Why won't travel insurance cover my missed tour?

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Carolyn Cluff's husband is injured in Portugal and he misses part of his tour. Now their travel insurance company is balking at paying their claim, even though their policy should cover them. How does she persuade the insurance company to reconsider?

Q: We are having trouble with a claim we made on our Allianz travel insurance we bought for our recent trip to Portugal with Vantage Deluxe Travel.

A day after we arrived, my husband fell in the bathtub, cutting his left cheek, leaving a huge bruise on his left hip, and injuring his lower back. He could not get out of the bathtub, so a friend came and assisted him.

The next day he missed his all-day tour. On the following day, we both transferred to a riverboat for a seven-day cruise. Our program director went with us by taxi to the ER for X-rays, a muscle relaxant shot, and pain prescriptions.

My husband stayed in the cabin most of the seven days, sleeping on a chair with a stool under his legs. He could not get in and out of bed. We missed many of the tours and incurred extra expenses as a result of his injury.

Allianz agreed to cover $96 for the ER visit and prescriptions. After some haggling, it also covered our minivan transfer, which cost about 350 euro. However, they refused to pay anything for the nine tours my husband missed and the five tours I missed. Can you help? -- Carolyn Cluff, Tucson, Ariz.

A: A close review of your Allianz policy will reveal that all of those expenses -- including your missed tours -- would be covered under your policy.

I've also reviewed the correspondence between you and the insurance company, and see that you provided your adjuster with more than enough information to document your husband's condition.

So why did Allianz balk at paying your full claim? I think the main reason is that when an injury like this happens, most travelers would opt to abandon their vacation and return home.

Your husband's injuries sound fairly serious. I'm not sure the adjuster knew what to make of someone who would go on, despite the excruciating pain your husband was suffering from.

Travel insurance is full of exclusions, but none of them applied to your situation as far as I could tell. The adjuster simply chose not to cover the missed tours.

When a claim like yours is turned down, you should appeal the rejection in writing (I list the names of Allianz's managers on my customer service wiki at http://www.onyoursi.de/wiki). If that fails, you should send a letter to your state insurance commissioner.

None of that became necessary. I contacted the company on your behalf.

"This was an unusual situation in that one member of the traveling party elected to continue their itinerary after the other member sustained serious injuries as Mrs. Cluff has described," a spokesman told me. "However, upon further consideration, we have decided to pay the claim for Mr. Cluff's missed excursions as they felt that the situation does meet the terms of his travel insurance policy."

Allianz has sent you a check for $720, which will cover the rest of your claim.

(Christopher Elliott is the author of "Scammed: How to Save Your Money and Find Better Service in a World of Schemes, Swindles, and Shady Deals" (Wiley). He's also the ombudsman for National Geographic Traveler magazine and the co-founder of the Consumer Travel Alliance, a nonprofit organization that advocates for travelers. Read more tips on his blog, elliott.org or e-mail him at chris@elliott.org. Christopher Elliott receives a great deal of reader mail, and though he answers them as quickly as possible, your story may not be published for several months because of a backlog of cases.)

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