How to get your policy to cover you — special circumstances and all

By | February 26th, 2017

“I’m at a loss,” Bill Dunn wrote to me recently. “I’m looking for advice on how to appeal a decision against my travel insurance claim.”

The problem: Dunn had bought travel insurance for a recent trip to see his nephew get married. Six weeks before his departure, he lost his job.

“Being unemployed, I can no longer afford to make the wedding, so I canceled my flight and asked for a refund,” he adds. He filed a claim with his travel insurance company, but was denied.

The reason? He hadn’t been employed long enough. He’d been on the job 15 months, but 6 of them were through an employment agency. His insurance required 12 months of full-time employment.

Gotcha!

Cases like this come through here every day. In our five-part buyer’s guide on insurance, we’ve taken a closer look at the most common special circumstances, how insurance handles them, what insurance covers, and what happens when circumstances change on your trip. Today, in the final installment of this series, we look at how to handle a claim.

Dunn’s case is still in progress, and I’m optimistic. Yet even if he didn’t contact our advocacy team for assistance, he could have reached out to his travel insurance company — I list the names, numbers and email addresses on my consumer advocacy site — and filed a formal appeal. The employment clause really seems like hair-splitting, and his insurance company should have been able to cover him. (If you’re still out there, Bill, please let me know — I’d love to help.)

All of which brings us to the matter of appeals, a part of the insurance mystery that insurance companies understandably are reluctant to talk about. Why? Because if they told us exactly how they decided their appeals then we’d win every one.

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Appeals are normally reviewed by a group of adjusters at a senior level. Their goal is to make sure nothing was overlooked by the first adjuster. This process can take as long as the initial claim, so give your company at least a month for a decision.


The adjusters have a surprising amount of flexibility. For example, I’ve seen cases like Dunn’s overturned on appeal, which is to say the insurance company honored the claim. And think about it: Technically, he was on the job more than a year.

The employment agency loophole really seems like an excuse to deny the claim, and honoring Dunn’s claim may not meet the requirements of his insurance down to the letter, but they more than meet the spirit. A senior claims adjuster probably would see that.

And what if the answer is “no”? Well, you only have one shot at an appeal, normally. After that, you have to ask a higher authority for help. (I offer a full examination of the appeals process in my frequently asked questions about travel insurance.)

Call your agent.
You can send a brief, polite email to your insurance agent or travel agent — whichever is appropriate — notifying them regarding your rejection. Agents often can and do act as intermediaries when something goes wrong with a policy. Remember, they took a commission on your policy, and they have to be licensed to sell the policy, so they have some skin in the game.

Contact the authorities.
Contact your state insurance commissioner. Your insurance commissioner may be able to help if your claim was rejected without cause. To find your insurance commissioner, visit the National Association of Insurance Commissioners site. Some travelers have reported that their claims were honored simply by copying their state insurance commissioner on their appeal.

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Contact your Better Business Bureau.
You’ll want to copy your agent and insurance company. The BBB is known to investigate claims of this nature, but it has little sway over the final outcome of your appeal.

If none of these steps work, you can take the agent or your insurance company to small claims court. You don’t need an attorney to go to small claims court, but there’s a limit on the claim amount. Typically, this is your last resort. If your agent or insurance company prevails in small claims court, you are usually out of options.

When it comes to travel, everyone’s circumstance are special. In a perfect world, you’ll never have to file a claim, not to mention an appeal. But if you do, it’s useful to know what is — and isn’t — typically covered.

A close look at your policy might pleasantly surprise you at how much you’re covered. And if the surprise isn’t positive — well, you know where to find me.



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