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

Significant Reduction in Farm Liability Claims Reflects Enhanced Safety Practices 25 Jan 2026: Paige Estritori Recent data from WFI Insurance indicates a substantial 75% decrease in farm liability claims over the past year, suggesting that Australian farmers are adopting more effective safety measures. This decline is particularly notable in incidents involving falls from height, which have reached their lowest level in four years. - read more

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

Australian Insurers Achieve $6.1 Billion Profit in 2024 25 Jan 2026: Paige Estritori In 2024, Australia's insurance industry recorded an after-tax profit of $6.1 billion, a significant increase from the five-year average of $2 billion. This surge is primarily attributed to substantial premium hikes and a reduction in severe weather events. - read more