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.

  • sirwired

    The initial denial makes sense, even if it isn’t particularly customer-friendly. It’s the claim examiner’s job to find reasons to deny claims, and making assumptions unfavorable to you (e.g. “The doctor didn’t say the pain WASN’T too bad to travel.”) is part and parcel of that.

    When filing a claim, you need to check the exclusions, and if something might lead to a claim denial, make sure part of your documentation shows why it shouldn’t.

  • Lindabator

    which is why I always fill the initial claim out for my clients – and even go so far as checking off what the doctor needs to correctly, with a sticky note explaining why for the doctor – goes much more smoothly

  • SierraRose 49

    Another couple was going to join us on a Viking cruise. Unfortunately, due to ongoing back issues that “flared up,” with the wife, they decided to cancel. Like you Lindabator, our travel agent who handled the entire trip for all four of us came to the rescue. He did exactly what you did – contacted the insurance company, filed the initial claim and told the doc (via phone and sticky note) what he needed to do to help process the claim. And yes, they got their $$$$ (not vouchers) returned. This is why an experienced, knowledgeable, helpful travel agent – not an OTA, but a real, live person – can be invaluable when planning, booking and spending big bucks for a trip – especially an overseas adventure.

  • The Original Joe S

    You are spot-on! They will try to weasel out if they can.
    My mom was sick, and the military insurance [ CHAMPUS at the time I believe ] would routinely DENY payments. I got the manual, and told Dad to copy the section on her particular affliction into the claim form so that the min-wage moron processing the claim could see that the claim read EXACTLY as the regulation did. No more denials.

    Read the policy, and get help in filling out the form, as LINDABATOR below says.

    Like cockroaches when you turn on the light, they are scurrying away when the pressure gets turned on…….

  • cscasi

    “It is typical for a cancel-for-any-reason policy not to pay cash”.
    The travel insurance company I use has a cancel for any reason clause (pays 75% of the prepaid costs that are not recoverable) and I used it last year when I canceled a trip because I did not feel well enough to go. I cancelled my trip and the company paid me 75% of the cost I had paid out for my trip, less what I recovered from cancelling various items I had paid for; i.e. seat reservations on a TGV train (I got back 80% from the train company and my insurance covered 75% of the 20% I lost). It also paid 75% of the “change fees on my airline tickets (Of course it did not pay me cash. It deposited the amount into my bank checking account via the Automated Clearing House (ACH). I did not get “vouvhers”)
    I am just bringing this out because one should check out various travel insurance companies and see what their policies offer; what’s covered or not and what stipulations they contain.

  • sirwired

    1st-party cruise policies are the ones that normally issue vouchers (usually the CFAR rider isn’t “insurance” covered by an underwriter, it’s a “waiver” covered by the cruise line.) There are some 1st-party policies that issue cash (HAL), but those are rare.

    3rd-party CFAR is insurance all the way.

    I think TripMate sells 3rd-party coverage, but they are mostly a claims processor for 1st-party policies.

  • Steve Rabin

    I definitely would not buy coverage from the travel provider. Even if it is on the up and up, it seems it’s a case of the ‘fox guarding the hen house’. I would much rather purchase 3rd party coverage.

  • sirwired

    There are certainly limited circumstances where it makes sense to purchase a 1st-party policy. For instance, if you are elderly, the cost of a 3rd-party policy can be prohibitive, and 1st-party policies are not priced by age. And if you want a 100% CFAR rider, no 3rd-party policy has one.

  • ArizonaRoadWarrior

    “It is typical for a cancel-for-any-reason policy not to pay cash”.

    This is usually correct IF someone buys a “policy” or a “travel protection plan” from the travel provider (i.e. tour operator, cruise line, airline, etc.).

    If a traveler buys a travel insurance from a site such as Squaremouth, InsureMyTrip, etc, those policies pay CASH.

    I just did a live chat with Matthew, a licensed insurance agent from InsureMyTrip. I asked him the following question: “Is it typical for a cancel-for-any-reason policy not to pay cash but to offer a voucher for future travel?” He responded back with “Only the travel suppliers such as cruise lines offer vouchers with their “cancel for any reason” coverage. Our policies offer cash reimbursement with that benefit, if you qualify.”

