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October 2011    Download the Entire Issue (PDF) Available to the Public Vol. 37, No. 10   RSS Feed for Undercurrent Issues
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One Insurance Claim DAN Should Have Approved from the Start

from the October, 2011 issue of Undercurrent   Subscribe Now

If you're having reimbursement hassles after filing a DAN TravelAssist insurance claim, press on, especially if you're talking by phone to the folks "at DAN," who may actually work at the insurance company TravelGuard. It might even get resolved quicker if you say, "I read about what happened with Chris Newbert." After nearly two months of back and forth, Newbert got paid in full for his claim, and his case led DAN to retrain TravelAssist customer-service operators, but it also leads to some interesting questions about how well DAN knows the companies it's outsourcing duties to.

Newbert, a leading underwater photographer, was diving in Lembeh Straits last year when his mild cough progressed into chest pains and a fever. A doctor guest diagnosed him with pneumonia and recommended Newbert go home immediately, as there were no medical facilities on the island they were on. Because Newbert carried DAN's premium "preferred" policy, the resort manager called DAN for instructions, and the TravelAssist representative he talked to agreed Newbert should go home, and DAN would cover the extra travel costs for an earlier departure date. The doctor recommended Newbert fly firstor business-class so he could lie prone during the flight. Newbert already had a business-class seat booked, but due to the airline's rebooking rules, Newbert would have to buy a similar seat on his desired date for $4,600. He flew home and made a speedy recovery.

Getting reimbursed was more painful. After submitting his paperwork, Newbert's claim was denied by Dick Clarke, president of National Baromedical Services, the outside claims consultant DAN uses to comply with insurance regulations. He emailed Newbert, "We have reviewed the record carefully, and see no reference to an assumption of financial responsibility on DAN's part." DAN was only responsible for getting Newbert to Singapore, where medical facilities were available, not all the way home, so Clarke offered Newbert only the $350 cost of an evacuation flight from Manado to Singapore.

"There is one additional option," Clarke also wrote in that e-mail. "DAN may consider negotiating with you to produce something for Alert Diver magazine, in exchange for a higher payment related to your travel costs." Whoa, that does not sound like a proper reimbursement procedure to us. It does sound like Clarke was offering a "scratch our back" scenario to use a celebrity's skills to DAN's advantage.

Newbert rejected both options, and kept arguing his claim. After all, the TravelAssist person on the phone said he was covered. Luckily, all TravelAssist calls with customers are recorded, and Clarke finally reviewed the call made from Newbert's dive resort . After that, Clarke e-mailed Newbert, "We have been able to verify that [the service rep] indeed provided incorrect advice. Consequently, your claim has been approved. We (at least TravelAssist) has taken action to minimize the likelihood of this happening again, but we are approving your claim none the less."

DAN Services president Bill Ziefle tells Undercurrent that after resolving Newbert's claim, DAN and TravelGuard retrained their customer service staffs "to ensure those taking calls understand DAN membership benefits, as well as the protocols associated with them." As for the "scratching back" offer Clarke made to Newbert, Ziefle said that was a misunderstanding and that Newbert was wanted as a profile for Alert Diver's regular column, "DAN Was There for Me." Ziefle said it was because "Newbert's case involved an evacuation, a misunderstanding of benefits and, in the end, an example of DAN providing service beyond what an insurance company might do."

Newbert doesn't buy that, saying DAN is covering up. "The offer Clarke made came in his very first e-mail to me, in which the bulk of my $4,612 claim was denied! To fit [DAN's scenario], this offer would have to have been made after my claim was settled, and that did not occur until over two weeks later. So the assertion that a misunderstanding was resolved, and that DAN provided service beyond what an insurance company might do, is nothing short of laughable. The fact is, Clarke's offer was undeniably a quid pro quo for a settlement. He was throwing me a bone, hoping to keep me quiet." Shortly after DAN replied to our questions about this case, Newbert got a call from Alert Diver editor Steven Frink, who said this was the first he had heard of the offer Clarke had made, and "was extremely upset and embarrassed on behalf of DAN."

Because DAN has multiple divisions, some of them outsourced, it will have to do a better job of overseeing them all, and having them adhere to proper - - and legal - - procedures.

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