Travel Insurance Dispute Highlights Pre-Existing Condition Clause
Travel Insurance Dispute Highlights Pre-Existing Condition Clause
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:
| QBE Insurance's Premium Growth Deceleration Impacts Share Value 29 Nov 2025: Paige Estritori QBE Insurance Group, a prominent player in the Australian insurance sector, has recently experienced a notable decline in its share value, reaching a seven-month low. This downturn is primarily attributed to a slowdown in the company's premium rate growth during the third quarter of the 2025 fiscal year. - read more |
| ACCC Scrutinises IAG's Bid to Acquire RAC Insurance 29 Nov 2025: Paige Estritori The Australian Competition and Consumer Commission (ACCC) has recently voiced concerns regarding Insurance Australia Group's (IAG) proposed acquisition of the Royal Automobile Club of Western Australia's (RAC) insurance business. Valued at A$1.35 billion, this deal aims to expand IAG's footprint in Western Australia. However, the ACCC warns that such consolidation could diminish competition in the state's motor and home insurance markets, potentially leading to higher premiums and reduced service quality for consumers. - read more |
| QBE Insurance Faces Market Challenges as Premium Growth Slows 29 Nov 2025: Paige Estritori QBE Insurance Group, Australia's largest insurer by market value, has recently experienced a significant downturn in its share price, reaching a seven-month low. This decline is primarily attributed to a slowdown in the company's premium rate growth during the third quarter of fiscal 2025. For tradespeople across Australia, this development could have notable implications, particularly concerning insurance premiums and coverage options. - read more |
| ASIC Highlights Concerns Over Self-Managed Super Fund Advice 29 Nov 2025: Paige Estritori The Australian Securities and Investments Commission (ASIC) has recently raised significant concerns regarding the quality of financial advice provided to individuals about self-managed superannuation funds (SMSFs). This development is particularly relevant for tradespeople considering SMSFs as a means to manage their retirement savings. - read more |
| Finding Accidental Coverage When Comprehensive Income Protection Isn't an Option Income protection is an integral part of maintaining your financial security, especially in the event that unforeseen illnesses or injuries prevent you from working. Enabling you to receive a percentage of your regular income, this type of insurance provides a safety net, ensuring that you can continue to cover your living expenses and financial obligations whilst recovering. - read more
|
| Tackling Unexpected Illness: How Income Insurance Can Help Maintain Your Standard of Living Illness limps in unannounced, derailing both physical health and financial stability without warning. When you're sideswiped by unexpected medical conditions, the uncertainty can compound, leading to a precarious balance of meeting health needs and financial commitments. Many are left pondering how to maintain their lifestyle amidst this turmoil. - read more
|
| Benefit and Wailting Periods: Choosing the Right Combination for Maximum Protection and Value In Australia, income protection insurance stands as a vital safeguard for professionals, ensuring security during times of unexpected illness or injury. It acts as a financial buffer, providing a percentage of your regular income, so you can maintain your lifestyle without the stress of lost earnings. - read more
|
| Understanding Income Protection Insurance: A Comprehensive Guide for Australians Income protection insurance is an essential component of financial security for Australians, designed to provide a safety net by replacing a portion of your income if you're unable to work due to illness or injury. Despite its critical role in safeguarding livelihoods, it's often overlooked in personal financial planning. - read more
|
The concept that individuals may take on more risk when they do not bear the full consequences of that risk, often relevant in insurance scenarios.