Will Allianz pay claim after mom in hospice care takes a turn for the worse?

By | September 29th, 2016

Mary Rosenthal’s mother has been in “slow decline” for years. But when there was a period in which her health seemed to be stabilizing, Rosenthal thought she could get away for a vacation.

Then her mother’s health took a turn for the worse and Rosenthal had to cancel her trip. Now her travel insurance company is stonewalling her on her claim for reimbursement of her airfares.

Rosenthal had booked a trip to Ireland by way of Boston, where she planned to meet a friend, and insured the Boston portion of the trip through TravelGuard, a division of AIG. She took out a policy from Allianz to cover the remainder of the trip to Ireland.

But several weeks before the trip, Rosenthal’s mother, who is in hospice care, took what Rosenthal terms a “precipitous downward turn.” Her doctor informed Rosenthal that “it might be a good idea to cancel the trip.”

Rosenthal canceled her trip on the doctor’s recommendation, filing claims with TravelGuard and Allianz. She sent in her paperwork, including medical forms and physicians’ reports, to both insurance companies. TravelGuard promptly issued her a reimbursement for her airfare to Boston.

Allianz, on the other hand, has requested more and more documentation to determine the extent to which Rosenthal’s mother’s health condition was pre-existing.

It is standard practice for insurance companies to inquire about pre-existing conditions when a policyholder files a claim, so it’s not surprising that Allianz is asking for further documentation about Rosenthal’s mother’s medical condition. And unfortunately, requesting increasing amounts of documentation from the insured is a common tactic used by insurance companies to delay paying claims — as is denying them altogether based on pre-existing conditions.

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But when do demands for documentation by insurance companies cross the line between reasonable claims adjustment behavior and unreasonable stonewalling and delays?

Rosenthal asks, “I learned trip cancellation due to aging family members’ illnesses is becoming more common and that TravelGuard is the only company that will insure in these cases. Is this, in fact, true? How could I have planned this trip and purchased travel insurance differently?”

It could be argued that Rosenthal should have insured her entire trip through TravelGuard, but even TravelGuard policyholders have had problems collecting on their claims, as we’ve recently reported. Or she might have tried to purchase insurance from other carriers, including those listed in the company contacts section of our website.


Rosenthal might have purchased “Cancel Anytime” travel insurance through Access America, the consumer travel insurance brand of Mondial Assistance, which is part of the Allianz Group.

According to Allianz’s website, “Cancel Anytime offers 80 percent cash-back, for virtually any reason, anytime a policyholder cancels their cruise or tour for an unforeseen reason. On average, this plan will cost ten percent of the client’s total trip cost.”

But Rosenthal’s case is not an easy one to advocate. On the one hand, Rosenthal’s mother has been in hospice care for over a year, so Allianz could have a valid claim that her condition was pre-existing at the time Rosenthal purchased her policy. And in any case, a pre-existing conditions waiver, if Rosenthal had it, would apply to pre-existing conditions Rosenthal herself had, and not her mother.

Apparently, Rosenthal did not have coverage of the “cancel-for-any-reason” variety, which would have paid her claim without an inquiry into whether her mother’s condition was pre-existing.

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But on the other hand, denying claims on the grounds of pre-existing conditions has the end result of preventing anyone who was unfortunate enough to be sick, or to have sick relatives, from ever collecting on claims that are otherwise valid, forcing them to absorb large financial losses that the insurance was supposed to protect them against in the first place.

Are insured people who have been sick but are currently well, might become sick or who have sick relatives never supposed to travel so that insurance companies don’t have to pay their claims?

When reading denial letters from insurance companies, it seems that the answer is “Yes.”

Unfortunately, all we consumer advocates can do is warn travelers to read travel insurance policies carefully to ensure that the policies meet their coverage needs — and that even travel insurance doesn’t always help.

Should Allianz pay Mary Rosenthal’s claim?

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Update (9/30): Allianz has responded to this post:

I asked our Claims Department to look into it, they reviewed the documentation and they said they have sufficient information to pay the claim. The Rosenthals should receive a check in 7 to 10 days and we’re sorry for their inconvenience and wish them the best.

 

(10/15): We have since learned from Mary Rosenthal that she has received the reimbursement check from Allianz.



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