Travel Insurance Dispute Highlights Pre-Existing Condition Clause

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.

Published:Wednesday, 22nd Jan 2025
Source: Paige Estritori

Please Note: If this information affects you, seek advice from a licensed professional.

Share this news item:

Insurance News

Strengthening Agricultural Insurance: Rural Affinity and Munich Re's Renewed Partnership

10 Feb 2026: Paige Estritori

Rural Affinity has renewed its partnership with Munich Re Specialty - Global Markets under a new five-year agreement, continuing a collaboration that began in 2006. This renewed alliance aims to support Rural Affinity's efforts to expand its agricultural insurance offerings across Australia and introduce new products leveraging technology and innovation. - read more

AFCA Mandates Insurer Payout for Engine Overheating Incident

10 Feb 2026: Paige Estritori

The Australian Financial Complaints Authority (AFCA) has recently ruled in favour of a truck owner whose insurance claim was initially denied following an engine overheating incident. This decision underscores the complexities surrounding insurance claims related to driver negligence and mechanical failures. - read more

AFCA Supports Insurer in Truck Theft Claim Denial

10 Feb 2026: Paige Estritori

The Australian Financial Complaints Authority (AFCA) has recently upheld an insurer's decision to deny a truck theft claim, citing misrepresentation of the insured's insurance history. This ruling highlights the critical importance of accurate disclosure when obtaining insurance coverage. - read more

AFCA Sides with Freight Company in Dangerous Goods Disclosure Case

10 Feb 2026: Paige Estritori

The Australian Financial Complaints Authority (AFCA) has recently ruled in favour of a freight company in a dispute over the disclosure of transporting dangerous goods. This decision provides valuable insights into the obligations of transport companies regarding insurance disclosures. - read more

Click for more Insurance News

Business Insurance Articles

Understanding Liability Insurance: A Must-Read for Australian Small Business Owners

Liability insurance is a form of insurance designed to offer protection against claims resulting from injuries and damage to people or property. It covers legal costs and any payouts for which the insured party would be responsible if found legally liable. Intended to protect against claims resulting from injuries and damage to other people or property, liability insurance is critical for small businesses as it shields them from potentially crippling legal expenses. - read more

How to Lower Public Liability Insurance Premiums Without Sacrificing Coverage

In the ever-evolving landscape of Australian commerce, business insurance stands as a crucial bulwark, safeguarding enterprises against unforeseen financial perils. Recognizing this, our in-depth exploration begins with an overview of the monumental role business insurance plays for Australian companies, both large and small. It's a cornerstone for risk management, providing business owners with peace of mind as they navigate the intricacies of their industries. - read more

Critical Risk Management Strategies for Every Australian Tradesman

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

The Importance of a Custom Risk Management Plan: A Guide for Australian Entrepreneurs

In the fast-paced world of entrepreneurship, the only constant is change, and with change comes the inherent realm of the unknown – risk. Australian entrepreneurs, much like their international counterparts, operate in dynamic environments where unpredictability is a staple. However, the unique economic, legal, and environmental aspects of Australia demand a more localized understanding of these risks. Acknowledging this unpredictability is the first step towards mitigating potential threats to one's business venture. - read more

Start Here !

Knowledgebase

Occupational Hazard:
A risk associated with the nature of a particular occupation, which may affect insurance premiums.

This website is owned and operated by Clark Family Pty Ltd (ACN 010 281 008) as Trustee for the Clark Family Trust (ABN 35 957 893 714), 43 Larch Street Tallebudgera QLD 4228. Clark Family Pty Ltd is an Authorised Representative (AR 1298860) of Unique Group Broker Services Pty Ltd (AFSL 509434) for financial product referrals and an Authorised Credit Representative (ACR 401491) of Saccasan Pty Ltd (ACL 386297). Check our licensing details on the ASIC registers: Clark Family Pty Ltd ACR, Clark Family Pty Ltd AR, Saccasan Pty Ltd, Unique Group Broker Services.

IMPORTANT: We do not provide financial product advice or credit assistance. We act solely as an introducer and refer enquiries to licensed third-party intermediaries, insurers, and lenders - with whom you can then deal directly. We may receive a fee or commission from these third parties in consideration for the referral. Before any action is taken to obtain a product or service referred to by this website, advice should be obtained (from either the third party to whom we refer you or from another qualified intermediary) as to the appropriateness of obtaining those products having regard to your objectives, financial situation and needs. Whilst we have our own process for validating the legitimacy of our referral partners, you should always verify the credentials of your financial adviser before proceeding with recommendations that they may present. Visit the ASIC website for further information.