Trip Mate, Inc. I purchased trip insurance coverage through TripMate for a planned return trip to the US in May, 2020. I am currently visiting Ecuador and, due to a full country and airport travel quarantine/lockdown, I filed four (4) individual and covered claims for trip cancellation, accompanied by all required documentation, since my trip involved four distinct legs of travel. Kansas City MO

I received a declination on the first claim/leg 05/04/2020, even though I am specifically covered under two different clauses contained in the purchased policy regarding quarantine and airport shutdown. I believe strongly that noncompliant insurers, and all service providers, should be held accountable for their failure to deliver according to a contract.

Below you will find the declination email from Trip Mate, followed by my appeals letter.

DECLINATION FORM LETTER FROM TRIP MATE, INC. (relevant sections in bold)

Claims Administrator
9225 WARD PARKWAY, SUITE 200, KANSAS CITY, MO 64114 TEL: 844-777-6859 FAX: 816-523-3379
Worldwide Coverage For The Traveler

May 4, 2020
Ms. Jari Buck

RE: Trip Cancellation – Claim ID # 6908329

Dear Ms. Buck:
Thank you for your claim submission. You have requested reimbursement for the penalties assessed due to your trip cancellation. As we will explain below, we are unable to consider this to be a covered claim with the information currently on file.

We reviewed your claim according to the trip cancellation provision of the plan; we have included the definition of Sickness from the plan:

TRIP CANCELLATION

Benefits will be paid, up to the Maximum Benefit Amount shown in the Schedule of Benefits, to reimburse You for the amount of the unused non-refundable Prepaid Payments or Deposits You paid for Travel Arrangements when You are prevented from taking Your Trip due to:
…2. Your or a Family Member’s or a Traveling Companion’s or a Business Partner’s covered Sickness or Injury, which: a) occurs before departure on Your Trip; b) requires Medical Treatment at the time of cancellation resulting in medically imposed restrictions, as certified by a Legally Qualified Physician; and c) prevents Your participation in the Trip;
…provided such circumstances occur while coverage is in effect.
“Sickness” means an illness or disease of the body which: 1) requires examination and treatment by a Legally Qualified Physician; and 2) commences while Your coverage is in effect.

While the plan provides a benefit for a covered Sickness, the information on file does not indicate that you, your traveling companion, or a family member became ill while coverage was in effect. Therefore, you were not required to be examined and treated by a physician who certified the medical condition was so disabling it prevented you from being able to go on the trip. Because you did not cancel due to a Sickness as defined, but rather to avoid exposure to the Coronavirus, we are unable to consider this to be a covered claim.

The plan lists the following non-medical covered causes of loss (i.e. “Other Covered Reasons”) for Trip Cancellation:
a. You or Your Traveling Companion being hijacked, quarantined, required to serve on a jury (notice of jury duty must be received after Your Effective Date), served with a court order to appear as a witness in a legal action in which You or Your Traveling Companion is not a party (except law enforcement officers);
b. Your or Your Traveling Companion’s primary place of residence or destination being rendered uninhabitable by fire, flood, burglary or other Natural Disaster. We will only pay benefits for Losses occurring within 30 calendar days after the Natural Disaster makes Your destination accommodations uninhabitable. Your primary place of residence or destination is uninhabitable if: (i) the building structure itself is unstable and there is a risk of collapse in whole or in part; (ii) there is exterior or structural damage allowing elemental intrusion, such as rain, wind, hail, or flood; (iii) immediate safety hazards have yet to be cleared such as debris on roofs or downed electrical lines; or (iv) the property is without electricity or water. Benefits are not payable if a storm, snow storm, blizzard or hurricane is named on or before the Effective Date of Your Trip Cancellation coverage;
c. a documented theft of passports or visas;
d. You or Your Traveling Companion being directly involved in a traffic accident, substantiated by a police report, while en route to Your scheduled point of departure;
e. unannounced Strike that causes complete cessation of services for at least 12 consecutive hours of the Common Carrier on which You are scheduled to travel;
f. Inclement Weather that causes complete cessation of services for at least 12 consecutive hours of the Common Carrier on which You are scheduled to travel;
g. mechanical breakdown that causes complete cessation of services for at least 12 consecutive hours of the Common Carrier on which You are scheduled to travel;
h. a government-mandated shutdown of an airport or air traffic control system for reasons other than terrorism or an act of war;
i. You or Your Traveling Companion is in the military and called to emergency duty for a national disaster other than war;
j. a Terrorist Incident that occurs within 30 days of Your Scheduled Departure Date in a city listed on the itinerary of Your Trip. Benefits are not provided if the Travel Supplier offers a substitute itinerary;
k. revocation of Your previously granted military leave or re-assignment due to war. Official written revocation/re-assignment by a supervisor or commanding officer of the appropriate branch of service will be required.

