Travel Insurance - Claim denial

[Karthik_s]

Jurisdiction

Maryland

Hello,

Recently, I booked a round trip flights from IAD (USA) to BLR(India) with one stop in London for transit, and also brought a Travel guard AIG insurance along with the ticket. My return flight from BLR to IAD was cancelled because of Covid-19 restriction imposed by UK government. Travel guard AIG helped me to book an alternative ticket with my own money which was in amount of $2100 and asked me to submit a claim. When I submitted the claim, they only have approved for $600, saying COVID-19 restrictions are not covered under their policy.

Do I have a case here?

If the customer representative of AIG doesn't know the details of the policy while booking the alternative ticket, Am I suppose to know the details by myself?

Thanks
Karthik

 

[Zigner]

A case for what?
They are denying your claim because your loss was not caused by one of the covered circumstances.
Did the agent specifically state that you would be reimbursed in full?

 

[Karthik_s]

A case for what?
They are denying your claim because your loss was not caused by one of the covered circumstances.
Did the agent specifically state that you would be reimbursed in full?

I'm not sure, hence I am here.

Travel Guard policy has the word "Quarantined" in bullet point (b). Please see the attached PDF.

According to dictionary "A quarantine is a restriction on the movement of people and goods which is intended to prevent the spread of disease or pests".


Trip was cancelled due to prevent the spread of disease or virus.


Can I reopen the claim based on that?

 

[Zigner]

I'm not sure, hence I am here.

Travel Guard policy has the word "Quarantined" in bullet point (b). Please see the attached PDF.

According to dictionary "A quarantine is a restriction on the movement of people and goods which is intended to prevent the spread of disease or pests".


Trip was cancelled due to prevent the spread of disease or virus.


Can I reopen the claim based on that?

You weren't quarantined.

 

[zddoodah]

Do I have a case here?

No one who hasn't read the policy in full can intelligently assess the validity of your claim.

However, based solely on the wording quoted in the letter you attached, I can tell you the following:

It says that the company will pay up to some unspecified "Maximum Limit" in the event of one of several enumerated "Unforeseen events." I'll start by asking when you bought your tickets. If you bought them at any point since the spring of 2020, you'd have a hard time arguing that what you described was "unforeseen." On the other hand, since it says "unforeseen," rather than "unforeseeable," you're in a better position.

Looking at the list of "Unforeseen events" (which appears to be an exclusive list), I do not see that any of them apply to your situation. In one of your follow up posts, you referred to the word "quarantined" in item (b), but I'm not sure why. Nothing you have posted suggests that you were quarantined. The definition you quoted is all well and good, but the fact remains that, while some people have been quarantined or have been required to quarantine because of COVID, you were not quarantined. Nor was your inability to fly into England the result of a quarantine. A travel restriction and a quarantine are not the same thing.

If the customer representative of AIG doesn't know the details of the policy while booking the alternative ticket, Am I suppose to know the details by myself?

This doesn't have any bearing on the potential validity of your claim.

Did the agent specifically state that you would be reimbursed in full?

I'm not sure, hence I am here.

"Zigner's" question was a factual question to which no one but you could know the answer.

 

[Zigner]

"Zigner's" question was a factual question to which no one but you could know the answer.

Thanks for mentioning that - I got caught up on the "quarantine" question and missed that.

 

[Karthik_s]

No one who hasn't read the policy in full can intelligently assess the validity of your claim.

However, based solely on the wording quoted in the letter you attached, I can tell you the following:

It says that the company will pay up to some unspecified "Maximum Limit" in the event of one of several enumerated "Unforeseen events." I'll start by asking when you bought your tickets. If you bought them at any point since the spring of 2020, you'd have a hard time arguing that what you described was "unforeseen." On the other hand, since it says "unforeseen," rather than "unforeseeable," you're in a better position.

Looking at the list of "Unforeseen events" (which appears to be an exclusive list), I do not see that any of them apply to your situation. In one of your follow up posts, you referred to the word "quarantined" in item (b), but I'm not sure why. Nothing you have posted suggests that you were quarantined. The definition you quoted is all well and good, but the fact remains that, while some people have been quarantined or have been required to quarantine because of COVID, you were not quarantined. Nor was your inability to fly into England the result of a quarantine. A travel restriction and a quarantine are not the same thing.



This doesn't have any bearing on the potential validity of your claim.



"Zigner's" question was a factual question to which no one but you could know the answer.

"Zigner's" question
Did the agent specifically state that you would be reimbursed in full?

Before handing out my credit card details to the agent for booking the alternative ticket, I specifically asked her, if this will be covered under the policy. Her answer and I quote was " Please have all your bills and submit the claim". I don't recall any sentence with the words "reimbursed in full" in our conversation.

BTW thank you all (Zigner and zddoodah) for your time and the information. Law is complicated.

 

[adjusterjack]

When I submitted the claim, they only have approved for $600, saying COVID-19 restrictions are not covered under their policy.

That doesn't make sense. Why would they pay you anything at all if there wasn't any coverage.

Am I suppose to know the details by myself?

Yes. You're supposed to read and understand the policy when you buy it.

Travel Guard policy has the word "Quarantined" in bullet point (b). Please see the attached PDF.

I would prefer to read the entire policy rather than just an excerpt.

According to dictionary "A quarantine is a restriction on the movement of people and goods which is intended to prevent the spread of disease or pests".

The policy might have its own definition of "quarantine."

At any rate I tend to agree that you weren't quarantined. Especially since you were able to make alternate travel arrangements.

