Feeling misled and confused, the couple turned to OLHI.
An emergency return trip by car
A couple had to return home urgently in the middle of a trip because of an emergency. They contacted their insurer’s emergency assistance provider. The provider agreed that returning by car was the fastest and most appropriate option.
How the reimbursement was calculated
The couple was told that expenses for gas, hotels and mileage would be reimbursed “as much as possible.” However, when the claim was processed, only 70% of the costs incurred were reimbursed. The amount was capped based on the cost of a round-trip economy airfare.
The city used for the calculation was different from the couple’s departure city. Because it was a larger city with more travel options, this choice may have caused the insurer to underestimate the applicable reimbursement cap.
Mileage was also excluded entirely. No information was provided about how the reimbursement amount had been calculated.
OLHI’s review and the settlement
Feeling misled and confused, the couple turned to OLHI. Our Complaints Analyst raised concerns about the vague guidance they had received. The Analyst also questioned the unclear method used to calculate the reimbursement cap.
After informal negotiations, the insurer agreed to reimburse an additional 15% of the total expenses. This covered half of the amount that had initially been denied.
The decision was based partly on the guidance provided by the assistance provider. The provider had failed to mention the contractual limit. Questions had also been raised about how the maximum reimbursement amount was originally determined.
The resolution proved satisfactory. The couple felt that it reflected the shortcomings in the communication process.
