After a hard fall in the Rockies, why won’t Trip Mate pay my claim?

Q: I recently took a Grand Circle tour of the Canadian Rockies. I purchased travel insurance through Trip Mate.

While I was on the tour, I tripped on uneven concrete in front of the Waterton Lodge in Waterton, Alberta, and slammed down directly onto my right knee. I was treated in a local hospital and, two days later, managed to get to the airport and fly home. A subsequent MRI revealed that I had suffered a fractured patella.

I contacted Trip Mate, and a representative advised me to file two claims — one for my medical expenses and one for trip interruption. Trip Mate paid most of the interruption claim. On the medical claim, a representative advised me to submit my claim to my primary insurance carrier. I’ve done that, and it has covered everything except $828. I’ve resubmitted the claim to Trip Mate, but it hasn’t paid. Do I have to file a lawsuit to get the money?

– Sondra Wolf, Marlton, N.J.

A: I’m sorry you couldn’t finish your trip in the Canadian Rockies. It’s one of the most scenic places in North America, and I hope you’ll have an opportunity to finish the trip someday when your knee heals.

Your case is a reminder not only of the importance of travel insurance, but also the fact that some trip coverage is secondary. For you, that meant you had to first file a claim with your primary health insurance. Trip Mate will then cover the rest, which for you is $828.

Your problem also underscores the reality that travel insurance claims can take weeks or months to process. You want your travel insurance company to process its claims carefully, of course, but both of these claims should have been settled a long time ago.

Many have suggested that foot-dragging is part of the travel insurance industry’s business plan. While it’s true that some travelers just give up when they don’t get their money, I have no evidence that the slowness is intentional or systemic.

I’m proud of you for sticking with it. A look at your paperwork showed that you had two perfectly valid claims. You also followed my proven methods for a resolution — you were patient, persistent and polite. Actually, you were very patient. I don’t blame you for wanting to go to court after your long wait.

When a travel insurance company takes its sweet time with a claim, you can always rattle its cage. I publish the names, numbers and email addresses of the Trip Mate customer service executives on my nonprofit consumer advocacy site.

I reviewed your paperwork, and it appeared you’d done everything correctly. There was only one thing left to do: Ask Trip Mate about your claim. I contacted the company on your behalf to find out if maybe you’d incorrectly filled out a claim form. In response, Trip Mate express-mailed checks for the entire balance due.