Back pain caused me to cancel my cruise. Why won’t Trip Mate pay my claim?

Pamela O’Meara books a cruise, but has to cancel her vacation for a medical reason. The trip insurance she bought won’t cover her cancellation. Can our advocates help get the insurance company to pay her claim?

Question: A friend and I booked a Viking ocean cruise through AAA. We purchased trip insurance within 14 days of booking, from Trip Mate, through the AAA agent.

I never saw the policy but know it was supposed to cover cancellation for any reason, including medical reasons. I had a back problem flare-up and was unable to take the trip. We canceled the trip and have been trying to get a refund ever since.

My doctor sent Trip Mate many letters and made many follow-up calls, but they won’t issue a refund. Trip Mate finally gave us vouchers for another trip, but they will expire before I’m able to travel. We spent $7,246 on the trip. Can you help us just get our money back? — Pamela O’Meara, Arden Hills, Minn.

Answer: I’m sorry that you experienced a back problem and weren’t able to take your cruise. By the time you contacted us for help, you had been trying to resolve this for six months. The problem was that Trip Mate considered it resolved, but you didn’t.

It seems that when your doctor sent the medical documents to Trip Mate, he indicated that you had been treated for the back condition in the 60 days preceding your purchase of trip insurance. Being treated by a doctor prior to the date of the policy, for a condition that becomes the medical reason you can’t travel, makes it a pre-existing condition. A pre-existing condition is commonly excluded from insurance coverage. You didn’t see the policy you bought, and you may not have been aware of the exclusions. It’s very important to get a copy of the policy and read it to ensure that you understand it.

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Because your policy also covered cancellation for any reason, you thought that the medical reasons affecting your trip were moot. You asked us if you couldn’t “just get my money back.” The insurance company will only act in accordance with the policy that you purchased. Being able to cancel for any reason doesn’t necessarily mean that you get a refund for the cost of your entire trip.

It appears that Trip Mate processed your claim under the cancel-for-any reason terms. Normally, this only covers a portion of the value of the trip, which is applied as a credit toward a future trip.

It is typical for a cancel-for-any-reason policy not to pay cash. The vouchers for a future cruise that Trip Mate issued to you seem to have been consistent with a policy of this type. The fact that you couldn’t use the vouchers prior to expiration doesn’t affect Trip Mate’s obligations under the policy.

But, a further review of your policy revealed that you should not have been denied a refund due to a pre-existing condition. You bought the policy within 14 days of booking the trip and were not disabled at the time of payment.

Again, this is where reading and understanding your insurance policy is important. Under the Cancellation Penalty Waiver provision of your policy, Trip Mate does not cover any loss due to,arising or resulting from:

a Pre-Existing Condition, as defined under the Cancellation Penalty Waiver Definitions, unless: a) your payment for this plan is received within 14 days of the date your initial payment or deposit for your trip is received; and b) you are not disabled from travel at the time your plan payment is paid.

Before you asked for help from our advocates, you could have posted your question to our help forums. Our help forums are staffed by travel industry experts, who may have had helpful suggestions about how to address this issue with Trip Mate. And, you could have tried to contact company executives for assistance. We list executive contact information for Trip Mate on our website.

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Our advocates reached out to Trip Mate and asked it to take another look at your case. Trip Mate informed us that it had received additional medical documentation from your physician that clarified that you were not disabled at the time you bought the plan. And therefore, you met the policy requirements for a refund.

Diane Perera

Diane and her family love to travel, and they do so as much as they can. Having experienced the downside of travel, and having learned so much from, led Diane to become an advocate and to help fight the good fight. Read more of Diane's articles here.

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