Will travel insurance cover my missed tour?

Douro river. / Photo by furibond – Flickr Creative Commons
Question: We are having trouble with a claim we made on our Allianz travel insurance we bought for our recent trip to Portugal with Vantage Deluxe Travel.

A day after we arrived, my husband fell in the bathtub, cutting his left cheek, leaving a huge bruise on his left hip, and injuring his lower back. He could not get out of the bathtub, so a friend came and assisted him.

The next day he missed his all-day tour. On the following day, we both transferred to a riverboat for a seven-day cruise. Our program director went with us by taxi to the ER for X-rays, a muscle relaxant shot, and pain prescriptions.

My husband stayed in the cabin most of the seven days, sleeping on a chair with a stool under his legs. He could not get in and out of bed. We missed many of the tours and incurred extra expenses as a result of his injury.

Allianz agreed to cover $96 for the ER visit and prescriptions. After some haggling, it also covered our minivan transfer, which cost about 350 euro. However, they refused to pay anything for the nine tours my husband missed and the five tours I missed. Can you help? — Carolyn Cluff, Tucson, Ariz.

Answer: A close review of your Allianz policy will reveal that all of those expenses — including your missed tours — would be covered under your policy.

I’ve also reviewed the correspondence between you and the insurance company, and see that you provided your adjuster with more than enough information to document your husband’s condition.

So why did Allianz balk at paying your full claim? I think the main reason is that when an injury like this happens, most travelers would opt to abandon their vacation and return home.

Your husband’s injuries sound fairly serious. I’m not sure the adjuster knew what to make of someone who would go on, despite the excruciating pain your husband was suffering from.

Travel insurance is full of exclusions, but none of them applied to your situation as far as I could tell. The adjuster simply chose not to cover the missed tours.

When a claim like yours is turned down, you should appeal the rejection in writing (I list the names of Allianz’s managers on my customer service wiki). If that fails, you should send a letter to your state insurance commissioner.

None of that became necessary. I contacted the company on your behalf.

“This was an unusual situation in that one member of the traveling party elected to continue their itinerary after the other member sustained serious injuries as Mrs. Cluff has described,” a spokesman told me. “However, upon further consideration, we have decided to pay the claim for Mr. Cluff’s missed excursions as they felt that the situation does meet the terms of his travel insurance policy.”

Allianz has sent you a check for $720, which will cover the rest of your claim.

Christopher Elliott

Christopher Elliott is an author, journalist and consumer advocate. You can read more about him on his personal website or contact him at chris@elliott.org. Got a question or comment? You can post it on the new forum.

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  • http://flyicarusfly.com/ Fly, Icarus, Fly

    Just a question: Had the OP opted to forego the cruise and head home, would the insurance have reimbursed the entire cost of the cruise? If so, that almost sounds like a better deal. Go home, recover, and re-do the cruise at a later date. 7 days stuck in your cabin in pain eating room service doesn’t sound like much of a holiday… That said, Allianz should’ve been happy they didn’t cancel the entire trip and only wanted reimbursement for the excursions!

  • Raven_Altosk

    Translation: When faced with bad press, we decided to fulfill our contract to avoid any further embarrassment of our crappy company.

    Stay classy, Allianz.

  • Kevin Mathews

    I don’t know the OP’s situation, but many times people won’t have enough vacation time to simply redo it once they are better. They would have to wait until the stored up enough again and sometimes that’s not always feasible…

  • Alan Gore

    Now that travel insurance has become the industry’s all-purpose replacement for the antique concept of customer service, it better cover all the odd little situations that used to elicit common courtesy from travel companies.

  • sirwired

    I can see why Allianz would have been confused. If he had gone home, this would have been pretty unambiguous. It shouldn’t have taken Chris’ intervention, but I can understand a first-line claim denial.

    Why didn’t they go home? Just resting in the cabin the whole time isn’t a great deal of fun, and return airfare would have been covered. In addition, they could have gotten the remainder of their cruise days reimbursed on top of the missed-tour expenses.

  • JenniferFinger

    I’m not going to vote in the poll because I don’t know the answer in general, but in this case, it does sound like insurance bad faith. Maybe travel insurance policies need to be rewritten to specially cover or not cover situations like the Cluffs’ so as not to give adjusters loopholes or red flags to deny claims, because it sounds to me like the idea that Mr. Cluff would continue even after his accident threw them for so big a loop that they tried to use it as a loophole, even though apparently they were covered for the lost tours.

