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
| Understanding the 4.41% Increase in Private Health Insurance Premiums for 2026 22 Feb 2026: Paige Estritori Australian private health insurance premiums are set to rise by an average of 4.41% from 1 April 2026, marking the most significant increase since 2017. Health Minister Mark Butler stated that this adjustment reflects the escalating costs of medical and hospital services, which have risen by 5% over the past financial year. This increase is expected to impact over 15 million Australians who hold private health insurance policies. - read more |
| Health Insurers Respond to Rising Costs with Increased Payments to Private Hospitals 22 Feb 2026: Paige Estritori In response to escalating operational costs faced by private hospitals, health insurers have increased their payments to these facilities. Recent data indicates that payments to private hospitals have risen by 7.7% in the year leading up to March 2025. This adjustment aims to support private hospitals during a period of financial strain and to ensure the continued delivery of quality health care services. - read more |
| Health Insurers to Include Natural Therapies in Coverage from 2026 22 Feb 2026: Paige Estritori In a significant policy shift, Australian health insurers will begin offering rebates for a range of natural therapies, including Yoga, Pilates, Tai Chi, Shiatsu, Naturopathy, Western herbal medicine, and the Alexander Technique, starting early 2026. This change follows legislative amendments allowing these therapies to be covered under private health insurance for the treatment of health conditions or as part of health management programs. - read more |
| Australian Insurers Highlight Key Challenges for 2026 22 Feb 2026: Paige Estritori As 2026 approaches, Australian insurers are facing a trio of pressing challenges: rising premium costs and shrinking insurability, escalating cyber and data risks, and increasing difficulty in hiring and retaining skilled workers. These concerns have been highlighted in industry feedback cited in Gallagher Bassett’s upcoming report, 'The Carrier Perspective: 2026 Claims Insights.' - read more |
| Income Protection Insurance Explained: Ensure Your Livelihood in Times of Uncertainty When life takes an unexpected turn, whether due to illness, injury, or other unforeseen events, the financial repercussions can be devastating. This is where income protection insurance becomes an essential component of maintaining financial stability. Income protection insurance acts as a safety net, ensuring that even in times of hardship, your financial obligations can be met, and your standard of living maintained. It provides peace of mind, knowing that your earnings are safeguarded should you become unable to work due to health reasons. - read more
|
| How Pre-Existing Conditions Affect Your Income Protection Insurance Options Income protection insurance is a type of insurance policy designed to provide you with a continuous flow of income in case you are unable to work due to illness or injury. It's a safety net that helps ensure you can maintain your standard of living, even when unforeseen health issues arise. - read more
|
| How Accidental Income Protection Insurance Can Provide Peace of Mind Accidental income protection insurance is a type of policy that provides financial support if you are unable to work due to an accident. Unlike regular income protection insurance, which can cover illnesses and injuries, this specific insurance focuses solely on accidents. - read more
|
| Income Protection Insurance and Tax Benefits: What You Should Know Income protection insurance is a type of cover designed to provide you with a safety net if you are unable to work due to illness or injury. By offering regular payments that replace a portion of your income, it helps ensure that you can maintain your lifestyle and cover essential expenses during challenging times. - read more
|