Travel Insurance Dispute Highlights Pre-Existing Condition Clause

1

The situation began when the policyholder purchased travel insurance for a family holiday scheduled to begin on December 12, 2023. Shortly after arriving in the U.S., the man was informed of his sister-in-law's critical health decline due to metastatic colorectal cancer. He returned home to be with her in her final days, later resuming his vacation on December 23.

However, upon claiming for the abrupt change in travel plans, the insurer, AWP Australia, denied the claim. They stated that the policy explicitly excluded coverage for incidents related to pre-existing medical conditions of the insured’s relatives. The sister-in-law’s diagnosis of cancer and a pulmonary embolism had been established for nearly a year prior to the start of the policy coverage.

The case highlights a common oversight among travelers: not accounting for family members' significant medical histories while planning their travels. Even though the policy allowed for early return and resumption of journey benefits, these did not apply as the sister-in-law's health condition predated the travel insurance policy.

The policyholder argued that the policy had not explicitly required him to disclose his sister-in-law’s medical background, which he felt was unfair. He also mentioned experiencing substantial financial hardship due to the rejection of his claim. Nevertheless, AFCA supported the insurer's decision.

In summarizing the decision, the AFCA ombudsman stated, “I acknowledge the complainant was not aware that [his sister-in-law] may fall seriously ill and pass away when he commenced his holiday. However, I am satisfied the exchanged information shows death was caused by her pre-existing medical conditions for the purposes of the policy. In the absence of any other information, I am satisfied the insurer is entitled to deny the claim.”

This resolution accentuates the criticality of reading and comprehending the exclusions present in travel insurance policies. Policyholders should be fully aware of what constitutes a pre-existing condition and how it may impact claim eligibility. The case serves as a cautionary tale for travellers to ensure all potential scenarios are accounted for in their insurance coverage. For further details, you can refer to the ruling as noted by Australian Financial Complaints Authority.

Published:Wednesday, 22nd Jan 2025
Source: Paige Estritori

Share this news item:

Insurance News

Travel Insurance Dispute Highlights Pre-Existing Condition Clause 22 Jan 2025: Paige Estritori In a recent case that underscores the importance of understanding insurance policy clauses, a man who cut short his vacation in the United States to be with his terminally ill sister-in-law has been denied an insurance payout. The ruling, made by the Australian Financial Complaints Authority (AFCA), favored the travel insurer due to the claimant’s lack of coverage for pre-existing medical conditions of relatives. - read more

Dutton Calls for Urgent Solutions as Insurability Crisis Hits Halls Gap 22 Jan 2025: Paige Estritori Peter Dutton, the leader of the Coalition, voiced pressing concerns over the growing issue of 'uninsurable risks' during a recent visit to the fire-stricken tourist town of Halls Gap in Victoria. The picturesque location, frequently visited by tourists, experienced significant bushfire disruptions over the Christmas holiday, highlighting broader insurance challenges. - read more

Storm Devastation: Over 11,000 Claims Filed in NSW and ACT After Severe Weather 21 Jan 2025: Paige Estritori The recent onslaught of electrical storms that lashed across New South Wales (NSW) and the Australian Capital Territory (ACT) has resulted in a flurry of activity from the insurance industry, as shown by the impressive number of claims filed. In an eventful week of wild weather, the Insurance Council of Australia reported an influx of 11,366 claims tied to the severe storms that began on January 15. - read more

Severe Weather in Eastern Australia Sparks Insurance Claims Spike 17 Jan 2025: Paige Estritori Recent storms sweeping across New South Wales and parts of Queensland have led to a surge in emergency calls and insurance claims, as residents grapple with the aftermath of strong winds, heavy rainfall, and hail. This extreme weather has posed significant challenges to numerous households and businesses, prompting a rallying cry for assistance. - read more

Broker Sentenced for Fraudulent Builders’ Insurance Scheme 15 Jan 2025: Paige Estritori In a significant legal crackdown, a broker has been sentenced for his involvement in selling fraudulent builders’ warranty insurance to construction firms in New South Wales. This case underscores the urgent need for regulatory vigilance in the insurance sector. - read more