Providing Quality Travel Insurance Worldwide

What is needed:

Complete cancellation of your travel arrangements:

• E-ticket receipt or original paper ticket from airline. International tickets require a written statement from the airline on ticket refundabilty.
• The Attending Physicians Statement completed in full by the patient's physician.
• Sign and complete Planholder/Patient Statement.
• Canceled checks or credit card statements showing all payments for your trip. If you paid cash, you must send a receipt from the travel coordinator/tour operator indicating the date and the amount paid for the trip.
• Credit card statements reflecting any credit transactions or a written statement from a travel agent or tour operator indicating why no refund was received.
• Please include proof of insurance payment.
• Please enclose a copy of the trip flyer and/or brochure.
• If death is the reason for claim, please provide a copy of death certificate. 

Required Documents for Cancel for Any Reason:
(In addition please refer to the Claimed Expense section at the top of the page)

• Written statement from tour operator or Travel Agent indicating the date of cancellation.

Required Documents for Cancel for Work Reasons:
(In addition please refer to the Claimed Expense section at the top of the page)

• Written statement from tour operator or Travel Agent indicating the date of cancellation.
• If you are cancelling your trip due to work reasons, please supply the following:
  • Notarized statement signed by an officer of Your or Your Traveling Companion's employer. (If applicable)
  • Written statement from the employer indicating why company is declared unsuitable for business. (If applicable)
  • Written statement from the employer indicating merger or acquisition and involvement with merger or acquisition. (If applicable)
  • Written statement from the employer indicating date of transfer, location and permanency of transfer. (If applicable)

Required Documents for Postponement of Departure Date:

• The receipt/airline ticket showing the upgrading expense.
• Verification of the cause for the predeparture upgrade.
• Travel Coordinator's Statement for any unused, nonrefundable land or sea arrangements.
• Please include a copy of the travel coordinator's invoices along with canceled checks or credit card statements showing the purchase of all travel arrangements.

Required Documents for Occupancy Upgrade:

• A completed Attending Physician's Statement for the patient whose illness caused your travel companion to cancel.
• Sign and complete Planholder/Patient Statement.
• A paid receipt showing the amount charged for occupancy upgrading.
• The travel brochure showing the price for a single supplement.
• Please include a copy of the travel coordinator's invoices along with canceled checks or credit card statements showing purchase of all travel arrangements.

Forms

	Trip Cancellation Claim Form
	Attending Physicians Statement

What is needed:

Additional Transportation:

Please supply the following:

• Please provide us with written verification from the common carrier as to the cause and length of the delay. Please include your flight itinerary.
• Please provide us with proof of payment for additional transportation expenses. i.e. invoices or receipts and a copy of your canceled check or credit card statement showing payment for the additional expenses.

Additional Accommodation and Meals:

Please supply the following:

• Please provide us with written verification from the common carrier as to the cause and length of the delay.
• Please provide us with proof of payment for additional accommodations and meal expense. i.e. invoices or receipts and a copy of your canceled check or credit card statement showing payment for the additional expenses.

Unused, prepaid nonrefundable portions of your missed trip:

Please supply the following:

• Please provide us with written verification from the common carrier as to the cause and length of your delay.
• Please provide us with a copy of your trip itinerary.
• Please have the Travel Coordinator's Statement completed by your travel coordinator for the prepaid unused nonrefundable portion of your land/sea that was missed. Please be sure that the land and sea arrangements are broken down.

Forms

Trip Delay Claim Form

What is needed:

• The Planholder/Patient Statement completed and signed.
• Verification of the reason your trip was interrupted. If interruption was due to a medical reason, please submit proof of medical treatment at the point of interruption.
• If death is the reason for claim, please provide a copy of death certificate.
• The original unused airline tickets, or original e-ticket receipt, International tickets require a written statement from the airline on ticket refund ability.
• Receipts verifying extra incurred expenses for transportation to return to final destination (i.e. airline tickets, train, or bus tickets).
• The enclosed Travel Coordinator's Statement completed by your travel coordinator if you are claiming unused, nonrefundable land or sea arrangements.
• A copy of your trip itinerary, along with a copy of the travel coordinator's invoices. Canceled checks or credit card statements showing the purchase of all travel arrangements.
• If you are claiming additional Pet Care expenses please supply a written statement from the boarding facility of extra charges and the original boarding dates.

Forms

	Travel Coordinator Statement
	Trip Interruption Planholder/Patient Statement
	Attending Physicians Statement

What is needed:

• Your cancelled check or credit card statement for the initial trip deposit.
• Verification of medical treatment, such as detailed medical statements from the treating physician indicating where and when the accident or sickness occurred.
• Copies of all medical bills incurred while on your trip.
• If patient received follow up treatment upon returning home, please have the Attending Physicians Statement completed in full by the patient's physician.
• Completed and Signed Planholder/Patient Statement.
• Verification of your travel arrangements. (i.e. copy of ticket, brochure, invoice, itinerary)
• Credit card statement, canceled checks or cash receipt for all medical payments while on your trip.
• Please attach all other insurance explanation of benefits reflecting medical expenses incurred on your trip. (This applies only if Optional Upgrade was not purchased)

Forms

	Medical Expense Claim Form
	Excess Medical Expense Claim form

What is needed:

• Answer all questions on both sides of the claim form.
• Include a copy of your Description of Coverage and all requested documentation including:
  • Copy of the initial and final auto rental agreement(s).
  • Copy of the repair estimate or itemized repair bill.
  • Two (2) photographs of the damaged vehicle, if available.
  • Copy of report filed with the police.
  • Copy of the damage report to your rental company.
  • Keep a photocopy of this completed form and all attachments for your records.
  • Mail the completed form along with all documentation to the address shown above.

Forms

Collision Damage Waiver Claim Form

What is needed:

Baggage Delay:

Please supply the following:

• Written statement from common carrier regarding baggage delay and length of delay.
• Receipts for necessary purchases.
• Copy of passenger ticket.
• Keep a photocopy of this completed form and all attachments for your records.
• Sign and date completed claim form.

Baggage Lost, Damaged or Stolen:

Please supply the following:

• Copy of passenger ticket.
• Report filed with common carrier along with their written response.
• Copy of report filed with police, hotel, tour operator if your loss did not occur on a common carrier.
• Keep a photocopy of this completed form and all attachments for your records.
• Sign and date completed claim form.

Forms

Baggage Claim Form