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:
| Australian General Insurers Report Record $7.3 Billion Profit 18 Jan 2026: Paige Estritori The Australian general insurance sector has reported a remarkable after-tax profit of $7.3 billion for the last financial year, marking its most substantial earnings in over ten years. This significant increase is primarily attributed to a decrease in catastrophe-related losses and robust investment returns. - read more |
| Australian General Insurance Premiums Set to Surpass $144 Billion by 2029 18 Jan 2026: Paige Estritori The Australian general insurance market is on a trajectory to see direct written premiums (DWP) exceed $144 billion by 2029, according to projections from data and analytics firm GlobalData. This anticipated growth is largely fueled by heightened demand for coverage in response to the increasing frequency of natural disasters. - read more |
| Understanding the Impact of New Regulations on Cosmetic Nurses' Insurance 18 Jan 2026: Paige Estritori The cosmetic nursing sector in Australia has experienced significant growth, driven by increasing demand for non-surgical cosmetic procedures such as injectables and skin treatments. This expansion has led to heightened scrutiny and the introduction of new regulations aimed at ensuring patient safety and professional accountability. - read more |
| Health Minister Addresses Insurers' Use of Loopholes to Raise Premiums 18 Jan 2026: Paige Estritori In December 2024, Australian Health Minister Mark Butler issued a stern warning to private health insurers regarding the use of 'underhanded' tactics to raise premiums. This statement came in response to findings that some insurers have been closing old policies and introducing more expensive ones, effectively increasing costs for consumers without transparent communication. - read more |
| Health Insurance for Young Australians: Why Starting Early Pays Off Health insurance is a crucial aspect of managing both health and financial risks. Many Australians may not realize the significance of having robust health coverage until they face unexpected medical expenses. Starting early with health insurance can not only provide peace of mind but also pave the way for better health management in the long run. - read more
|
| How to Protect Your Income During Health Setbacks: A Complete Guide Income protection is a crucial safety net for Australians, offering financial security when health setbacks strike. This type of insurance ensures that you continue to receive a portion of your income if illness or injury prevents you from working. It’s an essential aspect of financial planning, providing peace of mind knowing that you can maintain your lifestyle even when unforeseen health issues arise. - read more
|
| Top 5 Reasons to Consider Life Insurance While You're Young When you’re young, life is all about new experiences and making plans for a promising future. While factors like travel, career, and relationships often take centre stage, one aspect often overlooked is life insurance. It might seem like something to consider later in life, but starting a policy while you're young can be a savvy financial move. - read more
|
| How to Prepare Financially for Unexpected Sickness Life is full of surprises, and unfortunately, not all of them are pleasant. Unexpected sickness can strike anyone at any time, and when it does, it can have a significant impact on your income. Whether it’s a sudden illness, a chronic condition, or an accident, the loss of income can add stress to an already difficult situation. - read more
|
The process by which an insurance company seeks to recover the amount paid to the policyholder from a third party responsible for the loss.