Before handing out my credit card details to the agent for booking the alternative ticket, I specifically asked her, if this will be covered under the policy. Her answer and I quote was " Please have all your bills and submit the claim".

Certainly not a coverage interpretation nor any guarantee that any such claim would be paid.

 

[Karthik_s]

That doesn't make sense. Why would they pay you anything at all if there wasn't any coverage.



Yes. You're supposed to read and understand the policy when you buy it.



I would prefer to read the entire policy rather than just an excerpt.



The policy might have its own definition of "quarantine."

At any rate I tend to agree that you weren't quarantined. Especially since you were able to make alternate travel arrangements.



Certainly not a coverage interpretation nor any guarantee that any such claim would be paid.

That doesn't make sense. Why would they pay you anything at all if there wasn't any coverage.

I would prefer to read the entire policy rather than just an excerpt.

For the above two queries, Please see the attached PDF.

 

[zddoodah]

Karthik: First, you should not respond within a quote box. Doing so makes it hard to distinguish any new content you have added.

Second, the PDF you attached is an email that quotes what the sender believes is the "pertinent part" of the policy. It does not contain the entire policy.

Third, the email says that the insurer is "unable to extent a claim payment for the amount beyond the $600.00." However, that doesn't explain why the insurer is willing to pay $600.00. The way that the email is written suggests there were previous emails in which $600.00 was offered (possibly along with an explanation). My guess (and it's nothing but a blind guess) is that the policy covered up to $600 in additional expenses regardless of the reason but would cover more than that only for the reasons specified in the quoted paragraph. Again, that's why the entire policy is needed for a full analysis of your situation.

 

[Karthik_s]

Karthik: First, you should not respond within a quote box. Doing so makes it hard to distinguish any new content you have added.

Second, the PDF you attached is an email that quotes what the sender believes is the "pertinent part" of the policy. It does not contain the entire policy.

Third, the email says that the insurer is "unable to extent a claim payment for the amount beyond the $600.00." However, that doesn't explain why the insurer is willing to pay $600.00. The way that the email is written suggests there were previous emails in which $600.00 was offered (possibly along with an explanation). My guess (and it's nothing but a blind guess) is that the policy covered up to $600 in additional expenses regardless of the reason but would cover more than that only for the reasons specified in the quoted paragraph. Again, that's why the entire policy is needed for a full analysis of your situation.

Sorry for the late reply.

Please find the detailed policy in the below link.

 

[adjusterjack]

I read the policy. There's no definition of quarantine in it. There is nothing on the list of covered causes regarding travel restrictions due to a pandemic. As with any "named peril" policy if it's not listed it's not covered.

What's left is to argue whether a travel restriction due to the pandemic is a quarantine.

I don't see it. You weren't ill. You weren't quarantined. The restriction applied to everybody, even healthy people.

I'm still at a loss as to why you got $600. Maybe just count your blessings.

Now that I (and others) have read the policy I deleted it because it contained your personal information.

 

[Zigner]

I read the policy. There's no definition of quarantine in it. There is nothing on the list of covered causes regarding travel restrictions due to a pandemic. As with any "named peril" policy if it's not listed it's not covered.

What's left is to argue whether a travel restriction due to the pandemic is a quarantine.

I don't see it. You weren't ill. You weren't quarantined. The restriction applied to everybody, even healthy people.

I'm still at a loss as to why you got $600. Maybe just count your blessings.

Missed Connection + 1 day of Travel Delay would equal $600...just a shot in the dark.

 

[Karthik_s]

I read the policy. There's no definition of quarantine in it. There is nothing on the list of covered causes regarding travel restrictions due to a pandemic. As with any "named peril" policy if it's not listed it's not covered.

What's left is to argue whether a travel restriction due to the pandemic is a quarantine.

I don't see it. You weren't ill. You weren't quarantined. The restriction applied to everybody, even healthy people.

I'm still at a loss as to why you got $600. Maybe just count your blessings.

Quarantine and Isolation are two different things. You don't have to be ill to be quarantined. In-fact Quarantine is for healthy people and Isolation is for the ill.

What is the difference between isolation and quarantine?

What Is The Difference Between "Quarantine" And "Isolation"?

Policy doesn't say that if quarantine restriction is applied to everyone, that this Policy is not applicable. (Correct me if I am wrong)

You could argue that you didn't come in contact with new strain of coronavirus that was found in UK for which the travel restriction was imposed. I would say that I transited UK on my inbound flight from US to India just couple of weeks back before the outbound flight cancellation.

So for all the members in this forum, my question is , do I have a shot at asking the insurance company to reopen my case based on the ambiguity in the definition of the word "Quarantine". As one of the members said above they haven't defined the word "Quarantine" anywhere in the policy?

 

[zddoodah]

You can ask anything you like, but you weren't quarantined, the insurer is unlikely to reconsider its decision and, if you pursued this matter in court, you'd lose.

 

[Zigner]

Quarantine and Isolation are two different things. You don't have to be ill to be quarantined. In-fact Quarantine is for healthy people and Isolation is for the ill.

Your last sentence is not true. In any case, you were NOT quarantined, as evidenced by your ability to book a different flight. Had you been quarantined, you would not have been able to book a different flight out.

 

[adjusterjack]

Karthik, if you believe all that then it's time to consider small claims court. It's not us you have to convince.

I do not believe that we can be of any further help to you in this matter.

 

[Karthik_s]

Karthik, if you believe all that then it's time to consider small claims court. It's not us you have to convince.

I do not believe that we can be of any further help to you in this matter.

Thanks Everybody for all your help. Appreciate it. You can close this chain.

 

[adjusterjack]

You can close this chain.

Done.