Help filing a claim

[SchnauzerPup]

After almost 30 years of regular cruising and ALWAYS having travel insurance (with the same provider) DW and I are needing to file a claim for the first time ever.

 

We have submitted all documentation requested including notarized statements by doctors, receipts, you name it.

 

They keep asking for more and more intrusive, personal, and in my mind unwarranted and unrelated information.

 

I am beginning to believe they are not acting in good faith.  It feels they are just trying to make the process so painful or intrusive, or hoping we won't do some little thing incorrectly.

 

Is there such a thing as an agent or expert that can help negotiate on our behalf and act as our advocate?  The TA is doing her best but I think I need an expert.

 

[klfrodo]

who sold you the policy?

They made a commission on the sale of that policy. It's that person's job to help you to completion.

 

You can reach out for help from your State Insurance Commissioner. Every policy sold in the US is regulated by each individual state. They could be of assistance.

[Jersey42]

50 minutes ago, SchnauzerPup said:

They keep asking for more and more intrusive, personal, and in my mind unwarranted and unrelated information.

Was the claim for medical or for cancelation/interruption for medical reasons? Did your policy have a waiver of pre-existing conditions clause?  Many do if you insure the full non refundable amount of your trip and purchase the insurance within X days of you initial payment.

 

If you did not have a pre-existing conditions waiver, then some companies will ask for lots of seemingly unrelated information in an attempt to confirm or deny benefits due to a pre-existing condition.  

 

@klfrodo gave you some good advice.  If you purchased insurance from your TA and they can't help, you might want to take a different approach in the future.  Look at insurance brokers who offer claims assistance.  I have had good luck with tripinsurancestore.com.  They are a small outfit with excellent personal service.  Steve ( @iamtrustworthy) has helped a number of people, including me, in the past.  There are also other online brokers mentioned frequently on this forum.

 

Good luck and let us know the results.

[GeezerCouple]

2 hours ago, SchnauzerPup said:

After almost 30 years of regular cruising and ALWAYS having travel insurance (with the same provider) DW and I are needing to file a claim for the first time ever.

 

We have submitted all documentation requested including notarized statements by doctors, receipts, you name it.

 

They keep asking for more and more intrusive, personal, and in my mind unwarranted and unrelated information.

 

I am beginning to believe they are not acting in good faith.  It feels they are just trying to make the process so painful or intrusive, or hoping we won't do some little thing incorrectly.

 

Is there such a thing as an agent or expert that can help negotiate on our behalf and act as our advocate?  The TA is doing her best but I think I need an expert.

 

 

What types of "intrusive" quetiona are they asking?

I've read here on CC some complaints about being required to submit medical records or to give permission for the travel insurer to contact the medical provider.  If it's a claim based upon a medical problem, then the insurer absolutely has the right to documentation showing that the claim is valid (e.g., not a pre-existing condition IF that was excluded; a physician was indeed consulted at the time; generally, that there's no fraud; etc.).

 

klfrodo gave good advice.  That's part of the service that a travel insurance broker provides (and purchasing through one does not cost the travel any extra).

 

On rare occasions (not with travel insurance), we've mentioned that if <whatever> isn't resolved in a timely manner, then we would have no choice but to contact the <state agency> for assistance, although we'd definitely prefer not to need to deal with that.

 

And make *sure* that you aren't objecting, or being slow to provide, any documentation that the insurer does in fact have a right to see to determine the validity of the claim.  They might be needing to "keep asking for more" information if you are only parcelling out bits and pieces because you think it's "intrusive".  They ONLY want that information to determine validity of your claim.  With the number of claims that must be flying in these days, I suspect they just want to dot all the "i"s and cross all the "t"s, get your claim fully processed, and move on to the next.

 

Which travel insurer is it?

We've used Travel Insured, and IIRC, they've never requested that the physician documents be notarized.  Perhaps things have changed?  Our last claim, when very elderly MIL got very ill just before we were scheduled to fly to Europe for our cruise, was about 3 or 4 years ago.

