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:
| AustralianSuper Announces Reduction in Default Income Protection Cover 20 Feb 2026: Paige Estritori AustralianSuper, one of Australia's largest superannuation funds, has announced a significant change to its default income protection insurance. Effective from 28 February 2026, the fund will reduce the default income protection cover to $1,000 per month. This adjustment aims to align insurance coverage with members' actual income levels and prevent over-insurance, which can erode retirement savings. - read more |
| APRA Postpones Changes to Individual Disability Income Insurance Policy Terms 20 Feb 2026: Paige Estritori The Australian Prudential Regulation Authority (APRA) has announced a suspension of the planned changes to individual disability income insurance (IDII) policy contract terms. Originally set to take effect from 1 October 2022, the implementation has been deferred for at least two years, providing insurers and policyholders additional time to adapt to the forthcoming regulations. - read more |
| Ocean Underwriting Expands Product Suite with Cyber Insurance for SMEs 20 Feb 2026: Paige Estritori Ocean Underwriting, in collaboration with Tokio Marine Management Australasia, has launched a new cyber insurance product tailored for Australian small and medium enterprises (SMEs). This addition marks a significant expansion of Ocean's offerings, which already include property, liability, and professional indemnity insurance. - read more |
| Club Marine Revamps Policies to Reflect Modern Boating Innovations 20 Feb 2026: Paige Estritori Club Marine, Australia's leading provider of recreational boat insurance, has undertaken a comprehensive review of its product disclosure statements (PDS) to better align with contemporary boating trends and technologies. This initiative reflects the company's commitment to staying at the forefront of the marine insurance industry. - read more |
| What Australians Need to Know Before Choosing an Income Protection Plan Income protection insurance is a critical safety net for Australians, offering financial security in the event that one is unable to work due to illness or injury. The peace of mind it brings cannot be overstated, as it ensures that individuals and their families can maintain their standard of living even when the unexpected happens. - read more
|
| Essential Coverage vs. Optional Add-ons: Balancing Protection and Costs For Australian farmers, having the right insurance coverage isn't just a safety net—it's an integral part of sustaining their livelihood. Natural disasters, unpredictable climate conditions, and the inherent risks of agricultural production underline the critical importance of robust insurance for the agricultural community. As farmers navigate the complexities of insurance, understanding the basics becomes the first step toward securing their assets and ensuring the continuity of their operations. - read more
|
| Protecting Your Future: A Simple Approach to Life and Disability Insurance Welcome to the crucial conversation about safeguarding your future through life and disability insurance. Many of us ponder the distant horizon of life's 'what ifs,' but are we truly prepared? The reality is that our financial security can be drastically affected by unforeseen events—a serious illness or a sudden disability that prevents us from working. That's where life and disability insurance come into play, serving as critical safety nets that can keep us afloat during tough times. - read more
|
| Deciphering Your Policy: A Beginner's Guide to Insurance Terminology Welcome to the world of insurance – a domain where words like 'deductible' and 'premium' can significantly impact your financial protection and peace of mind. As a beginner, grasping the basics of insurance terminology is the first step towards making informed decisions about the policies that safeguard your assets and future. In this guide, we will embark on a journey through the language of insurance, which can often seem as complex as the policies themselves. - read more
|
Insurance which provides protection against liability to third parties.