trip insurance

That is surprising to me. We have always had trip insurance payments paid to us within a month when we became ill and had paperwork from doctors. Was any doctor involved in the diagnosis? I am sorry this happened to your group trip. We always have been treated by a doctor and/or medical center staff who filled out the claim paperwork.
What country did your friend become ill?

Thank you. He became ill in Hong Kong. We were seen by an ambulance service but I believe insurance wants to see records from a full medical doctor.

What are the specifics of your policy? I am going to infer from your posts that he / she did not see a doctor, was not hospitalized etc. I doubt they triggered the terms of the travel insurance. You need to understand the details of this type of insurance before you travel.

I have edited my post to add in this link: https://www.allianztravelinsurance.com/travel/trip-cancellation/trip-cancellation-claim-denied.htm. Some food for thought.

The biggest problem is what does the policy say -- fine print -- and what the OP thinks it says. Sometimes a world of difference. What are the reason for the denial? I am sure they have told you. And what are you trying to claim?

What type of insurance did you purchase, and from which company did you buy a policy from? Were you on a set, pre-paid tour, or traveling on your own? Are you wanting reimbursement for travel expenses or medical claims? Based on the limited information you shared, it's difficult to respond without knowing what your insurance coverage was. Many states have claims departments for Insurance complaints, so you may want to look into that, though I don't know if they cover travel insurance.

This is a bit confusing. Did you or your spouse get sick or a member of your traveling party? It is all going to depend on the “fine print” and what the insurance would or would not cover if your trip was interrupted. It may not accept someone other than you or your spouse becoming ill.

I expect the flight home would have to have been taken on medical advice, from a doctor, to be covered under the terms of the policy. It sounds like your friend got ill, called an ambulance and then decided to go home early. I can understand why they made that decision but insurance will want a solid medical reason for why the earlier flight was necessary.

We were seen by an ambulance service but I believe insurance wants to see records from a full medical doctor.

Was he seen by a 'full medical doctor'?

Does anyone here have recommendations for obtaining legal assistance to deal with the denial?

If he is a resident of USA, there is probably a State Insurance Commissioner office in his home state. That would be the 1st place to seek aid.

The insurance company denied our claim, even as we submitted additional support material several times.

Did they explain why the claim was denied? Did they specify what additional info was needed? did you provide what they asked for?

Thank you, everyone. The problem I'm facing is that this person was seen by a medic in the local ambulance service.

Our policy states:

Covered Events:
1. The Sickness, Injury or death of you, your Family Member, your Service Animal or your Traveling
Companion. The Sickness or Injury must first commence while your Trip Interruption coverage is in
effect under the Policy, must require the inperson treatment by a Physician, and must be so disabling in
the written opinion of a Physician as to prevent you from taking your Trip (either because your condition
prevents your travel, or because your Family Member, Traveling Companion or your Service Animal
requires your care);
 
The policy defines Physician as such:
PHYSICIAN means a person licensed as a medical doctor by the jurisdiction in which he/she is resident to
practice the healing arts. He/she must be practicing within the scope of his/her license for the service or
treatment given and may not be you, a Traveling Companion, or a Family Member of yours.

"licensed as a medical doctor" is what I'm trying to figure out...

I'll add that I have photos and the ambulance report, all of which show this person being ill and treated by the ambulance crew. I suppose my error was not having him seen after the ambulance crew by a medical doctor, and also not getting in touch with the insurance company when the incident took place.

I'm still wondering if there's something I can do here to make my case.

Unfortunately, probably not. Physicians are the gate keeper for the medical part of travel insurance policies.

The problem is that you read the fine print and try to interpret to your advantage. The insurance company does the same. To me -- "licensed as a medical doctor" -- is pretty clear. Since the US makes heavy use of PAs and NPs, I would wonder if a statement for them would be acceptable. Not sure what recourse you have. Good luck.

unfortunately, based on what you showed us, you don't have a licensed doctor (or perhaps the ambulance medic was, unless he was a Paramedic who isn't) or the name of the Medic, or can you blow up the picture of the ambulance (is the writing in English, I'm guessing bilingual) and see the medic's name badge? And then you're missing the critical Doctor Letter from the doctor who treated him confirming that he cannot complete the trip.

I'm afraid that I think you are on quite thin ice. Sorry. Good luck....

Just thought - maybe a Doctor's name is on the cash receipt?

I suppose my error was not having him seen after the ambulance crew by a medical doctor, and also not getting in touch with the insurance company when the incident took place.

Sadly looks like a case of hindsight being 20/20. Had either happened, you probably would not be in the situation you now face.

Did he see his MD once he got home? That might be your last best long shot to document that his condition met the policy threshold to be a 'qualifying event'.

Based on what you have shared, it appears the policy conditions to trigger coverage have not ( were not) met.

Hope the financial hit is an annoyance, and not devastating, and his condition has returned to normal.