Travel Insurance Question when one person didn't go

[Squadleader]

My son came down with appendicitis the day before our cruise. My ex-wife stayed with him and handled that.

 

My question is, does the travel insurance pay the $399 fare (third person in cabin fare) or do they pay 1/6 of the total fare for all of us (equal to about $800 per person)?

 

I'm wondering if the travel insurance company will try to pay $399 instead of $800. Before I call and make the claim, I was wondering if any of you had ever dealt with this particular issue before and what the outcome was?

 

The company is Travel Insured International.

[coevan]

have you called them and asked? When we book through insuremytrip.com it makes us lists all travelers and age

[msmayor]

As the PP said, you should call and ask...but it is likely that the reimbursement will be based on the $399 fare.  You will be required to provide receipts, and if he is listed as the #3 or #4 person on the booking, then the reimbursement may be based on the rate paid for that person.

 

Insurance is designed to make you whole, not provide more than you would have paid had your son not been booked at all.

[tallnthensome]

I would ask this in the travel insurance forum as its not Carnival related.

https://boards.cruisecritic.com/forum/499-cruisetravel-insurance/

[Squadleader]

I haven't called yet because I just wanted to see if anyone else had run into this before I talked to them. 

 

I've never made a claim before, so I'd never really thought about this aspect of it. Technically he just happened to be listed as a third passenger at the discounted rate of $399, he could just as easily been listed as a first or second in the cabin at the much higher rate though. However if I take the total of everyone, then divide by the number of people, it comes out to $800 per person.

 

I can see where this could turn into an argument with them, so I just wanted to see others experience.

 

I now realize the argument could be the cheap fare, or the average of all the fares, and if he had been listed as a first or second passenger, even that very high fare.

 

That this question could arise never even occurred to me when I bought the insurance. I realize now it should have, if I had thought about it.

[Squadleader]

I'm not looking for a profit, but making me whole would be 1/6 of the group cost, but I can see a reasonable argument on both sides of this. In the end I'm pretty sure it will break against me though, let's face it, their lawyers write the agreement, and they have been doing it for decades, so if there's any leeway, the lawyers have figured it out and tilted it towards their client, the travel insurance company. Everyone looks at the cut and dry issues, the real opportunity for the companies is in the exact wording of little things like this that can dramatically improve their bottom line by limiting the coverage.

 

Thanks for the tip Tallnthensome, I didn't know there was a travel insurance forum.

[cruisinmeme]

Want you be filling on your wife also. It seems she didnt go on the cruise.  It want be much of an argument. The amount you get back will be what is listed beside his name, and if wife missed the cruise what is listed beside her name.

i very recently had to file a claim (cancelled 3 days before the cruise) cruise line refunded the tax, port charges and prepaid gratuities. In strange sent checks for both of us that missed the cruise.

[Squadleader]

Thanks Cruisinmeme, my ex-wife wasn't booked, so it's just for my son.

 

Carnival did refund the taxes and port fees like you said. 

 

It'll be interesting to see how this plays out.

 

There can be a huge difference between the first and second passengers, and the third and fourth passengers, that could be thousands of dollars depending on the circumstances. Say it was a very expensive cruise, $2,500 for 1st and 2nd each, then third and fourth free. If you happen to list the person not going in the 3rd or 4th you get nothing, whereas if you had listed them as 1st or 2nd you get $2,500. 

 

Using that example, it's easy to see the fairest way to do it is to divide the number of people on the policy by the total fare.

 

If it's based on the listed fare for that particular person, then how you list your family turns out to be very important, and it's possible there's no coverage at all for third and fourth passengers in a room if there fare was free.

 

But I can tell you anyone traveling with a large family like me, considers the cost per person by dividing the cruise cost total by the number of people.

 

I'm going to call them on Monday, so it'll be interesting to see over the weekend,  if any other members have faced this before and what happened. If no one has run into this, I'll be sure and let y'all know what the insurance company says.

 

If someone is more prone to sickness in your family, better list them as a first or second!

[bahacca]

Check the policy you got in your email. Mine has the total amount divided evenly amongst the 4 of us on the policy itself. I have to go to the last page way at the bottom.

[Squadleader]

Well Bahacca, you inspired me to dive into all 35 pages (probably a bad sign) of the policy. The policy never addresses if only one person doesn't go. 

 

There were six of us, and by each name is listed $1,000 as the individual limit. Then on the schedule of benefits it says it pays 100% of trip cancellation and 150% of trip interruption. So since he never actually left to go because of illness, I'm assuming it's trip cancellation. The asterisk  after the 100% notation says "up to the lesser of the trip cost paid or the limit of coverage on your confirmation of benefits".

 

So it seems to say what it actually cost, up to $1,000 each. 

 

So whether it's $400 which is the third passenger rate, or $800 which is the total fare divided by all six of us, it would be under the $1,000 limit. 

 

The policy is completely silent on is the cost what's listed for that specific passenger, or the total fare divided among all six. It just says the "trip cost paid" and doesn't define how to calculate that if only one person doesn't go. 

[tonit964]

I think they will reimburse the 1/3 total fare paid. When you purchase the insurance, it will ask for the total paid for all travelers. Not broken out for travelers 1 & 2 and 3.

When there was three of us going together, that's how the insurance was purchased, total fare for all travelers.

[NautiGirlGA]

I look forward to seeing what the final outcome is. Hope your son is feeling better. 

[GeezerCouple]

<snip>

2 hours ago, Squadleader said:

The policy is completely silent on is the cost what's listed for that specific passenger, or the total fare divided among all six. It just says the "trip cost paid" and doesn't define how to calculate that if only one person doesn't go. 

 

I think this is not a case of it being "completely silent".

