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:
| WFI Insurance and Rural Aid Join Forces to Assist Farmers in Crisis 02 Feb 2026: Paige Estritori In a significant move to bolster support for Australia's agricultural sector, WFI Insurance has announced a formal partnership with Rural Aid, a leading rural relief charity. This collaboration is set to provide much-needed assistance to farmers and rural communities affected by recent natural disasters, including the devastating bushfires in Victoria and severe weather events in Queensland. - read more |
| Elders Insurance Warns Farmers of Escalating Summer Storm Threats 02 Feb 2026: Paige Estritori As the Australian summer approaches, Elders Insurance is calling on farmers to brace for an anticipated increase in storm-related damages. Recent claims data reveals a concerning trend, with summer months accounting for nearly half of all storm-related farm insurance property claims over the past two years. - read more |
| AFCA Observes Significant Increase in General Insurance Complaints 01 Feb 2026: Paige Estritori The Australian Financial Complaints Authority (AFCA) has reported a 17% increase in general insurance complaints for the year ending June 30, 2025, totalling 34,231 cases. This uptick is primarily attributed to issues surrounding add-on covers and delays in motor vehicle insurance claims. - read more |
| APRA's Findings: Stability in PI Claims and Decreasing Premiums 01 Feb 2026: Paige Estritori The Australian Prudential Regulation Authority (APRA) has released its latest National Claims and Policies Database, providing valuable insights into the professional indemnity (PI) insurance sector for the 2022 underwriting year. The data indicates that PI claims payments for non-facility business remained relatively stable at $1.111 billion, a slight increase from $1.109 billion in the previous year. - read more |
| Insuring Your Practice: Key Considerations for Australian Health Care Workers Income protection insurance is a safeguard for your financial stability, designed to provide peace of mind when you most need it. As a healthcare professional, you’re dedicated to caring for others, but it’s essential to protect your own income against unexpected events. - read more
|
| A Guide to the Australian Income Protection Insurance Landscape Income protection insurance stands as an unsung hero in the tapestry of financial security, often overlooked but irreplaceable in its role. Designed to provide a safety net, it ensures that individuals can continue to receive a portion of their income should they become unable to work due to illness or injury. It’s about peace of mind, knowing that life's unforeseen events won't sweep the ground from beneath you. - read more
|
| Why Every Tradie Needs Tailored Insurance: Protecting Your Livelihood In Australia, tradies are the backbone of many local communities, providing essential services in fields such as construction, plumbing, electrical work, and more. These skilled professionals often operate their own businesses or work as contractors, making financial stability paramount. - read more
|
| Understanding the Role of Life Insurance in Financial Security Life insurance can seem complex at first, but understanding the basics can help demystify this important financial product. At its core, life insurance is a contract between you and an insurer, where the insurer promises to pay a designated beneficiary a sum of money upon your passing, in exchange for premium payments. - read more
|
A type of life insurance that provides coverage for the insured's entire lifetime, with a savings component that builds cash value.