Travel Guard Trip Insurance Fraud

[Subman738]

I took out trip insurance prior to a cruise in Mar, 2022 with Travel Guard to include all medical, trip interruption etc. The first night of our cruise my wife fell and broke her glasses and her right pinkie finger which was going to require surgery. RCI medical staff did a good job of putting a splint on the hand and gave her some drugs for the pain. When the Dr. reviewed the hand the following morning he decided that it could wait for surgery until we returned home instead of having surgery in Cozumel the next day. When we got home I informed Travel Guard about the incident and was told to wait until all of the therapy sessions were completed prior to filing my claim. My wife had her surgery and several therapy sessions. When they were all done I submitted receipts for her glasses and various co-pays to Travel Guard. They came back and said that because the actual expenses didn't occur during the coverage period then they were denying the claim. It in kind of hard to replace prescription glasses in Mexico along with having the surgery and various therapy sessions done in a weeks time. 

[Jersey42]

I feel your frustration, but many polices will work the same way with medical coverage.  They only cover you for the duration of the trip and will not pay for medical expenses after you return home, even though the injury/illness first manifested itself while on the trip.  Unfortunately many people purchase policies based solely on online summaries and they do not understand the details until it is time to make a claim.  In the future, using a good broker or reading the policy can help minimize these problems.

 

Here is the medical language from the Travel Guard Plus plan.  The Premier plan is similar.  If you bought something else, take a look at the wording for your policy. If the exclusion is not in your policy, then appeal again based on what you see.  

 

TRAVEL MEDICAL EXPENSE BENEFIT

The Company will pay a benefit to reimburse the Insured for the Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule or Declarations Page (and after satisfaction of the Deductible) if the Insured suffers an Injury or Sickness on the Trip that requires treatment by a Physician. The Injury must occur or the Sickness must first begin while on a Trip. The initial documented treatment must be given by a Physician during the Trip.

 

Travel Medical Covered Expenses:

The Company will pay a benefit to reimburse the Insured the Medically Necessary expenses incurred for:

(a)   services of a Physician or registered nurse (R.N.), and related tests or treatment; and

(b)  Hospital charges; and

(c)   prescription medication to treat the Injury or Sickness; and

(d)   artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices.

 

The Company will not pay for any expenses incurred after the Coverage Termination Date as shown in the Effective and Termination Dates section of this Policy, regardless of the reason.

 

Eyeglasses are specifically excluded from the Plus and Premier plans as well. Check your plan document to see if yours is different.

 

Baggage Coverage Exclusions

In addition to the General Exclusions, the following exclusions apply to the Baggage Coverage benefit. No benefits will be paid for:

(a) loss caused by animals, rodents, insects or vermin; or

(b) loss of, or damage to, bicycles (except when checked with a Common Carrier); or

(c) loss of, or damage to, motor vehicles; or

(d) loss of, or damage to, artificial prosthetic devices, false teeth, any type of eyeglasses, sunglasses, contact lenses, or hearing aids; or . . .

Edited December 20, 2022 by Jersey42

[GeezerCouple]

Jersey42 has given you a clear explanation of why this is NOT any type of fraud.

Disliking the terms of a policy after you have a claim and find that something wasn't ever included in the first place... that's not fraud.  In this case, it's you not reading the policy thoroughly enough to understand it.  IF you hadn't liked these terms, you could have gotten a different policy, or not gotten any at all (they are probably all similar in this respect, but I'm not sure).

 

And posting this same complaint in 4 places in about 24 hours isn't going to help, either.

 

GC

[iamtrustworthy]

2 hours ago, Subman738 said:

I took out trip insurance prior to a cruise in Mar, 2022 with Travel Guard to include all medical, trip interruption etc. The first night of our cruise my wife fell and broke her glasses and her right pinkie finger which was going to require surgery. RCI medical staff did a good job of putting a splint on the hand and gave her some drugs for the pain. When the Dr. reviewed the hand the following morning he decided that it could wait for surgery until we returned home instead of having surgery in Cozumel the next day. When we got home I informed Travel Guard about the incident and was told to wait until all of the therapy sessions were completed prior to filing my claim. My wife had her surgery and several therapy sessions. When they were all done I submitted receipts for her glasses and various co-pays to Travel Guard. They came back and said that because the actual expenses didn't occur during the coverage period then they were denying the claim. It in kind of hard to replace prescription glasses in Mexico along with having the surgery and various therapy sessions done in a weeks time. 

Hi Subman738,

 

I'm sorry to hear about your experience. I also answered you in the Q & A I'm doing now:

https://boards.cruisecritic.com/forum/2606-qa-cruise-insurance-with-steve-dasseos-of-the-tripinsurancestorecom-november-2022/

 

When your wife fell broke her right pinkie finger, did you contact Travel Guard and whoever you bought your policy from to find out what you had to do when you were still on your trip? If so, what did they tell you?

 

Steve Dasseos