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:

Insurance News

Broker Held Accountable for Uncommunicated Policy Exclusions Leading to Claim Denial 10 Apr 2026: Paige Estritori In a recent decision by the Australian Financial Complaints Authority (AFCA), a broker has been found liable for failing to adequately inform a client about critical exclusions in a truck insurance policy, resulting in the denial of a damage claim. This case underscores the paramount importance of clear communication between brokers and clients, especially concerning policy terms that can significantly impact coverage. - read more

Understanding the Impact of Seasonal Risks on Truck Insurance in Australia 10 Apr 2026: Paige Estritori Seasonal changes in Australia bring about varying weather patterns and traffic conditions, significantly impacting the trucking industry. These fluctuations not only affect operational efficiency but also have profound implications for insurance coverage and premiums. Understanding these seasonal risks is crucial for truck owners and operators to ensure adequate protection and cost management. - read more

Navigating Insurance Requirements for Food Truck Operators in Australia 10 Apr 2026: Paige Estritori Operating a food truck in Australia presents unique challenges, particularly when it comes to securing appropriate insurance coverage. Unlike traditional brick-and-mortar establishments, food trucks combine elements of a business, vehicle, and commercial kitchen, necessitating a tailored approach to insurance. - read more

Zurich Australia's New Income Protection for Women's Health 09 Apr 2026: Paige Estritori Zurich Australia has unveiled a pioneering income protection benefit tailored specifically for women's health conditions, including menopause and endometriosis. This initiative addresses the significant impact these conditions have on women's professional lives and financial stability. - read more