 

IF there is a line item for each person, showing what that person's fare cost, then.... that is what that person's fare is.  And that is what would be covered.

Otherwise, *everyone* in this situation would claim the "highest" person's fare, and that would not be how the total coverage would have been calculated, because not everyone actually paid that fare.

 

IF there is some other listing elsewhere on the forms, that might be different.

But we've had many policies with TI, and (unfortunately) several claims.  This situation almost came up, so we asked.  But because we didn't in the end cancel, we don't know exactly what would have happened.  We assume that insurance would reimburse for the amount actually PAID for someone cancelling (or interrupting) as shown on the "receipt", which would be the booking confirmation.

 

GC

[Squadleader]

Thanks NautigirlGA my son is 15, so he was only down for a few days, and after that, like it never happened. Oh to be young again and to heal like a Greek God!

 

Thanks GeezerCouple, that was my thought too at first, I hadn't ever thought about it before and figured they had me because he was by chance listed as a discounted third passenger ($400).

 

But think about it. Many times I've run into fares where the third and fourth were "free". Is it really fair that the insurance pays nothing just because someone happened to be listed as third instead of first or second?

 

You don't buy this insurance thinking it's possible third and fourth aren't covered at all. On the other hand, like you said, it isn't fair for the insurance company to pay the much higher first and second either, if it's them that makes the claim. Really the only fair way to do it is to divide the total fare by the total people covered, and then pay that amount. That's fair to the customer and the insurance company. 

 

If the company will only pay the fare listed by the cruise company (low third and fourth, high first and second) then they are agreeing in some cases to give much higher (could be thousands more) single payout on first and second and in other cases paying absolutely nothing (in the case of third and fourth being listed as free).

 

When you consider it that way, it makes no sense at all to use the fares listed by the cruise company individually, but instead the average of all the fares together. That's fair to both parties.

 

You're also right about the policy being silent, it's not, you can bank on that, it's in there somewhere, written in some obtuse way that I'm not able to see. 

 

Just like the medical coverage, since Obamacare, we now only have one policy to choose from in our area. I have a $13,600 deductible for the whole family. I have to pay every nickel of the cost until I hit that number. 

 

So obviously his operation went way past that. Since his operation happened the day after his trip coverage started, I thought there might be a chance the travel insurance might pay the medical up to the $13,600, where the regular medical policy kicked in. 

 

Turns out the language in the travel policy says the beginning date of the travel insurance doesn't mean anything. The coverage doesn't begin until the "first travel arrangement", which in their opinion is not when the policy start date is, and is not when you get in the car to begin the journey, it's only when that "first travel arrangement" begins, which is when you board an aircraft or board the ship. 

 

So we drove down three days early, stayed in hotels, had his medical issue, but according the travel insurance company that period had no medical coverage because we hadn't boarded an aircraft or ship.

 

That's the point I'm making, yes they will pay clear cut cases, no doubt. But they've been doing this for decades, and have figured out all the language to use in policies to exclude anything but clear cut cases. It's a great business model from their point of view. I'd bet overall they lower their total payouts companywide by a third or more by using obtuse language to limit their coverage to only clear cut claims.

 

Ok, I get it, they clearly have the advantage and I'm not going to complain too much because to me, and maybe most people, the real reason we buy this policy is to pay overseas medical costs and the possible crazy cost of medical evacuation, especially if an air ambulance is required. But you'll also note even that coverage has lots of exclusions, terrorism, exotic car rental, many shore excursion things like waterskis, zip lines, scuba, a whole long list of things that void your coverage. Imagine having an accident while doing any of those things and suddenly you're faced with no coverage at all for medical or evacuation. I'm telling you, they definitely have this thing figured out and are excluding a very large percentage of their possible claims. 

 

In the end, me arguing with the insurance company over whether my sons trip cancellation claim is worth $400 or $800, is more an intellectual exercise than any sort of financial necessity. I'd be way more concerned if I had a $100,000 incident overseas, which as noted, has a decent chance of being excluded as well because of the many exclusions in the policy.

 

I really believe the true liability risk, and the real reason to buy this insurance is the overseas medical and evacuation. For that reason I'd encourage people to read what activities are excluded from coverage, and not engage in any that are if you want the coverage. Just a note, in my research before buying the travel insurance, I found there were very wide differences in what different policies paid and covered. I found a policy that had $500,000 in evacuation coverage and $100,000 in medical coverage. There are also some policies designed for people who want to do more adventure activities like water-sports, zip-lines those sorts of things. 

 

Bottom line is make sure you read the list of activities that are excluded from coverage, that's the whole point of buying the policy, having the coverage. Most of us do at least a few things on a cruise that will not be covered. I'm older, so I have no problem cutting out any of these activities, if I know they are excluded, younger families, maybe not. Maybe they need the adventure policy instead.

 

 

[klfrodo]

Either way, just know that if you adamantly disagree with what the insurance company says, you have a backup. You can always appeal the decision to your States Insurance Commission. They are the people you voted in to regulate any and all insurance policies sold in your State.

If the insurance company says" we interpret our policy to say this" and you interpret the policy a different way, then contact the Commission.

[Squadleader]

Thanks Klfrodo, I appreciate that, but I think the medical coverage is clear after the insurance company pointed pointed it out, that the coverage doesn't start when the policy starts, it only begins with your first travel arrangement, which they define as a common carrier, so I don't think it's worth going to the state about it. By using the right language, obtuse to the uninformed like me, but clear once it becomes a claim issue, the insurance company is able to exclude all but obvious coverage. It's home field advantage, their lawyers wrote the policy.

 

This incident has had the benefit of making me aware of how many common activities are excluded, and therefore, I should make sure my group doesn't engage in them, in order to keep the insurance coverage.