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:
| Rural Affinity and Munich Re Strengthen Agricultural Insurance in Australia 09 Jan 2026: Paige Estritori In a significant development for Australia's agricultural sector, Rural Affinity has renewed its partnership with Munich Re Specialty – Global Markets under a new five-year agreement. This collaboration, which began in 2006, is set to enhance the availability and scope of agricultural insurance products across the country. - read more |
| WFI Insurance Highlights Significant Drop in Farm Liability Claims 09 Jan 2026: Paige Estritori WFI Insurance has reported a notable decrease in farm liability claims across most categories, signaling a positive trend in safety practices within the Australian agricultural sector. The insurer observed a 75% reduction in falls from height over the past year, alongside a 30% decline in impact injuries, marking the lowest level in four years. - read more |
| Elders Insurance Highlights Increased Summer Storm Risks for Farmers 09 Jan 2026: Paige Estritori Elders Insurance is urging Australian farmers to prepare for another damaging summer, with claims data revealing the scale and financial impact of storm activity across the country's agricultural regions. Analysis of storm-related farm insurance property claims over the last two years indicates that summer accounts for the highest number of claims nationally. - read more |
| Insuregroup Achieves Significant Milestone in Truck Insurance Policies 09 Jan 2026: Paige Estritori Insuregroup, a specialist insurance brokerage serving Australia's transport and logistics sector, has recently achieved a significant milestone by processing over 10,000 insurance policies since its inception. This accomplishment includes a 25% year-on-year increase in policy count, highlighting the escalating demand for comprehensive truck insurance solutions among Australian freight operators. - read more |
| Finding Accidental Coverage When Comprehensive Income Protection Isn't an Option Income protection is an integral part of maintaining your financial security, especially in the event that unforeseen illnesses or injuries prevent you from working. Enabling you to receive a percentage of your regular income, this type of insurance provides a safety net, ensuring that you can continue to cover your living expenses and financial obligations whilst recovering. - read more
|
| Understanding Income Protection: How Much Insurance Do You Really Need? Income protection insurance is a type of policy designed to provide you with a safety net in case you’re unable to work due to illness or injury. The concept hinges on securing a portion of your earned income when adverse health conditions impede your ability to generate revenue through your profession. This protection becomes a financial bulwark, ensuring that despite unforeseen health challenges, your livelihood is safeguarded and your lifestyle can be maintained as closely as possible to your current standard. - read more
|
| Understanding the Differences: Income Protection vs Total and Permanent Disability Insurance Income protection insurance is a type of policy that provides financial support to individuals who are unable to work due to an illness or injury. The insurance company will pay a portion of the policyholder's earnings, which can be used to cover everyday living expenses and bills. This type of insurance is different from total and permanent disability insurance (TPD) in a few key ways. - read more
|
| Income protection insurance It's trite but true to say that, for most people, their most valuable asset is their ability to earn an income. But how relevant is income insurance to most Australians? - read more
|
An additional insurance policy that provides extra liability coverage beyond the limits of the insured's primary policies.