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:
| Heightened Road Risks During Holiday Season Due to Increased Freight Traffic 25 Jan 2026: Paige Estritori As Australia enters the summer holiday season, insurers and transport specialists are raising alarms about heightened road risks resulting from the convergence of increased freight activity and holiday travel. This period sees a significant uptick in both passenger vehicles and heavy trucks on the roads, amplifying the potential for accidents and safety incidents. - read more |
| Celebrating Excellence: 2025 National Trucking Industry Award Winners 25 Jan 2026: Paige Estritori The Australian Trucking Association (ATA) has proudly announced the recipients of the 2025 National Trucking Industry Awards, recognizing outstanding contributions and achievements within the sector. These awards highlight the dedication and excellence of individuals and organizations that drive the industry forward. - read more |
| Premiums Decline in Australian Construction Insurance Market 25 Jan 2026: Paige Estritori Australia's construction insurance market has entered a softer phase in 2025, with premiums decreasing across various lines due to heightened competition among insurers. According to Marsh's Construction Insurance Market Update 2025, premium reductions averaged between 5% and 15% in the first half of the year. - read more |
| Labour Shortages and Supply Chain Issues Elevate Insurance Claims Costs 25 Jan 2026: Paige Estritori In 2025, Australia's insurance industry is grappling with rising claims costs, particularly within the construction sector, due to labour shortages and supply chain disruptions. Crawford & Company's latest Claims Inflation Update highlights that construction expenses are increasing at a rate faster than general consumer prices, with the Building Cost Index (BCI) rising nearly 5% annually. - 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
|
| What Hospitality Business Owners Need to Know About Income Protection Insurance The Australian hospitality industry is renowned for its vibrancy, yet it also faces significant challenges. With fluctuating demand, seasonal changes, and unpredictable external factors such as economic downturns and pandemics, hospitality businesses often operate in a high-risk environment. For hotel operators, the stakes are even higher due to substantial investments in property, staff, and customer service. - read more
|
| How to Prepare for a Hassle-Free Life Insurance Claim Being prepared when it comes to life insurance claims can make a world of difference. Proper preparation helps you prevent delays and denials, ensuring that your loved ones receive the financial support promised by your policy without unnecessary hold-ups. By paying attention to the details, you can streamline the claims process, giving you and your family peace of mind during what is already a stressful time. - read more
|
| Income Protection vs. Life Insurance: What's Best for You? Financial protection is an essential aspect of sound financial planning. It ensures that you and your family are safeguarded against unexpected events that could lead to financial hardship. Two common types of financial protection are income protection insurance and life insurance. - 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.