Question about Trip Insurance Claim

[golfergal]

I'm posting for a friend, so I only have the basic. The person was injured on a cruise and had travel insurance. They were flown back first class and hospitalized in the US. The travel insurance paid for the flight and maybe something for lost days, but I'm not positive about that part. They have a high deductible medical plan, so the hospital stay is being covered under their primary medical insurance, but clearly they are still out-of-pocket about $1,500. There may also be some reimbursement for the out-of-pocket medical costs under the travel insurance, but I'm not sure.

 

While the cruise line hasn't "admitted" any fault in the injury, they have agreed to reimburse the couple for some unreimbursed medical expenses and the lost days on the cruise. Their question is whether or not the travel insurance or medical insurance will try to lay claim to part of the unofficial settlement? I don't think there is an issue on the medical insurance side based on the plan. But I have no experience with travel insurance claim.

 

Thanks!

[RichardK]

I know, second hand and vague, but I can offer this.......

 

Chances are that the travel insurance is secondary coverage regarding their medical expenses. Their "at home" insurance will cover the medical costs, and any deductibles, etc., can then be submitted to the travel insurance as a claim for payment.

 

With two insurances, they should be covered 100% (unless there are any unallowables). Why the cruise line is making any gestures, I can't say, unless they are afraid of a lawsuit and wish to settle and then get releases signed on your friend's part??

 

However, you can't get the deductibles paid by BOTH the travel insurance company and the cruise line. Insurance is supposed to make you whole, not give you windfall profits. Why the offer from the cruise line -- I don't know, but see paragraph above??

[Spikesgirl]

You are asking whether or not the travel insurance company will try to collect some of your friends settlement as reimbursement for their loss - yes? If that's the case, I don't think they can. If you have a burglary, get a check from the insurance company and then sell your house, the insurance company doens't try to get its check back. To know for sure, read the fine print on the insurance policy - it should state there whether or not it expects or demands reimbursement for any settlement due to injury. This is according to the insurance company I was part of for 13 years.

 

IThe adjuster said that if you want a solid answer to this question, ask a lawyer, especially one who specializes in this sort of injury.

 

Charlie

 

Charlie

[golfergal]

Thanks for the input. As I said, I only have a few details and clearly I need more details to help them. There is a subrogation clause in the travel insurance policy, so it comes down to what the policy covers and if there is overlap. I work in the group insurance field, so I know what policies generally state about subrogation and what should/could happen. Their question was a more practical one and if the insurance companies usually subrogate in these circumstances. That depends on the overlap and if the company has a threshold. I couldn't see any reason why this would be different than a settlement from workers' comp or an auto accident.

 

Thanks again for the prompt responses.

[cruiseco]

There is a subrogation clause in the travel insurance policy, so it comes down to what the policy covers and if there is overlap.

 

Subrogation is almost universal in the travel insurance industry and it makes no difference whether it's a primary or secondary insurer.

 

Basically, they're stating that they'll only pay for the insured's actual loss -- if that loss is reduced by a third party (in this case the cruise line) they will reduce their payment by a like amount. Here's one example from Travelex (a primary insurer):

 

"Subrogation: If the Company makes any payment under this policy and the person to or for whom payment is made has a right to recover damages from another, the Company shall be subrogated to that right."

 

But pay special attention to any state-specific amendment riders. There's seven or eight states that do not allow this type of subrogation and others have specific wording that might be pertinent to your friend's situation.

[iamtrustworthy]

I'm posting for a friend, so I only have the basics. The person was injured on a cruise and had travel insurance. They were flown back first class and hospitalized in the US. The travel insurance paid for the flight and maybe something for lost days, but I'm not positive about that part. They have a high deductible medical plan, so the hospital stay is being covered under their primary medical insurance, but clearly they are still out-of-pocket about $1,500. There may also be some reimbursement for the out-of-pocket medical costs under the travel insurance, but I'm not sure.

 

While the cruise line hasn't "admitted" any fault in the injury, they have agreed to reimburse the couple for some unreimbursed medical expenses and the lost days on the cruise. Their question is whether or not the travel insurance or medical insurance will try to lay claim to part of the unofficial settlement? I don't think there is an issue on the medical insurance side based on the plan. But I have no experience with travel insurance claim.

 

Thanks!

 

Hi golfergal,

 

Besides the questions you raise that get into subrogation, it'd be good for your friends to find out if their travel insurance covers them at all in the USA. That's because many plans' coverage ends as soon as you return from your trip.

 

I hope this helps.

[Cuizer2]

You are asking whether or not the travel insurance company will try to collect some of your friends settlement as reimbursement for their loss - yes? If that's the case, I don't think they can. If you have a burglary, get a check from the insurance company and then sell your house, the insurance company doens't try to get its check back. To know for sure, read the fine print on the insurance policy - it should state there whether or not it expects or demands reimbursement for any settlement due to injury. This is according to the insurance company I was part of for 13 years.

 

IThe adjuster said that if you want a solid answer to this question, ask a lawyer, especially one who specializes in this sort of injury.

 

Charlie

 

Charlie

 

Your example is wrong. If there is a burglary and your homeowners carrier pays you, then the thief is caught and the thief is ordered by the court to make restitution, then the homeowners carrier would be entitled to that money. Selling the house has nothing to do with the insurance claim.

 

The answer to the OP's question is in the policy. Read it. If the policy allows the insurer to place a lien on any recovery or if the policy allows the carrier to subrogate, then the insurer can ask for the reimbursement. So, to get an answer to your question, read the policy.