We are a proud member of the Financial Services Online network!
Connect with us on your favourite social media platform for the latest financial news, views, tips, tricks, resources and information.
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:
| Travel Insurance Dispute Highlights Pre-Existing Condition Clause 22 Jan 2025: Paige Estritori In a recent case that underscores the importance of understanding insurance policy clauses, a man who cut short his vacation in the United States to be with his terminally ill sister-in-law has been denied an insurance payout. The ruling, made by the Australian Financial Complaints Authority (AFCA), favored the travel insurer due to the claimant’s lack of coverage for pre-existing medical conditions of relatives. - read more |
| Dutton Calls for Urgent Solutions as Insurability Crisis Hits Halls Gap 22 Jan 2025: Paige Estritori Peter Dutton, the leader of the Coalition, voiced pressing concerns over the growing issue of 'uninsurable risks' during a recent visit to the fire-stricken tourist town of Halls Gap in Victoria. The picturesque location, frequently visited by tourists, experienced significant bushfire disruptions over the Christmas holiday, highlighting broader insurance challenges. - read more |
| Storm Devastation: Over 11,000 Claims Filed in NSW and ACT After Severe Weather 21 Jan 2025: Paige Estritori The recent onslaught of electrical storms that lashed across New South Wales (NSW) and the Australian Capital Territory (ACT) has resulted in a flurry of activity from the insurance industry, as shown by the impressive number of claims filed. In an eventful week of wild weather, the Insurance Council of Australia reported an influx of 11,366 claims tied to the severe storms that began on January 15. - read more |
| Severe Weather in Eastern Australia Sparks Insurance Claims Spike 17 Jan 2025: Paige Estritori Recent storms sweeping across New South Wales and parts of Queensland have led to a surge in emergency calls and insurance claims, as residents grapple with the aftermath of strong winds, heavy rainfall, and hail. This extreme weather has posed significant challenges to numerous households and businesses, prompting a rallying cry for assistance. - read more |
| Broker Sentenced for Fraudulent Builders’ Insurance Scheme 15 Jan 2025: Paige Estritori In a significant legal crackdown, a broker has been sentenced for his involvement in selling fraudulent builders’ warranty insurance to construction firms in New South Wales. This case underscores the urgent need for regulatory vigilance in the insurance sector. - read more |
| Income Protection vs. Life Insurance: Why You Need Both Insurance plays a crucial role in safeguarding our financial future. It serves as a safety net, ensuring that we can manage unexpected events without severely impacting our financial stability. For Australian adults, having the right types of insurance coverage is essential for peace of mind and financial security. - read more
|
| Preparing for the Unexpected: Why Income Protection is Essential for Financial Security Life's unpredictability can often bring unforeseen challenges, particularly when it comes to our finances. One day you might be climbing the career ladder, the next you could find yourself unable to work due to illness or injury. This is where income protection insurance steps in, serving as a financial safety net that ensures you can continue to meet your living expenses, even when the unexpected happens. - read more
|
| Comparing Income Protection Policies: What Australians Should Look For Income protection insurance serves as a financial safety net for countless Australians, offering a replacement income when unforeseen circumstances such as illness or injury impede their ability to earn. For the self-employed and entrepreneurs who may not have the safety nets offered by corporate employment, such protection is particularly important. - read more
|
| Why Every Australian Entrepreneur Needs Income Protection Insurance Entrepreneurship in Australia - a landscape overview: The allure of entrepreneurship in Australia is undeniable, with the promise of innovation, personal autonomy, and potentially limitless earnings. However, the path of an entrepreneur is often unpaved and unpredictable. Without the safety nets traditionally provided by corporate employment, Australian entrepreneurs must proactively safeguard their personal finances against the capricious winds of business fortune. - read more
|
| Navigating Pre-existing Conditions in Income Protection Insurance Income protection insurance is a safety net that many Australians rely on to secure their financial future in the event of illness or injury preventing them from working. It's a type of policy that provides a replacement income if you are unable to earn your regular income due to a health-related absence from the workplace. - read more
|
|
Income Insurance: The Safety Net for Your Financial Goals in Australia Financial security is pivotal for anyone striving to meet their life goals, be it owning a home, educating children, or ensuring a comfortable retirement. In Australia, where uncertainties can disrupt our best laid-out financial plans, having a safety net in place is essential. Income insurance offers just that—protection against the unforeseen events that could impact your income earning abilities. - read more
|
|
Understanding the Process: A Beginner's Guide to Income Insurance Claims Income insurance, an often-overlooked component of financial security, is gaining traction among Australia's burgeoning self-employed population. In an economy where traditional employment is no longer the sole path to success, this form of insurance has become a cornerstone for proactive financial planning. Touted as a safety net, it ensures that personal livelihoods and business operations remain secure in the face of adversity. - read more
|
|
|
Comparing Income Protection Policies: What Australians Should Look For Income protection insurance serves as a financial safety net for countless Australians, offering a replacement income when unforeseen circumstances such as illness or injury impede their ability to earn. For the self-employed and entrepreneurs who may not have the safety nets offered by corporate employment, such protection is particularly important. - read more
|
|
|
Preparing for the Unexpected: Why Income Protection is Essential for Financial Security Life's unpredictability can often bring unforeseen challenges, particularly when it comes to our finances. One day you might be climbing the career ladder, the next you could find yourself unable to work due to illness or injury. This is where income protection insurance steps in, serving as a financial safety net that ensures you can continue to meet your living expenses, even when the unexpected happens. - read more
|
|
The Role of Rehabilitation Benefits in Income Protection Insurance When the unexpected strikes, such as an illness or injury hindering our ability to earn a living, the financial repercussions can be devastating. This is where income protection insurance becomes a pivotal part of our financial safety net, ensuring a stream of income during challenging times. - read more
|
