A few years ago, Renee had surgery to remove a brain tumour. Following the surgery, the doctors noted that Renee had poor impulse control and fixation as a result of the injury to her brain.
Renee recovered well and decided it was time to get out and see the world. In March, Renee booked a trip to Italy and purchased travel insurance cover. She would depart on 15 June and be in Italy for 2 weeks taking in the sights.
On 23 May Renee was admitted to the hospital emergency department with low sodium levels and a very high white blood cell count. The doctors diagnosed Renee with psychogenic polydipsia, a condition which means she had drunk too much water without any physical cause.
Given the deterioration in Renee’s condition, the doctors advised Renee not to travel alone as she had previously planned. Renee was told she would likely need to complete a blood test while overseas to monitor her progress.
In early June Renee decided to cancel her trip to Italy and claimed for the loss of deposits, approximately $2500, from her insurer.
The insurer reviewed Renee’s medical history and declined Renee’s claim, relying on a general exclusion for mental illness and also that Renee’s loss was a result of pre-existing medical condition.
In early October, Renee complained to FSCL.
Dispute
Renee said that a blanket mental illness exclusion was unfair. She felt that she was not admitted to hospital due to any mental illness, but had been thirsty due to using nicotine gum to help stop smoking. Renee also questioned how drinking too much water could be a pre-existing medical condition.
The insurer said that Renee’s claim was a result of her hospital admission and excluded because it was directly linked to her mental illness.
Review
We asked the insurer to provide us with the full policy wording and a full copy of all Renee’s relevant medical records.
The exclusion for mental illness was broad with a number of subheadings. It said that the insurer would not pay for any claim that arises directly or indirectly from, or in any way connected with, a number of related mental conditions including conditions that have resulted in behavioural issues.
We were satisfied that, on the medical evidence, Renee’s hospitalisation for drinking too much water was a manifestation of her behavioural issues, namely organic obsessive-compulsive disorder and fixation.
We considered that the insurer had reasonably considered Renee’s claim and assessed the medical evidence correctly.
We found that Renee had been to 6 medical appointments to discuss her behavioural issues in the past 18 months prior to her booking travel and that the claim could equally be declined as being a pre-existing medical condition.
Resolution
After explaining to Renee the effect of the exclusion clause and how it applied to her claim, Renee accepted the insurer’s decision and agreed to discontinue her complaint.
Insights for consumers
Many insurance policies have broad exclusions for any loss that is linked to mental illness. If you have a mental illness or any other pre-existing medical condition, you will not be covered unless you have disclosed the condition to your travel insurer and they have agreed to cover the condition.
