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:
| TAL's Health Sense Plus Now Covers Income Protection Policies 19 Jan 2026: Paige Estritori In a significant development for policyholders, TAL has expanded its Health Sense Plus program to encompass income protection (IP) policies. This initiative, effective from August 8, 2025, aims to incentivise proactive health management by offering premium discounts to clients who engage in preventative health checks. - read more |
| New Legislation Prohibits Life Insurers from Using Genetic Test Results 19 Jan 2026: Paige Estritori The Australian government has enacted legislation prohibiting life insurers from using the results of genetic tests to refuse coverage or increase premiums. This landmark decision aims to eliminate genetic discrimination and encourage individuals to undergo potentially life-saving genetic testing without fear of financial repercussions. - read more |
| Markel Insurance Expands into Australian Marine Market with New Leadership 19 Jan 2026: Paige Estritori Markel Insurance has announced the appointment of Tim Wills as Head of Marine for Australia, marking a significant expansion into the country's marine insurance sector. Based in Sydney, Wills will spearhead the introduction of Markel's marine products, starting with marine cargo insurance. - read more |
| Pelagic Risk Services Strengthens Marina Support with Gold Sponsorship 19 Jan 2026: Paige Estritori Pelagic Risk Services, a specialist marine insurance broker, has elevated its commitment to the marina industry by upgrading from Silver to Gold Sponsorship with the Marina Industries Association (MIA). This move underscores Pelagic's dedication to supporting marinas across Australia through enhanced financial contributions and the provision of exclusive risk management resources. - read more |
| Why Income Protection Insurance is Vital for Your Financial Security Income protection insurance is a type of coverage that provides you with a financial safety net in case you are unable to work due to illness or injury. It typically pays up to 75% of your regular salary, helping you to continue meeting your financial obligations during difficult times. - read more
|
| Life Insurance for Entrepreneurs: Protecting Your Business and Family Life insurance is a financial product designed to provide a safety net for your loved ones and business in the event of your passing. At its core, life insurance aims to deliver financial protection by paying out a lump sum or ongoing payments to a designated beneficiary upon the insured's death. - read more
|
| Life Events That Should Trigger a Life Insurance Review for Aussie Families Life insurance is a cornerstone of financial planning for Aussie families, offering protection and peace of mind. But what happens when the bustling flow of life brings changes? This is where a life insurance review comes into play. A life insurance review is a thorough analysis of your existing policy to ensure it aligns with your current life circumstances and financial goals. - read more
|
| Top 10 Tips to Find Affordable Health Insurance in Australia Finding affordable health insurance can be a daunting task, particularly in a landscape as diverse as Australia’s. With a myriad of options available, it's crucial to understand the financial support mechanisms in place that can ease the burden of healthcare costs. One such mechanism is the health fund rebate, a key feature of the Australian health insurance system designed to make healthcare more accessible. - read more
|
A specific risk or cause of loss covered by an insurance policy, such as fire, theft, or flood.