Roger planned a trip to Europe with his wife for which he paid $3000 for non-refundable tickets.
Unfortunately, Roger was forced to cancel his trip after he suffered a type B aortic dissection. Complications from his surgery led to him being airlifted and hospitalised.
Roger had a pre-existing condition which had required surgery an aortic dissection in the past. He had not disclosed this to the insurer.
The insurer declined Roger’s claim for compensation of his travel costs because the claim arose directly or indirectly from a pre-existing medical condition which was excluded under the travel policy.
Roger said he did not know he had purchased travel insurance until he contacted the travel agent to cancel his journey. He was not advised by the travel agent nor asked to declare any pre-existing medical conditions. As a result, Roger did not have the opportunity to declare his pre-existing medical condition.
Roger felt it was unfair for the insurer to decline his claim based on a pre-existing medical condition and complained to FSCL.
Review
Upon review, we agreed with the insurer. The policy wording was clear. It excluded cover for losses arising directly or indirectly out of a pre-existing medical condition. As the exclusion was widely drawn, Roger did not have cover for complications arising from aortic dissection surgery.
We also found that the insurer had twice emailed the travel insurance quote and policy to Roger, noting no pre-existing medical conditions had been declared, and should cover be required for a pre-existing medical condition, Roger should contact the insurer.
So, while Roger had the opportunity to disclose his pre-exiting medical condition, he did not do so. We did not accept that Roger was not aware that he had travel insurance.
Outcome
Roger did not agree with our view and argued that the complications that led to his hospitalisation were due to medical misadventure and were unforeseeable circumstances beyond his control. It was the medical misadventure that led to his travel being cancelled, rather than surgery for the pre-existing medical condition itself.
We were not persuaded to change our view. We accepted that the complications while unforeseeable, and not a pre-existing condition in itself, arose in the context of surgery for a pre-existing medical condition. The insurer was entitled to decline the claim.
Insights
As the insurance policy forms the contractual basis between parties, it is the insured’s responsibility to read their policy and make any necessary disclosures. An insured cannot obtain cover for a pre-existing medical condition that has not been declared and accepted by the insurer. It is important that consumers declare all pre-existing medical conditions prior to purchasing insurance.
