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
| Allianz Australia Penalised for Misleading Travel Insurance Information 15 Jan 2026: Paige Estritori In a significant ruling, the Supreme Court of New South Wales has imposed fines totaling $16.8 million on Allianz Australia Insurance and its subsidiary, AWP Australia, for disseminating misleading information about their travel insurance products between 2016 and 2018. This decision underscores the critical importance of transparency and accuracy in the insurance sector. - read more |
| Surge in Medical Claims Among Australian Travellers Highlights Importance of Comprehensive Insurance 15 Jan 2026: Paige Estritori In 2024, medical incidents emerged as the leading cause of travel insurance claims among Australian travellers, accounting for more than 40% of all claims handled by nib Travel. This trend underscores the critical importance of securing comprehensive travel insurance to mitigate the financial risks associated with medical emergencies abroad. - read more |
| Seafood Business Wins Insurance Dispute Over Storm-Induced Power Outage 15 Jan 2026: Paige Estritori A recent ruling by the Australian Financial Complaints Authority (AFCA) has significant implications for businesses seeking insurance compensation for losses due to power outages caused by natural disasters. In this case, a seafood distribution company experienced substantial stock losses when a storm-induced power outage left its refrigeration systems inoperable for a week. The insurer initially denied the claim, citing a flood exclusion clause. - read more |
| Insurance Council Advocates for Liability Law Overhaul to Curb Rising Premiums 15 Jan 2026: Paige Estritori The Insurance Council of Australia (ICA) has called for urgent reforms to civil liability laws to address the escalating costs of liability insurance premiums affecting businesses nationwide. In a recently released white paper, the ICA highlights the need to review state-based civil liability laws that have remained unchanged for nearly 25 years. The report identifies key areas requiring attention, including psychological injuries, worker-to-worker claims, and leisure and recreational risks. - read more |
| The Devil's in the Detail: What Your Income Protection Policy Really Covers In today's ever-fluctuating economic landscape, income protection insurance emerges as a vital component of comprehensive financial planning. While many understand the significance of insuring assets like homes and automobiles, securing one's income stream often gets overlooked. However, considering the life's unpredictable nature, safeguarding our ability to earn should be of utmost importance. - read more
|
| Understanding Your Insurance Needs at Every Life Stage Navigating the complex world of insurance can often feel daunting, but understanding the importance of life stage consideration when choosing life insurance is essential. As we journey through the various chapters of our lives, our financial responsibilities, dependents, and personal circumstances evolve. These changes invariably have significant implications for our insurance needs. - read more
|
| The Essential Guide to Travel Insurance for Australians on a Working Holiday in Canada Welcome to your guide to embark on an amazing journey from Australia to the breathtaking landscapes of Canada on a working holiday. This adventure presents an inviting blend of work and travel, allowing you to immerse yourself fully in Canadian culture while supporting your explorations financially. - read more
|
| How Life Insurance and Estate Planning Work Together for Your Benefit For many Australian families, the concept of estate planning might evoke imagery of vast wealth and complex legal documents, reserved for the very affluent. However, this misconception overshadows the universal importance of having an estate plan, which at its core, is about ensuring your loved ones are cared for and your wishes are honored upon your passing—even if you don't consider yourself wealthy. - read more
|