Travel Insurance Dispute Highlights Pre-Existing Condition Clause

2

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

Surge in Mental Health Claims Challenges Australia's Income Protection Insurance 25 Dec 2025: Paige Estritori Recent data from the Council of Australian Life Insurers (CALI) reveals a significant shift in the landscape of income protection insurance in Australia. Mental health conditions have emerged as the leading cause of total and permanent disability (TPD) claims, accounting for nearly one-third of all claims paid. In 2024 alone, insurers disbursed over $2.2 billion for retail mental health claims, a figure that has almost doubled compared to five years prior. - read more

Decline in Income Protection Premiums Reflects Market Adjustments in Australia 25 Dec 2025: Paige Estritori Recent research from Rainmaker Information indicates a notable decrease in income protection insurance premiums across Australia. Direct income protection premiums have fallen by 12% for policies with a 30-day waiting period and 13% for those with a 90-day waiting period since 2024. Similarly, premiums for life products sold through advisers have decreased by 5%, with income protection premiums dropping by 7% for 30-day waiting periods and 5% for 90-day periods. - read more

Superannuation Insurance Extends Coverage to 6 Million More Australians 25 Dec 2025: Paige Estritori New research from the Association of Superannuation Funds of Australia (ASFA) reveals that superannuation insurance now provides critical protection to over 6 million Australians who would otherwise be uninsured. This expansion has been achieved without impacting household spending, as the coverage is included within superannuation contributions. - read more

Adore Beauty's Strategic Acquisition of Ikou Enhances Market Presence 25 Dec 2025: Paige Estritori In a significant move within the Australian beauty industry, Adore Beauty has announced the acquisition of wellness and skincare brand Ikou for $25 million. This strategic decision aims to bolster Adore Beauty's private label offerings and marks its entry into the physical retail space. - read more