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Dwayne B.
Dwayne B., Lawyer
Category: Consumer Protection Law
Satisfied Customers: 33932
Experience:  Practicing for over 20 years and handled many cases and trials for consumers.
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Good afternoon. My question is regarding travel insurance.

Customer Question

Good afternoon. My question is regarding travel insurance. My family and I were supposed to travel from Washington DC to Los Angeles in January 2016 but my husband fell ill two days before departure and was unable to travel due to a doctor's note. He was highly contagious and told to remain under a doctor's care and not even work for one week. Travel was originally booked November 16, 2015 and the travel insurance was purchased through the Spirit Airlines booking. The company is Travel Guard through AIG. The insurance was purchased mostly due to the fact that we live in the mid-Atlantic and figured that weather might become a factor in January and could have an affect on our flight, not that anyone would get sick.
I submitted the claim and all information that the claims database asked for (airline ticket receipt and itinerary for all family members, credit card statement showing the charge, the doctor's signed note excusing my husband from traveling.
However, the travel insurance claims department says they need an actual diagnosis on paper. Our doctor's office will not honor it due to the HIPAA regulation and they state they do not need to know the actual diagnosis to make an adjudication. We are out of pocket almost $1500 and I just want to know if we should pursue further with the doctor's office to get the diagnosis on paper or is the travel insurance company just pushing this off? The travel insurance company will not make an adjudication and I refuse to give up on this. Thank you in advance.
Submitted: 1 year ago.
Category: Consumer Protection Law
Expert:  Dwayne B. replied 1 year ago.
Hello and thank you for contacting us. This is Dwayne B. and I’m an expert here and looking forward to assisting you today. If at any point any of my answers aren’t clear please don’t hesitate to ask for clarification. Also, I can only answer the questions you specifically ask and based on the facts that you give so please be sure that you ask the questions you want to ask and provide all necessary facts. Please note: This is general information for educational purposes only and is not legal advice. No specific course of action is proposed herein, and no attorney-client relationship or privilege is formed by speaking to an expert on this site. By continuing, you confirm that you understand and agree to these terms. No one can answer whether the insurance company has a legit excuse since we don't have a copy of the insurance policy. However, the doctor's reason is BS since your husband can sign a HIPAA release form and give the doctor permission to reveal the information to the insurance company. That happens all the time.My suggestion would be to get a local lawyer to write a couple of letters for you and see if they can get it resolved. The lawyer shouldn't charge much, if anything, for the letters. The lawyer can also take a look at the actual insurance policy and determine whether the insurance company is being reasonable and is acting within the limits of their policy. I suspect they are and that they will be allowed to get a specific diagnosis before issuing a decision on whether they will pay or not. Most insurance policies allow them to obtain as much info as possible to make a decision. You can then file a complaint with the state licensing agency for physicians and for insurance companies and if that doesn't work you can file a lawsuit. If you use a lawyer to file the lawsuit then the attorney's fees are recoverable as well.