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A pre-existing problem – the need to declare

Visits to the doctor 

Gillian saw her doctor on 17 June 2013. She was suffering from ‘acute infective exacerbation of bronchial asthma’. She was prescribed antibiotics and Prednisone for 2 weeks. 

Gillian travelled to Australia over 22/23 June 2013. On 10 July 2013 Gillian attended a doctor in Australia for breathlessness. The doctor wanted to carry out tests to rule out a pulmonary embolism (“PE”), and provided Gillian with a medical certificate stating she was unfit for travel from 11 July 2013 up to and including 19 July 2013. 

This meant that Gillian could not travel back to New Zealand on 14 July 2013, and incurred costs in having to remain in Australia longer than she had planned. 

Thankfully, it transpired that Gillian was not suffering from a PE. 


The complaint 

Gillian submitted a claim to her travel insurance company for the costs she incurred. The insurance company declined the claim because, in its view, the claim arose directly or indirectly from a pre-existing medical condition – asthma. As Gillian had not sought cover for asthma, the insurance company declined the claim. 

Gillian complained to FSCL that her travel back to New Zealand was delayed not because of her pre-existing asthma condition, but because of a suspected pulmonary embolism. 


The medical evidence 

The insurance company sought medical evidence from the doctor who treated Gillian in Australia. The doctor confirmed that after the PE was ruled out, she was still of the view that Gillian was not fit for travel for another few days, because Gillian was still experiencing respiratory symptoms due to exacerbation of asthma. The doctor reiterated that the symptoms were due to ongoing unresolved asthma that Gillian was already suffering from when she travelled from New Zealand. 


FSCL’s view 

In our view it was clear that the costs Gillian had incurred arose from asthma, a pre-existing medical condition, and we agreed with the insurance company that there was no cover under the policy. Gillian accepted our view and withdrew her complaint. 


Lesson to be learned 

It is common for people to suffer from ill-health while travelling overseas. Most travel insurance policies will exclude cover for losses arising from pre-existing medical conditions. 

It is most important when applying for travel insurance, and many other types of insurance (such as health insurance), that you disclose any pre-existing medical conditions. If you are in doubt whether you need to disclose any of your medical history, always disclose it. You will then have placed the insurance company on notice of any condition which may affect its decision to insure you, and on what terms.