Trip Delay Claim

Guidelines
All fields with an asterisk are required. In the final step, you will be asked to attach documentation relevant to your claim. You can take a photo of your documents and upload the photo files. Acceptable forms of proof of payment include:
  • Provide documentation from the common carrier (airline, cruise line, etc.) confirming the delay, length of the delay, and the reason for delay.
  • Purchase receipts for additional expenses incurred as a result of the delay.
  • Airline itineraries (Please include the original flight itinerary and a copy of the new flight itinerary).
  • File types allowed: pdf, doc, txt, jpeg, tif, bmp, gif, png. You can take a photo of your documents and upload the photo files.

If you need help finding your certificate number or other information, give us a call 800-690-6295 (toll free) or 317-818-2808 (collect).

Primary Insured (Information must match exactly what is on your ID card.)
Whose trip was delayed?
Travel Details
Payment Information
Method of Payment*
ACH/EFT: US $ Canada(CAD) $
Country
International/non-U.S. Account Information

Complete for payment through bank transfer outside the U.S.

Account type
Signature
Any person who, with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits. In submitting this claim to Seven Corners, Inc., I declare that I have read & understood my policy’s terms and conditions and agree to the privacy policy and to the Fraud Notices.

I hereby authorize Seven Corners, Inc. (hereinafter COMPANY) to mail any payments to the above listed address and to deposit any amounts owed me for reimbursement of medical expenses or services rendered by initiating credit entries to my account at the financial institution (hereby BANK) indicated above. Further, I authorize BANK to accept and to credit any credit entries indicated by COMPANY to my account. In the event that COMPANY erroneously deposits funds in my account (by way of example, I am not entitled to the funds or the amount of deposit Is incorrect or such funds are deposited in the wrong account), I authorize COMPANY to debit or credit my account in the amount necessary to correct the initial deposit, but in no case shall any debit exceed the amount of the initial deposit. I further agree COMPANY is not responsible for any transaction fees charged and will release Seven Corners of any liability in the event of lost or stolen payments.

Document Upload
Please submit proof of payment for claimed expenses. You can take a photo of your documents and upload the photo files. Acceptable forms of proof of payment include:
  • A credit card statement and/or a copy of the front and back of the negotiated check
  • Copies of the invoice/reservation for hotel, cruise, and tour bookings
  • Airline ticket, e-ticket
  • Travel supplier cancellation notice
  • File types allowed: pdf, doc, txt, jpeg, tif, bmp, gif, png. You can take a photo of your documents and upload the photo files.

Documents

Privacy Information
Terms of Use
Security Statement

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