especially in light of your vast previous experience with travel insurance policies, that this will be a tough one to prove.

 

Usually, I have observed that people sometimes become the angriest and go the most "overboard" with their reactions to these situations when they have a niggling feeling that they may be the littlest bit wrong. Before expending lots of time and money, highly advise you follow the procedures both I and other posters have given you.

[sirwired]

Did the travel agent (or AA) provide you with a copy of the policy within the "free look" period? (TravelGuard always e-mails and/or sends a USPS copy with every policy.) If so, I don't think you have a leg to stand on, as the pre-ex exclusion is listed in the policy text, which is the contract between you and the insurance company.

 

This is unfortunate for you that you were caught by the pre-ex exclusion, but I don't see how AA is necessarily in the wrong here with the denial.

[Host Caroline]

There is no legal leg to stand on with AA.... it's up to everyone to practice "due diligence", i.e. if you don't understand the language, get it clarified and never ever accept anyone's word but the insurance company's if you have any question about the fine print or any portion of the policy. When I was a TA we offered insurance but always told people to call the ins. co. directly if they had questions b4 purchasing.

[6rugrats]

OP - I forgot about your posts in another thread discussing this same issue. In that other thread you stated:

 

Travel Insurance - ACCESS AMERICA

Do not purchase Access America....without reading the small print. Especially concerning "pre-existing" conditions. We purchased a policy earlier this year to cover a major (almost $50,000) cruise. And, we are so upset with ACCESS AMERICA. We had to cancel at the last minute due to a medical situation; and, now, within the last few days, we have been informed that our claim has been DENIED. They say it was a pre-existing condition; and, SINCE WE DID NOT PURCHASE THE POLICY WITHIN THE FIRST 14 DAYS OF SIGNING UP FOR THE CRUISE, they denied our claim. We are so upset with ACCESS AMERICA. We are major cruisers and over the years have given them easily over $20,000 in cruise insurance.

That is great advice about not purchasing anything without reading the fine print. I would be upset too, if I lost $50,000. But, I'd have to accept responsibility for my own carelessness.

 

And, now they found a little clause, and denied our claim.

We are not finished - and currently seeking legal assistance!! I am now so turned off about cruise insurance!

I have purchased many travel insurance policies, and I'd hardly call this a "little clause". The Pre-existing Condition waiver is prominently stated on the Declaration Page on every policy I've ever bought. Still have no idea what "legal assistance" will do for you, but cost more money. Please post what happens.

[happy cruzer]

Now I understand what is going on...

 

I agree the pre-existing info has been very prominent in all policies that I have read.

 

However, I will add that I have to request the policies. Sometimes they point you to an electronic version on a website for you to print. I prefer for them to send me my actual policy for review. I know I have the correct version plus I have it if there is an issue. If you do not have a hard copy, you might get a later version with different info in it is one of my concerns.

[sirwired]

Did some more thinking on this last night... the only avenue I can think of for recovery would be if the Travel Agent neglected to provide so much as the declarations page for the final policy. (As others have pointed out.) Not providing the policy terms, or reference to said terms, could be considered an error. (Although a lawyer would have to say for sure.)

 

But if the declarations page was provided, and that page made reference to the full policy text (available on request), then the OP is subject to the exclusions in that full policy.

 

Really, the TA should have mentioned the 14-day window when the insurance was not purchased within that time, but I'm not sure if that is an actionable error. (Again, that is a lawyer question, and I am not one.) But in no case do I see Access America at fault here; they have a well-documented restriction within their policies, and that restriction is totally industry standard. I suppose if the condition were not pre-exsisting by AA's definition that would be another avenue of recovery, but we certainly don't have enough details here to judge that.

[pms4104]

Knowing that you had passed the 14-day window for pre-existing coverage and knowing that perhaps one of the travelers had a health issue that could lead to cruise cancellation ... the T/A should have recommended a policy with a cancel for any reason provision, or one that did not exclude pre-existing (if there is such a thing). Or, perhaps, the T/A wouldn't get her commission of, say $10, for the policy if she had recommended something else that would have been more appropriate that she didn't sell. Or, maybe, the T/A doesn't even know what she's selling and what the provisions and exceptions are.