    For years, I have commented on this site about the differences between Travel Insurance Policies from companies like Squaremouth, InsureMyTrip, etc. and the ‘Travel Insurance Policies’ and Travel Protection Plans from travel providers (i.e. airlines, cruise lines, tour operators, etc.). One difference is it is very common that payment is a voucher, credit, company scrip, etc. instead of CASH from plans from the travel providers.

    I can still recall a story of an older gentlemen who purchased a $ 8,000 tour and he purchased a ‘travel insurance policy’ from the tour operator. The man became ill and his new health condition prevented him from traveling anymore…he received a $ 8,000 credit but the credit is NOT transferable to anyone else. In the words, he lost $ 8,000! What a rip-off!

  • ArizonaRoadWarrior

    You are a smart traveler…you probably purchase your policy from a site like Squaremouth, InsureMyTrip, etc. where those policies pay CASH!

    “PoliciesPlans” from travel providers usually pay company scrip, voucher, credit, etc. for future travel. Those policiesplans are written to benefit the travel provider not the traveler. I can still recall a story of an older gentlemen who purchased a $ 8,000 tour and he purchased a ‘travel insurance policy’ from the tour operator. The man became ill and his new health condition prevented him from traveling anymore…he received a $ 8,000 credit but the credit is NOT transferable to anyone else. In the words, he lost $ 8,000!

  • ArizonaRoadWarrior

    I totally agree. Those ‘policies’ or ‘plans’ are written to benefit the travel provider not the traveler.

    We went on a tour to Europe and we received a free travel protection plan since we were AAA members. The normal cost was $ 78 for this protection plan. When I read the details of the plan, it was a joke. We ended up purchasing a policy from Squaremouth or InsureMyTrip.

  • ArizonaRoadWarrior

    Insurance is based upon risk. If you remove the ‘age risk’ from the equation…the younger travelers are subsidizing the older travelers by paying a higher premium OR they reduce the benefits and/or payout. If they don’t do one of these two items, they are going to lose money.

    In regards to our European tour, do you think that $ 78 is going to cover a tour that we cost us $ 7,000? After we read the free ‘travel plan’, it didn’t cover anything worthwhile. We purchased a plan that cost around $ 300 that had real benefits for us.

    You are right about the 100% CFAR…75% of cash is better than 100% of a vouchercredit that you can’t use. I can still recall a story of an older gentlemen who purchased a $ 8,000 tour and he purchased a ‘travel insurance policy’ from the tour operator. The man became ill and his new health condition prevented him from traveling anymore…he received a $ 8,000 credit but the credit is NOT transferable to anyone else. In the words, he lost $ 8,000!

  • Annie M

    It’s all based on how thoroughly your doctor completes the claim form. Your doctor apparently didn’t do it properly the first time but you can always appeal a decision and follow up with proper paperwork

  • Michael__K

    “It’s the claim examiner’s job to find reasons to deny claims”

    Actually, it’s supposed to be the claim examiners job to faithfully apply and honor the policy contract and to ask for additional information if that is needed to reach a determination.
    According to the article, the claim originally was denied under the 60-day pre-existing condition look-back period, not based on passenger’s inability to travel at the time of purchase. With the slightest amount of due diligence, the examiner should have known that the policy was purchased within 14-days of booking.

  • Michael__K

    The flip-side is that the cash payments for CFAR policies are often 50% of the trip cost (so you still lose half of your money). Some costlier policies pay as high as 75%.
    Coverage with vouchers is generally for a higher percentage of the trip cost, in many cases 100%. Of course the potential pitfalls as observed here are the expiration date and non-transferability.

  • Michael__K

    All policies and plans (even if they are on Squaremouth or InsureMyTrip) are written to benefit the seller of the plan first and foremost.

  • sirwired

    If you read the end of the article, the insurance company explained that they were under the impression the policyholder was unable to travel at the time of purchase. (Which put them under the exclusion for the pre-ex waiver.) While the article spent a lot of time talking about the pre-ex exclusion, and how they should have had a waiver, the insurance company thinking they didn’t have a waiver does not appear to have been the source for the denial.

    I don’t know if that was a mis-communication between the insurance company and policyholder, or if something got mis-translated between the OP, the author, and the article. (It wouldn’t be the first time.)

  • Michael__K

    That was how TripMate justified itself at the end, yes.
    But given the customer’s and the advocate’s first impression, and given how long it took to resolve this — in the customer’s favor, because they were indeed fit to travel at the time of purchase — it seems unlikely that the insurer disclosed up front that they had determined the customer was not fit for travel at the time of purchase.

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