The information on this website is general in nature and does not take into account your objectives, financial situation, or needs. Consider seeking personal advice from a licensed adviser before acting on any information.
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.
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.
Please Note: We do not endorse any specific products or companies. Some content is sourced from third parties, including press releases, and may not be independently verified for accuracy or completeness.
New South Wales strata communities should keep a close watch on renewed efforts to reform the way emergency services are funded through insurance premiums. The long-running concern is that adding emergency services charges to insurance bills can make cover look more expensive, particularly for apartment buildings, mixed-use schemes and larger owners corporations already managing high rebuilding values and complex risk profiles. - read more
The Australian Financial Complaints Authority’s latest reporting has again highlighted insurance as a major source of disputes, with claim delays, communication breakdowns and disagreements over policy outcomes remaining common pressure points. For domestic and home service businesses, the message is practical: the strength of a policy is often tested not when it is bought, but when a claim is made. - read more
The insurance fallout from Ex-Tropical Cyclone Alfred is a timely reminder that severe weather is not just a household issue. For Australian freelancers, consultants and sole traders, a storm can interrupt work, damage essential equipment, delay client delivery and expose gaps in cover that only become obvious at claim time. - read more
Fresh industry commentary on business underinsurance is a timely reminder for personal trainers, fitness instructors and small studio owners to look beyond the headline price of a policy. While parts of the commercial insurance market have become more competitive, rising replacement costs and changing business models can still leave fitness operators exposed if their cover has not kept pace. - read more
Professional indemnity insurance can help protect Australian professionals and service businesses against claims arising from alleged errors, omissions, negligence or breaches of professional duty. This guide explains what it may cover, how claims-made policies work and what to check before arranging cover. - read more
As a business owner in Australia, navigating the complexities of protecting your company is crucial, with product liability insurance being an essential aspect to consider. This type of insurance is designed to shield businesses from financial losses that may arise if a product they manufacture, supply, or sell causes harm to a consumer or damages property. - read more
Welcome to the crucial world of risk management for Australian tradesmen. Whether you're a seasoned professional or just starting, understanding and mitigating the inherent risks in the trades industry is paramount to both the safety and sustainability of your business. This article intends to guide you through the world of risk management, emphasizing the pivotal role of liability insurance. - read more
Public liability insurance is a crucial safety net for both businesses and individuals, providing protection against the financial fallout from claims of injury or damage that your business operations might cause to third parties. This type of insurance is designed to cover legal and compensation costs, safeguarding you from unexpected financial burdens. - read more
Start Here !
Knowledgebase
Public Liability Insurance: A very broad term for insurance covering liability exposures for individuals and business owners. It provides broad coverage, generally including all exposures for property damage and bodily injury.
No comments yet. Be the first to share your thoughts.