Wednesday, June 8, 2011

The Second Denial Letter: If we can't avoid paying using one exclusion, we'll pull another exclusion from our bag of tricks!!!

Shortly after sending our appeal letter (which pointed out that the exclusion they cited wasn't legally applicable to us), we received a letter from American Express citing a new Exclusion for our "Covered Incident" (jpg of their letter shown below).

All they did was rely upon another overly broad part of their exclusions! If we can't avoid payment using one exclusion, we'll pull another exclusion from our bag of tricks...

"Benefits are not payable if the loss for which coverage is sought was directly or indirectly, wholly or partially, contributed to or caused by:  ....9. not being reasonably safeguarded by You..."

Talk about being able to apply Exclusions to any "Covered Incident!"

I think American Express could save people a lot of time and effort by just having one blanket Exclusion: "Benefits are not payable under this policy in the event you submit a claim."

The second letter was signed by "Brittany deSousa" and included a phone number to call. We called and chatted with Brittany about the second denial and after a few minutes, point-blank asked her "how were we supposed to safeguard the iPod anyway?"

She answered with "I can't answer that...."

I guess we erred by not "safeguarding" the iPod prior to immersion in water?  Our bad, I guess, as there are waterproof containers available that could have safeguarded the iPod? Just as there are shockproof cases available to avoid damage from dropping devices. And, heavy safes available to avoid theft of devices.

My point is that "failing to safeguard" allows American Express to exclude any and all claims. Just as their "abuse" exclusion gives them an out also.

There's a saying that "insurance is only for those people who don't make claims" and it couldn't apply more in this case.


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