Questionable questionnaire

Kevin and his wife flew to Brisbane to meet their daughter, Elisa, before the three of them carried on to Denpasar, Bali for a holiday. Elisa was flying back to Brisbane from Denpasar nine days earlier than her parents were to fly home to New Zealand.

Elisa’s flight back to Brisbane was cancelled due to volcanic activity near Denpasar. Elisa was able to rebook her flight for a week later.

 

Dispute

On Kevin’s return to New Zealand he contacted his travel insurance company to make a claim for the additional expenses incurred as a result of Elisa’s cancelled flight, being:

  • $1201.55 for additional accommodation
  • $194.30 for food
  • $199.20 for calls to the airline to organise a substitute flight

The claim totalled $1,595.05.

The insurance company declined Kevin’s claim because Elisa did not hold return overseas flights from New Zealand, which was a requirement for cover under the policy.

Kevin disagreed with this and contacted FSCL.

 

Kevin’s view

Kevin had completed the insurance company’s online eligibility questionnaire, and believed he and his family were covered under the policy. the insurance company’s eligibility questionnaire asked “do you hold a return overseas ticket for your journey?”. Kevin understood the question to only be asking if he had a return overseas ticket, rather than himself, his wife and Elisa.

 

The insurance company’s view

The insurance company said “you” was defined in its policy and the definition made it clear that all travelling passengers must meet the eligibility criteria to be covered.  

 

Review

When assessing the merits of a case we must give fair regard to the terms of the insurance policy. We looked at the “important information” section of the policy under the eligibility criteria. Throughout this section the word “you” is written in bold, indicating the word is defined in the policy. This definition included “any accompanying spouse and/or any dependent children, as the context requires”. The important section of the eligibility criteria required that “…you must hold a return travel ticket for your travel before you depart New Zealand…” This clearly excluded Elisa from cover.

The main issue for Kevin was that the wording of the online eligibility questionnaire was not clear. Unlike the policy, there was nothing in the questionnaire indicating that the word “you” meant anything other than its ordinary meaning. There were other questions asked which had more specific wording, for example “is everyone to be insured under the policy a citizen or a permanent resident?” It would have been possible for the insurance company to make the questionnaire clear by having a question akin to “does everyone to be insured under the policy hold a return overseas ticket to New Zealand?”

The purpose of the insurance company’s questionnaire is to help people seeking insurance ensure they meet the standard eligibility criteria to be covered. If the questionnaire had been unambiguous, Kevin would have had the opportunity to seek alternative travel insurance for Elisa.

 

Outcome

The insurance company was entitled to decline Kevin’s claim under the policy. However, we considered it appropriate that the insurance company pay Kevin $750 to compensate for:

a)      The inconvenience caused by its questionnaire’s shortcomings, and

b)      The fact that Kevin would likely have been able to find alternative insurance which would have covered his claim, if the questionnaire had been clearer.

 

We also strongly encouraged the insurance company to improve its questionnaire’s clarity.