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:

Insurance News

AIA Australia's Latest Enhancements to Priority Protection Insurance 24 Mar 2026: Paige Estritori AIA Australia has recently updated its Priority Protection life insurance suite, introducing changes designed to simplify discounts, enhance policy clarity, and support premium affordability. These enhancements, effective from 9 November 2025, reflect AIA's commitment to providing value-driven solutions for policyholders. - read more

Australia's Life Insurance Coverage Falls Short of Global Standards 24 Mar 2026: Paige Estritori Recent findings from a survey conducted by Zurich and the University of Oxford reveal that Australia has one of the lowest life insurance penetration rates globally. The study indicates that only 27% of Australians have income protection insurance, and 25% possess life insurance coverage. These figures are notably lower than the global averages of 33% for income protection and 32% for life insurance. - read more

Zurich's Pioneering Women's Health Benefit in Income Protection 24 Mar 2026: Paige Estritori Zurich has introduced a groundbreaking Women's Health Benefit within its Corporate Care Income Protection product, marking the first dedicated corporate income protection benefit in Australia designed specifically for female health conditions and events. This initiative aims to provide targeted support for women experiencing health issues that can impact their professional lives. - read more

Club Marine Introduces Land-Based Insurance for Race Boats 24 Mar 2026: Paige Estritori Club Marine, Australia's leading boat insurance provider, has announced a new partnership with the Australian Offshore Powerboat Club (AOPC) to offer specialised insurance coverage for race boats while they are on land. This initiative addresses a significant gap in the market, providing protection against accidental loss, damage, theft, or malicious damage to vessels during storage and transit. - read more