Martin was taking his daughter, Ellie, and three grandchildren on an overseas holiday. When arranging the travel insurance for the trip Martin disclosed that his four-year-old grandson, Jackson, has asthma and eczema. Both were noted as pre-existing medical conditions covered by the policy.
While overseas Jackson experienced severe eczema. Ellie called the travel insurance emergency help line and spoke to a nurse. The nurse sympathised with Ellie being overseas with a sick child, but advised that as the condition was not sufficiently serious to warrant medical evacuation home, the insurer would not cover the costs of rearranging flights.
Over the following day Jackson’s condition did not improve and Martin and Ellie decided to fly the family home, incurring costs of about $1,500 to rearrange tickets. When they got home, Martin submitted an insurance claim form, supported by a letter from the doctor who said she was unable to prescribe any further relief for Jackson.
The insurer declined the claim. Martin did not accept the insurer’s decision and complained to FSCL.
Dispute
Martin said the insurer did not appreciate the severity of Jackson’s reaction, that the overseas doctor was unable to help and that they had no option but to return home early.
The insurer explained that under the policy it will only cover the costs of returning home early if that decision is made on written advice from a medical adviser approved by the insurer. When Ellie spoke to the insurer, she was advised that it would not cover the costs of returning home early. The medical certificate from the doctor who saw Jackson also did not recommend that he return home on medical grounds.
Review
We acknowledged that eczema is not a trivial condition. Faced with a child in extreme distress, Martin and Ellie made the best decision for their family in the circumstances in which they found themselves and returned home.
However, the insurer only agreed to cover the costs of this early return if the decision to return was based on medical advice. Neither the insurer’s nurse, nor the treating doctor, recommended medical evacuation.
We explained to Martin that the insurer was entitled to decline the claim.
Resolution
Martin remained dissatisfied with the decision. He felt we did not appreciate the severity of Jackson’s eczema and asked us to reconsider. However, as Martin did not have any new evidence or argument to support a different decision we explained, and Martin agreed, there would be little point continuing with the complaint.
Insights for consumers
An insurer is entitled to impose conditions before it will agree to pay for the early return of an insured person. If you are overseas and experience a bad dose of the flu or stomach bug, this may well severely impact your enjoyment while on holiday, but this does not mean that your insurer is obliged to fly you home. Before returning, you must get your insurer’s approval or a letter from a doctor certifying that you must return home for medical reasons.
