- Report: #737802
Complaint Review: BerkelyCare Insurance - Jericho New York
Reported By:
Alan -
Wellington, Florida, United States of America
Submitted:
Updated:
-
Author Not Confirmed
Why?
BerkelyCare Insurance
300 Jericho Quadrangle Jericho, 11753 New York, United States of America
Phone:
800-382-6841
Web:
Categories:
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BerkelyCare Insurance Travel Insurance Fraud Jericho, New York
I booked a cruise on the Oceania "Marina" for a 3-16-11 departure. I took out travel insurance with BerkelyCare on 12-6-10. In early February I took a fall and fractured my left leg, leaving me wheelchair bound for almost 2 full months. Furthermore, I was prescribed for 3 months of physical therapy. I canceled the cruise in February. I received refunds from the cruise line and the travel agent without a problem.
I sent BerkelyCare reports from three physicians, two of whom were orthopaedic surgeons, who either diagnosed and/or treated my fractured leg. I received a form letter from BerkelyCare rejecting my claim based upon the "Pre-existing Conditions" clause in the insurance contract. When I demanded to know what could possible be a pre-existing condition to a fractured leg, I received no reply.
I advised by certified mail that I would litigate the matter unless I received a check for $8923.50 no later than 4-15-11. On that same date I received a letter stating that they were re-opening my claim, but that they would need my medical history from my primary care physician. They received that information (over 15 pages) and have been sitting on it. Having received no further communication from BerkelyCare, and upon the advice from my attorney, I informed BerkelyCare that unless I receive payment by the close of business on 6-17-11, a lawsuit will be filed. Also a claim will be filed with the US Attorneys Office in NY
I have been advised that under New York State statutes pertaining to insurance practices, the probability exists for a treble damages award + counsel fees and other punitive damages. Fortunately, I have the time and patience to see this matter through.
Frankly, I learned a lesson from this. Most people over the age of 70 or 80 usually see a variety of physicians on a regular basis. Any cause for a trip cancelation other than a sudden fracture or death of a family member, will allow the insurance company to claim a pre-existing condition for a claim rejection. Another lesson: Never do business with BerkelyCare.
I sent BerkelyCare reports from three physicians, two of whom were orthopaedic surgeons, who either diagnosed and/or treated my fractured leg. I received a form letter from BerkelyCare rejecting my claim based upon the "Pre-existing Conditions" clause in the insurance contract. When I demanded to know what could possible be a pre-existing condition to a fractured leg, I received no reply.
I advised by certified mail that I would litigate the matter unless I received a check for $8923.50 no later than 4-15-11. On that same date I received a letter stating that they were re-opening my claim, but that they would need my medical history from my primary care physician. They received that information (over 15 pages) and have been sitting on it. Having received no further communication from BerkelyCare, and upon the advice from my attorney, I informed BerkelyCare that unless I receive payment by the close of business on 6-17-11, a lawsuit will be filed. Also a claim will be filed with the US Attorneys Office in NY
I have been advised that under New York State statutes pertaining to insurance practices, the probability exists for a treble damages award + counsel fees and other punitive damages. Fortunately, I have the time and patience to see this matter through.
Frankly, I learned a lesson from this. Most people over the age of 70 or 80 usually see a variety of physicians on a regular basis. Any cause for a trip cancelation other than a sudden fracture or death of a family member, will allow the insurance company to claim a pre-existing condition for a claim rejection. Another lesson: Never do business with BerkelyCare.
1 Updates & Rebuttals
Alan
Wellington,Florida,
United States of America
BerkeleyCare Insurance - Oceania Cruises
#2Author of original report
Tue, June 21, 2011
As a follow-up to my report of 6-7-2011, BerkeleyCare reversed their original decision to reject my claim, and on 6-15-2011, issued checks covering the full reimbursement to which we were entitled.
You have to act like a pitbull with a bone. They use every possible avenue of delay, with an endless demand for more and more documents, hoping to wear you down. If your claim is legitimate, never give up. Keep up the pressure. The law is on your side.
