Feeling misled and confused, the couple turned to OLHI.
A couple had to urgently return home mid-trip due to an emergency. They contacted the insurer’s emergency assistance provider, who agreed that returning by car was the fastest and most appropriate option.
They were told that expenses for gas, hotels, and mileage would be refunded “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 from a city that was different from where the couple departed.
Although the location was further, because it was a larger city, more travel options existed from the destination used to process the claim. This potentially led the insurer to underestimate the applicable reimbursement cap. Mileage was excluded entirely, and no information was provided regarding how the calculation was made.
Feeling misled and confused, the couple turned to OLHI. Our Complaints Analyst raised concerns about the vague guidance they had received, and the unclear method used to calculate the reimbursement cap. After informal negotiations, the insurer agreed to reimburse an additional 15% of the total expenses— covering half of what had initially been denied.
This decision was based on the guidance provided by the assistance provider, who failed to mention the contractual limit, as well as the questions raised regarding how the maximum reimbursement amount had originally been determined. This resolution proved satisfactory, as the couple felt it reflected the shortcomings in the communication process.