We certainly understand the decision made to cancel this trip in light of the threat presented by the Corona virus. However, because the information on file does not document that this cancellation resulted from one of the above listed covered reasons, this claim is not covered under the plan provisions. Please note a government order, such as a stay at home order or a state of emergency, is not a specific quarantine of you or your Traveling Companion. Consequently, we must respectfully decline your request for reimbursement.

Trip Mate, Inc. is the claims administrator for Plan F200B, which includes short-term travel insurance underwritten by United States Fire Insurance Company. We must process claims according to the plan provisions and the information on file. If you have additional information which you think will have a bearing on your claim, please forward that information to appeals@travelclaimsonline.com indicating your claim ID # 6908329 and name in the subject line, and we will be happy to review our decision.

Sincerely,
S. Weiser
Claims Department

MY APPEALS EMAIL

TripMate,So, you “think” I was not quarantined in Ecuador? (from your denial letter) “Please note a government order, such as a stay at home order or a state of emergency, is not a specific quarantine of you or your Traveling Companion. Consequently, we must respectfully decline your request for reimbursement.”

According to Napavale Inc. v. United Nat. Idem. Co. (1959) 169 Cal. Ap. 2d 119, “where a particular phrase in an insurance policy is not defined, the understanding of an ordinary person and approved usage of words must be guides in construing the insurance contract.” Or put another way, when an insurer makes no attempt to define a term or phrase which is the subject of dispute, the meaning of the word most acceptable to the insured should be accepted. (1973) City of Kimball v. St. Paul Fire and Marine Ins. Co. 206 North West 2d 632.

https://books.google.com/books?id=TytqDmFZWlAC&pg=PA5&lpg=PA5&dq=what+guides+a+word+definition+in+insurance+policy+when+not+defined&source=bl&ots=YnC0d5FFbo&sig=ACfU3U14G40OIosFX-v_XsbMq1jni4TvNw&hl=en&sa=X&ved=2ahUKEwiNgrOXxJvpAhWflnIEHdFsDZ0Q6AEwDHoECA0QAQ#v=onepage&q=what%20guides%20a%20word%20definition%20in%20insurance%20policy%20when%20not%20defined&f=false

Here is the definition/meaning of the word you chose NOT to define in your policy, “quarantine,” according to Dictionary.com at https://www.dictionary.com/browse/quarantine.
“noun
• a strict isolation imposed to prevent the spread of disease.
• a period, originally 40 days, of detention or isolation imposed upon ships, persons, animals, or plants on arrival at a port or place, when suspected of carrying some infectious or contagious disease.
• a system of measures maintained by governmental authority at ports, frontiers, etc., for preventing the spread of disease.
• the branch of the governmental service concerned with such measures.

verb (used with object), quar·an·tined, quar·an·tin·ing.
• to put in or subject to quarantine.
• to exclude, detain, or isolate for political, social, or hygienic reasons.”

Below I have provided published documentation PROVING my status as a quarantined individual in Ecuador. When I would be either immediately challenged and sent home and/or fined for leaving my current rental in Cuenca due to my age (69) per Cuenca city laws, disallowed to travel between provinces per Ecuador country laws, stopped outside Guayaquil (my airport departure destination) forcibly by trucks and police IN THE ROAD per Guayaquil city mandate and prevented from leaving the country or crossing borders per Ecuador country laws, YOU TELL ME HOW THIS DOES NOT CONSTITUTE A QUARANTINE!

I am ALSO covered under an additional “Other Covered Reason” of Plan F200B - "h. a government-mandated shutdown of an airport or air traffic control system for reasons other than terrorism or an act of war."

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• On March 16, [President] Moreno... announced the suspension of transport between provinces and of domestic flights starting in the evening of March 17 initially for 14 days, later extended through the month of April. Schools are also closed through April.
• On the evening of March 15, Moreno announced a series of measures, including the suspension of citizens’ movements within the country except to buy food, medicine, and basic goods.
https://www.as-coa.org/articles/where-coronavirus-latin-america#ecuador

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From 23:59 (local time) on Sunday, March 15, all international arrivals to Ecuador by air will be suspended and all foreign nationals will be barred from entering the country at any of its air, land, or sea border crossings. Similarly, all Ecuadorean nationals will be barred from returning to Ecuador from 23:59 on Monday, March 16.
https://www.garda.com/crisis24/news-alerts/322931/ecuador-government-to-close-all-borders-due-to-covid-19-march-15-16-update-1

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Due to the current nationwide quarantine and travel restrictions, U.S. citizens located outside of the Guayas province may not be able to travel to Guayaquil for flights departing from the Guayaquil airport....
• The Government of Ecuador has restricted movement throughout the country with very limited exceptions and imposed a curfew from 9 p.m. to 5 a.m. (changing to 7 p.m. to 5 a.m. starting Saturday, March 21). Local jurisdictions have enacted additional restrictions, as the curfew in Guayas province is from 4 p.m. to 5 a.m. These restrictions can change at any time. U.S. citizens should comply with all local laws and monitor local news for any updates.
• People who experience coronavirus symptoms during quarantine isolation – or at any time – should immediately report themselves to local health authorities, to activate corresponding health protocols. Individuals with symptoms may call 171 or 911.
https://johnlewis.house.gov/media-center/press-releases/coronavirus-information-americans-abroad