 

ETA:  Regarding what Jersey42 mentioned, and perhaps for your future consideration IF relevant, is that we always get coverage that does NOT exclude pre-existing conditions.  Aside from that making coverage/payment easier/more likely, it also means that the insurer does *NOT* need to review ANY of our prior medical records.  None of that would matter. All that would matter would be the *current* situation, be it medical or otherwise. So at the most, all they'd need would be documentation about the actual medical event that caused the loss.

 

GC

Edited January 5, 2022 by GeezerCouple

[SchnauzerPup]

Thank you all for the informative and insightful information.

 

The insurer in question is AIG.

 

My wife's mother was hospitalized after a surgical procedure that went awry ( she is doing better )

 

As a direct result of dealing with that situation my wife had stress induced dangerously elevated blood pressure, chest pains, anxiousness, and other issues.

 

Her physician has attested to all of this and we have provided full documentation.

 

The issue is that AIG is demanding the medical records for her mother and that, to me, seems like an overreach.  We have asked her mother and she does not feel comfortable sharing those records.

 

The documentation from my wife's physician as to the nature of the symptoms, the fact that they were not pre-existing, and that the trip was cancelled based on her medical advice seems like it should suffice.

 

Perhaps I am incorrect and their request is typical.  If so please let me know.

 

Thank you and regards

 

RKM

[klfrodo]

32 minutes ago, SchnauzerPup said:

 

 

The issue is that AIG is demanding the medical records for her mother and that, to me, seems like an overreach.  We have asked her mother and she does not feel comfortable sharing those records.

 

This is NOT overreach. Your policy covers you for issues with non-traveling family members. Therefore, the insurance company has the obligation if not the right to review her medical records.

 

Of course, you and she have the right not to comply. Then the insurance company has the right to deny any and all claims and close the case.

[Babr]

Klfrodo is correct that some policies include pre-existing conditions even for family members that are not traveling with you. It may be that is why they are asking for her mother’s records since it was her mother’s condition that precipitated your wife’s health problems which in turn caused the cancellation.

 

It is a complex issue, but another look at your policy’s pre-existing conditions clause might explain it.

 

 

[GeezerCouple]

It sounds a bit complicated...

 

It might be possible that IF you had only had your wife's physician state that travel wasn't possible due to HER (your wife's) medical situation, and provide documentation, that alone would have been enough.

That's just a guess, whether the insurer would have found the situation was covered.

 

But you apparently linked her condition to her mother's condition.  Once you put that in as a factor that caused you to cancel, yes, it seems they would have the right to get documentation about your claim about her mother's condition.  

(I *do* understand the problem.  Has your wife's physician stated clearly that your wife was too sick to travel regardless of *why* she was sick?  That the claim is NOT based upon her mother's illness?  Perhaps AIG is only considering it as "not traveling due to family member's illness", rather than due to the *traveler's* illness?  Have you and the physician made this completely clear?   I'm not sure how this would be handled once you link her mother's illness to your wife's claim.  If your wife was "too sick to travel", it would seem that would fit the coverage, so mentioning her mother may have confused things?)

 

However, to get the coverage, an insurer needs to to document that the grounds are as described, and signed by physicians, etc. - including the mother's condition.

No one is interested in any personal details, and they don't care who the person is.

(Is the mother someone famous where there is a concern that someone actually might "blab" about her medical situation?  No, that should NOT happen, but at least it might be more understandable as to why one wouldn't want to provide the records to an insurer.  Otherwise, the insurers are no doubt swamped these days, and it is so unlikely that anyone is going to pay any extra attention to medical records for some person they never before heard of.  They'll want to move on asap to process the next claim... and the next claim... and then the next.....)

 

I'm also still surprised about the requirement that the medical forms be notarized.  We've filed several claims, including some large ones, and the physician had to sign, including acknowledging penalties for fraud, the same as we did.  There was no need to notarize any of our claims, small or large.  Does AIG do this for all claims?  Or is there something specific about this claim that we don't know about?

 

Did you get the insurance through an insurance broker?  This would be the time to ask them to step in to assist, which is part of what they are paid to do when needed.

 

GC