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
| Call for Enhanced Support for Indigenous Insurance Customers 09 Dec 2025: Paige Estritori The Life Code Compliance Committee has identified significant gaps in support for Indigenous customers within the insurance sector, following an audit of three major insurers representing two-thirds of the market. The analysis reveals that these insurers lack adequate procedures for safe self-identification, a critical step towards ensuring cultural inclusivity and accessibility. - read more |
| Australian Insurtech Startups: Pioneering the Future of Insurance 09 Dec 2025: Paige Estritori The Australian insurtech sector is experiencing significant growth, with startups introducing innovative solutions that enhance efficiency, security, and customer engagement within the insurance industry. A recent report titled 'Insurtech Down Under: Trends, Tech and Triumphs' highlights the pivotal role these companies play in reshaping the market. - read more |
| Australian Insurers Address Surge in Mental Health Claims 09 Dec 2025: Paige Estritori The Australian insurance industry is facing unprecedented challenges due to a significant rise in mental health-related claims. The Council of Australian Life Insurers reports that mental health has become the leading cause of total and permanent disability claims, accounting for nearly one in three payouts. - read more |
| Calls for Overhaul in Australian Insurance Claims Handling Processes 09 Dec 2025: Paige Estritori Australian consumer advocacy groups are intensifying their calls for substantial reforms in the insurance industry's claims handling processes. The Australian Consumers Insurance Lobby (ACIL) has criticised the current system, highlighting ongoing issues that compromise consumer outcomes. - read more |
| Deciphering Your Policy: A Beginner's Guide to Insurance Terminology Welcome to the world of insurance – a domain where words like 'deductible' and 'premium' can significantly impact your financial protection and peace of mind. As a beginner, grasping the basics of insurance terminology is the first step towards making informed decisions about the policies that safeguard your assets and future. In this guide, we will embark on a journey through the language of insurance, which can often seem as complex as the policies themselves. - read more
|
| Decoding the Fine Print: What to Look out for in Your Income Protection Policy Income protection insurance serves as a vital safety net for Australian workers, ensuring financial stability in the face of unexpected illness or injury. As the landscape of work and health continues to evolve, understanding the essentials of income protection becomes increasingly crucial for anyone who relies on a steady income to support themselves and their loved ones. - read more
|
| Why Income Protection Insurance is Essential for Every Australian Adult Income protection insurance is designed to provide financial support to individuals who are unable to work due to illness or injury. This type of insurance ensures that you continue to receive a portion of your income, allowing you to maintain your standard of living even when unexpected circumstances arise. - read more
|
| Protecting Your Legacy: Estate Planning and Life Insurance for Australians When thinking about the future, it's essential to have a comprehensive strategy that ensures the well-being of your loved ones and the security of your assets. Estate planning and life insurance are two critical pillars in safeguarding your family's financial stability. Despite the complexity often associated with these topics, understanding their importance and implementing them correctly can provide immense peace of mind. - read more
|