After Daniele Spellman learned that her sister, Tessa Loehwing, couldn’t travel after surgery, she canceled their vacation. She thought the CSA Travel Protection (now Generali) insurance policy they had purchased through VRBO would cover their expenses. But she was wrong.
Spellman asked our advocates to help her get their CSA trip insurance claim paid. But our advocates have determined that they can’t help Spellman and Loehwing.
Their story is a warning that insurance companies will not pay claims unless the insured complies with all of their requirements. For medical claims, this includes written records indicating that a doctor personally examined the insured. Phone calls won’t do.
A trip to Maui, interrupted
Spellman and Loehwing planned last February to take a trip to Maui in April. They reserved a studio through VRBO and purchased travel insurance through CSA’s offer on VRBO’s website. The owner required full payment of $2,200, including $581 for taxes, a cleaning deposit and VRBO’s service fee. Spellman and Loehwing also purchased an Allianz travel insurance policy to cover their airfares.
Then Loehwing needed knee surgery.
Ten days later, Loehwing learned that she would have to ask her surgeon whether she could travel in April. Unfortunately, her surgeon told her that she could not travel before mid-May or June. She would not be able to accompany her sister to Maui.
Spellman and Loehwing called VRBO and the studio owner to ask that the dates of their stay be moved forward. But the owner told them that it would not be possible to reschedule their visit. They decided to cancel their trip, but neither the owner nor VRBO was willing to refund their deposit. VRBO’s agent told Spellman that the window for requesting a refund had closed. The owner kept their deposit.
Denied CSA trip insurance claim
Spellman and Loehwing then submitted a claim on their CSA Travel Protection policy with 14 pages of required documentation. They included a letter from Loehwing’s doctor and hospital emails that documented the no-travel order. CSA then requested extensive medical records for Loehwing. Spellman and Loehwing released the records, believing that the request was part of the claim review. They also filed a claim on their Allianz policy and provided the same medical documentation.
Allianz paid Spellman and Loehwing’s claim within a week of their filing it. CSA, on the other hand, took six weeks to review their claim. Then they received CSA’s denial:
According to the information provided, your trip was cancelled as a result of your traveling companion’s sickness. While the plan purchased provides benefits if your trip is cancelled due to an illness, it specifically states, … “SICKNESS means an illness or disease of the body that requires in-person examination and treatment by a Physician.” …
The medical documentation provided indicates that the only communication the patient had with the doctor within coverage was over the phone. As there was no in-person treatment in coverage, unfortunately, there are no benefits payable for your claim.
The denial, says Spellman, felt “like a total rip-off on all fronts.” But was it?
Diagnosed over the telephone
Spellman says that Loehwing’s doctor didn’t see her in person when he informed her that she couldn’t travel. She feels that CSA is wrong because
[the] reasoning for the denial … doesn’t take into account that the doctor has been treating my sister with plenty of documentation and that the exchanges over the phone and on the email thread are explicit as to why the doctor is not allowing the travel to take place. In addition, the surgeon wrote two letters to CSA Travel Protection stating that his restriction on travel was made for a medical reason and the date for that decision.
According to Spellman, CSA did not inform them that Loehwing needed a doctor’s physical examination when they filed the claim.
“Not medically able to travel”
Our advocate, Dwayne Coward, told Spellman that it’s unlikely that she could successfully appeal her claim denial. The policy Spellman and Loehwing provided had a pre-existing condition waiver. This would provide coverage for Loehwing’s pre-existing medical condition if she was medically able to travel when they purchased the policy.
Loehwing’s doctor didn’t physically examine her before issuing his no-travel order. He based the order on an examination that took place a few days before she and Spellman purchased the coverage.
Thus, as far as CSA was concerned, she wasn’t “medically able to travel” when they bought the policy. Even though Spellman didn’t know this until after they purchased the travel insurance, it wouldn’t affect CSA’s denial. But had Loehwing’s doctor personally examined her when he issued the no-travel order, then CSA might have paid her claim.
Spellman and Loehwing’s case is a reminder to read the fine print whenever you purchase travel insurance coverage. Make sure the policy covers any of your existing medical conditions before you complete your purchase. Otherwise, you may lose your travel expenses and your premiums if the insurance company denies your claim. And if that happens, then we will have to treat your case, like Spellman and Loehwing’s, as a Case Dismissed.