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Ecuador has closed its borders entirely to both visitors and returning citizens.
https://www.forbes.com/sites/jamesasquith/2020/04/02/april-update-coronavirus-travel-update-90-of-countries-have-travel-restrictions/#68a764663024

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From March 16, borders were completely closed, including to citizens and residents, for 21 days.
https://www.aljazeera.com/news/2020/03/coronavirus-travel-restrictions-border-shutdowns-country-200318091505922.html

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While quarantine has immersed Ecuador's cities in a mandatory stillness, in rural areas, small farmers have sped up their harvesting, never losing sight of the fact that farmers and people in the city are facing a common enemy.
https://www.heifer.org/blog/heifer-ecuador-farmers-covid-19.html

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Because of the strict quarantine measures taken to restrict the spread of COVID-19, people have been limited in what they can do for loved ones or neighbors who die at home.
https://www.cbsnews.com/news/ecuador-bodies-streets-guayaquil-coronavirus-covid-19/

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Ecuador aims to restart economy after coronavirus quarantine
QUITO, April 21 (Reuters) - Ecuador is readying a plan to reactivate its economy and authorize flights home for citizens stranded abroad, the government said on Tuesday, following a month of strict quarantine to curb the coronavirus pandemic.
With 520 deaths and 10,398 confirmed infections, the virus has devastated the economy of the oil-producing nation, while overwhelmed public health services in its outbreak epicentre of Guayaquil saw corpses left in homes or on streets for hours.
https://www.nasdaq.com/articles/ecuador-aims-to-restart-economy-after-coronavirus-quarantine-2020-04-21

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Ecuador has closed its borders and halted regular commercial flights. Non-essential movement is restricted, and a curfew applies throughout the country.
https://www.smartraveller.gov.au/destinations/americas/ecuador

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QUITO (Reuters) - Ecuador on Monday exceeded 30,000 confirmed cases of the coronavirus, while the government launched a plan to start gradually relaxing quarantine measures that have been in place since mid-March... Following a month of strict quarantine to curb the pandemic, the government said it would now allow some businesses to operate through phone and internet services for home deliveries, while also extending the hours of operation for taxis.
https://ph.news.yahoo.com/ecuador-exceeds-30-000-confirmed-225309704.html
https://www.nytimes.com/reuters/2020/05/04/world/americas/04reuters-health-coronavirus-ecuador.html
https://www.metro.us/ecuador-exceeds-30000-confirmed/

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The country was quick to close its borders, with the entry of foreigners prohibited from March 14th, a day after all schools closed, while gatherings of more than 30 people were forbidden and a lockdown was imposed that same week, as well as a suspension of road transportation and domestic flights between provinces... Quarantine measures across Ecuador are expected to remain in place until the end of May, but local authorities will decide when to lift measures imposed to isolate the population, the country’s President Lenin Moreno said on April 26th.
https://www.leadersleague.com/en/news/covid-19-in-latin-america-brazil-hardest-hit-as-region-braces-for-peak-pandemic

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In March, just days before Ecuador declared a national lockdown in response to COVID-19, the new Minister for Energy and Non-renewable Natural Resources, René Ortíz, said during a television interview that he planned to “take advantage of this crisis” to not only continue, but to speed up oil and mining projects to extract “all possible natural resources.”
https://time.com/5826188/amazons-indigenous-people-coronavirus/

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Countries that have suspended air traffic
These are the countries that have suspended air traffic in and out of the country: Ecuador (all flights)
https://thepointsguy.com/guide/clean-bill-of-health-travel-coronavirus/

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Ecuador is readying a plan to restart its economy and authorize flights home for citizens stranded abroad, the government said on Tuesday, following a month of strict quarantine to curb the pandemic.
https://www.nytimes.com/reuters/2020/04/30/world/americas/30reuters-health-coronavirus-ecuador.html

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Ecuador’s strict quarantine restrictions were scheduled to end today but will be extended due to large increases in recorded COVID-19 cases and deaths.
https://www.foreignbrief.com/daily-news/equador-to-extend-coronavirus-lockdown/

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And finally, I have to tell you how bitterly disappointed and ashamed I am of TripMate, a Kansas City company, for placing insurance payout liability and shareholder returns ahead of their insured. I lived in KC from 1985 - 2016, and my last home was approximately 1.5 miles from your offices. I currently survive solely on Social Security, and this trip marked my first return home since 2016, plus a HUGE investment of money for me. This is exactly why I took out trip insurance!

I expect to receive funds associated with my APPROVED claim dispute (Claim ID: #6908329), along with notification of approval plus the funds associated with the three (3) additional, related claims (Claim ID: #6908308, Claim ID: #6908223, Claim ID: #6908347) ASAP. I will not remain silent about this egregious and self-serving behavior on social media, nor will I accept your illegal declination without follow-up litigation.