I would note that for the vacation trip she had scheduled with Road Scholar -- we had separate insurance coverage there -- not with the Road Scholar folks -- and so had American not refunded the insurance company would have seen the claim there.

In fact the comprehensive insurance coverage worked well -- after providing them with all the information (including a doctor's certification), the insurance coverage was handled very quickly. I got all the paperwork together -- took about a week or so for that -- sent it off to the insurance company via email, and within 48 hours they confirmed full payment -- received the check within a week. So that worked out as well. We've always used comprehensive insurance for international vacation travel and this was the first time we needed to make a claim and I am happy to report it was handled painlessly and quickly.