  • emanon256

    I am glad it worked out, but agree it should have been covered from the get-go.

    I may be a cynic, but I feel like had the changed their flight and gone home immediately, the insurance company would have been less likely to cover anything. How many times has Chris reported on just that situation and the insurance company finds some way to deny the claim?

    I agree with @google-e5eabf0d11935de7741833b357dae45c:disqus it could have been very hard for them to re-schedule and get time to go on another vacation. I think this is a great OP, so many of them go home and complain about their once in a life time trip begin ruined. This OP still made the most of it and did not come across as complainers. They mitigated their damages, had the most fun they still could, and were very positive. They are truly good people, and I am happy they made the most of their situation and ended up getting justice.

  • KneeDefender

    emanon256 said – “I may be a cynic, but I feel like had the changed their flight and gone home immediately, the insurance company would have been less likely to cover anything.”

    Less likely?

  • Michael__K

    90% of the time Chris writes about a dubious travel insurance denial, the insurer is Allianz (f.k.a. Access America).. They are extremely aggressive with denials — especially if they’re on the hook for a large amount — which leads me to agree with emanon’s cynicism here.

    There’s lots of ways they could have been difficult (and have been difficult in the past) if the couple went home immediately, including:

    * They could object to the return trip costs and argue that they didn’t approve it in advance (even though the contract makes no stipulation that this is necessary).

    * They could object if the OP can’t provide a written medical record (presumably translated to English at the OP’s expense) stating that a doctor explicitly advised the OP to cancel the trip rather than go on.

    * They could argue that the OP wouldn’t have suffered any “serious and irreparable harm” if they didn’t return home immediately to be treated at home.

  • Dutchess

    I think anyone buying and using travel insurance needs to know their needs and read the policy very carefully. Do they have a lot of exceptions, yes, do they have too many? I can’t answer that because if you read your policy coverage statement before you buy you can see what they do and don’t cover.

    I just bought a policy for a trip coming up at the end of the month. I travel with my tablet computer, phones and expensive camera and I know I will be doing some hiking and climbing, I needed to make sure I had a policy that covered all of these things. I found one that worked for me. Had I chose the first policy I found, I would be out of luck, it specifically excluded computers and any type of adventure sports activity.

    I think the other lesson here is don’t give up! From what I’ve read like most insurance their initial response is to deny everything initially and then pay on appeal. This is what really makes travel insurance scamy.

  • pauletteb

    “No” seems to be the standard initial response of most insurance companies, hoping that at least some claimants will accept that as the final answer.

  • Michael__K

    As we’ve seen repeatedly, nothing is unambiguous with Allianz/Access America. Reading their contract literally, unless the doctor who immediately examined them specifically advised them to immediately return home on medical grounds (as opposed to taking it easy and foregoing some tours) then I could see Allianz arguing that return airfare is not covered.

    Aside from that, I don’t see why it’s relevant to us *why* they didn’t go home. Maybe Mr. Cluff didn’t want his wife to miss out on what she could enjoy. Maybe he preferred resting in his cabin to resting at home. Maybe he didn’t think he could endure a long flight until he healed a bit. Maybe (like Kevin Mathews suggested) he didn’t have enough open vacation time to redo the trip in the foreseeable future. Why does it matter?

  • KneeDefender

    “Difficult”? Sure. The insurance company might have been just as unlikely to pay. But, I just don’t see how the company would/could/might have been “less likely” to pay if the couple had gone home.

  • Michael__K

    To the extent that the claim amount might have been considerably higher, they would have greater incentive to put up a fight.

  • KneeDefender

    Oh. OK. I don’t agree – because going home is how most people would deal with what happened to this couple; that’s the SOP – but what you say does seem possible.

  • Carver Clark Farrow

    I wholeheartedly agree. There are any number of reasons why he didn’t go home. We can’t begin to fathom the specifics of his situation, but none are relevant here.

  • http://gspirits.com/ Zod

    Unless you have a medical condition (and yes, old age is a medical condition) insurance is basically pointless in my opinion.

  • Miami510

    A word of caution when considering travel policies. There is often a significant difference between the brochure handed out by travel agencies and the actual policy. It’s not that the brochures are fraudulent, but there are often significant omissions. It’s best to ask for a copy of the policy before purchasing such insurance. Ocassionally the “small print” requires arbitration at some distant place, or has exclusions not mentioned in the brochure.