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

Envest Group Unveils TLI Underwriting for Heavy Motor Fleets 31 Dec 2025: Paige Estritori Envest Group, a prominent player in Australia's insurance sector, has announced the launch of TLI Underwriting, a new agency dedicated to providing specialised insurance solutions for heavy motor fleet operators. This strategic move aims to address the unique challenges faced by larger transport businesses in Australia. - read more

IAG Boosts Profit Forecast Post-RACQ Insurance Acquisition 31 Dec 2025: Paige Estritori Insurance Australia Group (IAG) has announced an upward revision of its annual profit forecast, attributing the increase to the recent acquisition of RACQ Insurance. The company now anticipates a reported insurance profit ranging between $1.55 billion and $1.75 billion for the financial year, marking a $100 million enhancement from the previous estimate. - read more

NTI Report Highlights Human Error as Leading Cause of Major Truck Crashes 31 Dec 2025: Paige Estritori The National Truck Accident Research Centre (NTARC), supported by National Transport Insurance (NTI), has released its latest Major Incident Investigation Report, shedding light on the predominant causes of significant truck crashes across Australia. The findings underscore the critical need for targeted interventions to enhance road safety within the transport industry. - read more

Hutch Underwriting Launches Comprehensive Professional Indemnity Insurance for Tradies 31 Dec 2025: Paige Estritori Hutch Underwriting has unveiled a revamped professional indemnity (PI) insurance policy tailored specifically for tradespeople, including electricians, carpenters, and painters. This innovative coverage consolidates protection against advice, design, and incidental cyber exposures into a single, streamlined solution. - read more