UPDATE: TripMate has provided Consumerist with a statement, which has been added to the bottom of the post.

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Whenever we hear stories from people who have been forced to cancel flight or cruise reservations because of illness, the response from the carrier is inevitably, “The customer should have purchased optional travel insurance.” But what happens when you buy the insurance but the insurer says you were not sick enough to cancel the trip?

That’s what happened to a married pair of octogenarians in California, who had to cancel their reservations on a cruise up the Danube river after the wife became ill and her doctor prescribed medication that would leave her too weak to take the trip.

The cruise company was sympathetic and made good on its refund policy, giving the couple a check for 60% of the total cost. But the couple tells the L.A. Times’ David Lazarus that things didn’t go so easily when they approached the insurance company, Trip Mate, to make a claim that would reimburse them for the remaining 40% (around $5,000).

At first, the company didn’t respond to their claim, but a follow-up attempt resulted in a denial. See, while Trip Mate agreed that the wife had visited her doctor after booking the cruise, it said the couple had not provided evidence that her illness merited cancelling their reservation.

Per Trip Mate, “The plan states a covered sickness must necessitate medical treatment at the time of cancellation.”

So the couple appealed, this time including a letter from the doctor describing the side effects of the medication and confirming that the wife “was forced to cancel her trip with my complete concurrence.”

Appeal denied.

In spite of the doctor’s note, Trip Mate insisted, “the medical records on file do not document you received medical treatment at the time you canceled.”

Lazarus hit a similarly stony wall when he contacted Trip Mate, which stated that the doctor’s letter “did not show that the plan requirements for trip cancellation due to a medical condition were met.”

But, Trip Mate then claimed that it had made contact with the doctor and would pay the couple’s claim based on this new information.

Except, the doctor told the couple that Trip Mate had never made any further attempts to contact him for additional information.

So perhaps this is like when the car salesman goes to talk to the “manager” and really just walks down the hall for a few minutes before coming back to tell you he talked the boss into a sweetheart deal.

Regardless, the couple is now getting reimbursed for the canceled trip. All it took was several months and the involvement of a major newspaper to get it sorted out.

Here is the full statement provided to Consumerist by a representative for TripMate:

We appreciate the Los Angeles Times shedding light on the misfortunes that can sometimes occur when planning a trip. As the article states, there was not adequate documentation at the time the claim was submitted. During the appeal process, we reached out and obtained information directly from the doctor’s office which allowed us to process payment for this claim. Please note that the call to the doctor’s office and the decision to overturn the claim occurred prior to any contact from the LA Times.

We hope that the [customer’s] story shows the importance of travel insurance and the coverage it can offer in situations such as these. At Trip Mate, we monitor and attempt to resolve all complaints including those from the Better Business Bureau. Trip Mate is currently an industry leader in customer satisfaction, handling hundreds of thousands claims each year. We are pleased to report that the vast majority of those claims result in a favorable outcome and happy customers.

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