 

Further, I don't get that the T/A is filing the claim with Access America. She has all the appropriate documentation and medical information? Maybe she actually realized after the fact that the insurance wouldn't cover and only said she had filed a claim and that it was denied.

 

The OP's beef is with the T/A ... not with Access America.

[cruiseco]

Further, I don't get that the T/A is filing the claim with Access America. She has all the appropriate documentation and medical information? Maybe she actually realized after the fact that the insurance wouldn't cover and only said she had filed a claim and that it was denied.

 

The OP's beef is with the T/A ... not with Access America.

 

It's not established that the TA filed the claim. The OP only said that the TA was the source of the information that the claim had been denied. Back in my TA days I quite often would follow up on a client's claim status and would let them know what was going on but I never filed a claim for them. You're making a leap here that's not justified by what little information we have.

[sirwired]

There do exist policies that will cover pre-ex well outside of the 14-day window. CSA and HTH will cover up until final payment (with the caveat that if a doctor has already told you you probably can't go, not even a pre-ex waiver is likely to save you.)

 

Also, more and more cruise line policies now include Any Reason riders as their primary cancellation coverage with their own policies. Coverages range from a 75-100% cruise credit (CCL-owned lines) to an incredible 90% cash refund on the cruise fare (RCI.) Those policies can also be purchased up to final payment, and they'll ALWAYS pay out.

[pms4104]

It's not established that the TA filed the claim. The OP only said that the TA was the source of the information that the claim had been denied. Back in my TA days I quite often would follow up on a client's claim status and would let them know what was going on but I never filed a claim for them. You're making a leap here that's not justified by what little information we have.

 

Indeed, there are days when jumping to conclusions adds to my daily exercise routine.

 

I guess what I don't get, not just in the OP's case, is that the travel insurance company would share claim info with a third-party, the travel agent. The contract, made by virtue of premium payment, is between the traveler and the insurance company ... and it would seem that claim info would not be shared with anyone else.

[6rugrats]

I guess what I don't get, not just in the OP's case, is that the travel insurance company would share claim info with a third-party, the travel agent. The contract, made by virtue of premium payment, is between the traveler and the insurance company ... and it would seem that claim info would not be shared with anyone else.

 

We don't know that they did. OP has never made it quite clear exactly what happened.

[cruiseco]

Indeed, there are days when jumping to conclusions adds to my daily exercise routine.

 

I guess what I don't get, not just in the OP's case, is that the travel insurance company would share claim info with a third-party, the travel agent. The contract, made by virtue of premium payment, is between the traveler and the insurance company ... and it would seem that claim info would not be shared with anyone else.

 

As a TA, in order to sell travel insurance to my clients I also had to be licensed in my state by the department of insurance and be an appointed producer by the insurer. I'm sure the same applied to the TA in this case. This gave me wide authority (as an insurance agent, not as a TA) to request the status of a claim on policies that I sold. This allows me to intercede on my client's behalf if necessary. It's the same as your local State Farm agent down the street keeping you informed about the status of your fire damage claim. The actual medical information attached to the claim is protected but I don't care about that anyway.

[sirwired]

I will point out that state regulations vary wildly. Many states do not require licensure for travel agents to sell trip insurance. (Just like Best Buy doesn't need to license cashiers to sell extended warranties, which are also insurance products.)

[cruiseco]

I will point out that state regulations vary wildly. Many states do not require licensure for travel agents to sell trip insurance. (Just like Best Buy doesn't need to license cashiers to sell extended warranties, which are also insurance products.)

 

Yep, the ones that don't are AL, DC, IA and WI. However, any TA, even the ones from these states. if they have clients that reside in Washington State must also have a WA license in order to sell travel insurance to them. So I needed two licenses (CA and WA) and it's possible that even those from AL will have a WA license.