Filing an insurance claim 101, cont., cont...

As noted in previously, we were forced to cancel our trip in January due to the Captain (me) testing positive for covid. We had purchased World Nomads covid insurance and filed a claim on January 6, 2022.
Trip Mate is the claims negotiator for World Nomads.

Since I was able to get a refund from Jet Blue, the only claims I have filed are for the charter and fishing license.
Neither of which were refundable.
After months of emails and a few phone conversations with Trip Mate we are making progress.... sort of.

In order for Trip Mate to pay on a claim, they need to see:
1. the original contract/,
2. proof of all payments, and
3. proof of cancelation w/o any refund.
Which I supplied to them.

Since the charter contract was in my name, and all payments to the charter company were made my me, I have been trying to get the full amount of the charter refunded to me.
Trip Mate saw in the charter contract that there were seven guests listed and is trying to get each of them to file a separate claim. Since only I can fulfill 1-3 above, this is an issue.

This weekend I got an email from Trip Mate stating.... "Great news, we have approved your claim."
They are sending my wife and I separate checks for 1/7 of the charter cost.
My check contains an extra $50 for the govt fishing license.

I have responded once again with a call and email stating how completely unacceptable this is.

Will I cash the checks once I receive them...HELL YES !, but this is knot over.

Chuck,

Should you cash the checks? I would be concerned that cashing the checks acknowledges agreement to their final terms. I would definitely read what is on or with the checks before cashing. Just my two cents sir.

Did you all have the same insurance? My concern is the others' claims could be denied because they didn't have Covid. That would fail to acknowledge that the trip hinged on your availability as the captain.

Five of the crew all had same insurance. I am definitely breaking ground with the insurance company, it would seem, on how these charters trips are run and the importance of the "Captain". Too this they have agreed.

Finally got to speak with a "Help Desk" supervisor on the phone yesterday.
Been trying to talk with a "Claims Processor" but find out now they do not make or receive calls.
No direct contact with the customer???
The Help Desk supervisor said they would contact claims directly and find out what is going on.

This is the email I received from Trip Mate today. What is going on is they are blowing me off.
There was no letter attached and no signature on the email.

Our claims team has reviewed your claim based on the plan provisions and the information we have on file.
Please see attached letter for your reference explaining the outcome of your claim.
We understand this may not be the outcome you had hoped; however, we must review all claims per the plan provisions. If you have questions on your plan provisions, you can visit https://www.tripmate.com/main/plan-documents/ and enter your plan #.
If you have additional information which you think will have a bearing on your claim, please forward that information to our office, attention Appeals Unit, and we will be happy to review our decision.
*Please note – appeal information should be documentation showing your claim meets plan provisions as shown in your plan documents.
MAIL: PO BOX 527 Hazelwood MO 63042 (this address cannot accept FedEx or UPS)
EMAIL: appeals@travelclaimsonline.com
Thank you,

Wow this is fun

So World Nomads hires TripMate to process their claims. Are they thinking if they deny claims, it makes them look like a good subcontractor? Is there a state regulator?

"So World Nomads hires TripMate to process their claims?"

Yes

I believe this is similar to how the US health care insurance provider's work.
When your doctor requests a procedure like an MRI, it first has to go through a third-party approval.
These third-party companies get paid by the health insurance companies, like CIGNA, based on the procedures they deny.

I suspect that Trip Mate must have a similar deal with World Nomads which is a Nationwide Insurance company.

If all else fails, I will be contacting Virginia's State Corporation Commission's Bureau of Insurance to file a complaint.