Troubleshooters: Man sues travel insurance company over amputated toe

Ed Wilkie called our newsroom recently after he had to cancel a flight to San Francisco. Shortly before he was supposed to depart, he contracted a severe infection, and doctors had to hospitalize him and amputate his toe.

Wilkie purchased travel insurance for his trip, but the insurance company has denied his claim, saying he had a pre-existing condition.

“They’re stating that this was a pre-existing condition, and I’m thinking that, what do these people think that I did to keep from going to California?” Wilkie said. “That I woke up one morning, and said, ‘Well I’ll just go down to Dosher Hospital and get ’em to wack a toe off me?'”

Wilkie and his wife planned to fly to San Francisco for Christmas to visit their daughter. Instead, he had his toe amputated and was told to stay close to his doctors in Brunswick County.

The Wilkies paid an extra $40 a ticket for travel insurance with Access America, and called them to file a claim. They sent Wilkie some forms for his doctor to fill out, and his doctor immediately suspected that getting any money from the insurance company was going to be an uphill battle.

“Dr. Satterwhite told me that he has not had a patient yet that has ever received anything on their travel insurance,” Wilkie said. “It’s always deny, deny, deny.”

Sure enough, that’s what happened.

We called Access America for answers. They say they only insure against “unforeseen medical problems.” Wilkie says he’s never had any problems with the particular toe that was amputated, but he has a condition called diabetic neuropathy that makes him prone to infections.

Access America tells us Wilkie was treated for that condition the same month he purchased his ticket, but Wilkie says as a person living with diabetes, he makes a lot of trips to the doctor, and it’s ridiculous to imply he should have known he was going to have to have his toe amputated.

“There was nothing wrong with me on the 27th of August when the travel insurance was purchased,” Wilkie said.

Access America executives say they paid out 100,000 claims last year, but refused to tell us how many claims they denied.

Wilkie says Access America took his hard earned money under the pretense that they would cover him if there was a problem, and he’s not letting this drop. He’s taking the company to small claims court, and filing complaints with the Attorney General’s office and the North Carolina Insurance Commission.

If you’ve had a similar experience, he’d love for you to call him at (910) 351-0000.

Update 3/31/2010:

We got an e-mail from an executive with the insurance company, and after further review, they have decided to pay Wilkie’s claim. Wilkie’s doctor wrote a follow-up letter to Access America Insurance, insisting that Wilkie’s toe problems did not stem from diabetic neuropathy, the pre-existing condition the insurance company cited. That prompted the insurance company to reverse their decision, and cover Wilkie’s claim.

Categories: Brunswick

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