Compare Life Insurance :: News
SHARE

Share this news item!

Travel Insurance Dispute Highlights Pre-Existing Condition Clause

Travel Insurance Dispute Highlights Pre-Existing Condition Clause

In a recent case that underscores the importance of understanding insurance policy clauses, a man who cut short his vacation in the United States to be with his terminally ill sister-in-law has been denied an insurance payout.
The ruling, made by the Australian Financial Complaints Authority (AFCA), favored the travel insurer due to the claimant’s lack of coverage for pre-existing medical conditions of relatives.

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

Strengthening Agricultural Insurance: Rural Affinity and Munich Re's Renewed Partnership Strengthening Agricultural Insurance: Rural Affinity and Munich Re's Renewed Partnership
10 Feb 2026: Paige Estritori

Rural Affinity has renewed its partnership with Munich Re Specialty - Global Markets under a new five-year agreement, continuing a collaboration that began in 2006. This renewed alliance aims to support Rural Affinity's efforts to expand its agricultural insurance offerings across Australia and introduce new products leveraging technology and innovation. - read more
AFCA Mandates Insurer Payout for Engine Overheating Incident AFCA Mandates Insurer Payout for Engine Overheating Incident
10 Feb 2026: Paige Estritori

The Australian Financial Complaints Authority (AFCA) has recently ruled in favour of a truck owner whose insurance claim was initially denied following an engine overheating incident. This decision underscores the complexities surrounding insurance claims related to driver negligence and mechanical failures. - read more
AFCA Supports Insurer in Truck Theft Claim Denial AFCA Supports Insurer in Truck Theft Claim Denial
10 Feb 2026: Paige Estritori

The Australian Financial Complaints Authority (AFCA) has recently upheld an insurer's decision to deny a truck theft claim, citing misrepresentation of the insured's insurance history. This ruling highlights the critical importance of accurate disclosure when obtaining insurance coverage. - read more
AFCA Sides with Freight Company in Dangerous Goods Disclosure Case AFCA Sides with Freight Company in Dangerous Goods Disclosure Case
10 Feb 2026: Paige Estritori

The Australian Financial Complaints Authority (AFCA) has recently ruled in favour of a freight company in a dispute over the disclosure of transporting dangerous goods. This decision provides valuable insights into the obligations of transport companies regarding insurance disclosures. - read more


Life Insurance Articles

Income Protection Insurance vs. Life Insurance: What's the Difference? Income Protection Insurance vs. Life Insurance: What's the Difference?
Insurance is a crucial aspect of financial planning, offering protection against unexpected events that can have significant financial impacts. Among the various insurance options available, two prominent types are Income Protection Insurance and Life Insurance. - read more
Why Every Australian Needs Income Protection Insurance Why Every Australian Needs Income Protection Insurance
Income protection insurance is designed to provide financial support if you are unable to work due to illness or injury. It ensures that you continue to receive a portion of your income, allowing you to cover your living expenses and maintain your standard of living during difficult times. - read more
5 Tips to Save on Health Cover as an Australian Senior 5 Tips to Save on Health Cover as an Australian Senior
Finding the right health insurance coverage is a critical concern for Australian seniors, who often face the dual challenge of managing chronic health conditions and maintaining financial stability in retirement. As the cost of healthcare continues to rise, the importance of securing an affordable health cover that still meets their needs cannot be overstated. - read more
Life Insurance for Entrepreneurs: Protecting Your Business and Family Life Insurance for Entrepreneurs: Protecting Your Business and Family
Life insurance is a financial product designed to provide a safety net for your loved ones and business in the event of your passing. At its core, life insurance aims to deliver financial protection by paying out a lump sum or ongoing payments to a designated beneficiary upon the insured's death. - read more


Start Here !
life insurance
Apply now for your free Insurance assessment and price comparisons!

Start Here

Life Cover Amount:
Postcode:


All quotes are provided free and without obligation. We respect your privacy.
Knowledgebase
Beneficiary:
The person or entity designated to receive the death benefit from a life insurance policy.