If i recall with the ticket refunds if you got to TRIPS and look under REFUNDS, search for the ticket used/partially used you can get the refund for the downgraded sector. Don't think you need to submit your "stub" since its an electronic transaction ie e-ticket.
With the medical claims/ESA it's still back to the old days of licking an envelope, addressing it correctly and posting it. Guess soon they will issue stamps to affix onto the envelopes.