Insights for participants and consumers
Travel booked later this year? Tell your insurer about any health changes that occur before you depart, even if you don’t think they are important.
Travel insurance policies don’t cover pre-existing medical conditions that you haven’t disclosed. Being transparent with your insurer about your health can avoid your claim being declined as well as unexpected medical bills or additional travel expenses.
David and Meena booked an international holiday. They spent $24,000 on their prepaid travel expenses and were looking forward to extended travel throughout North America and Europe.
What happened?
Before the couple booked their holiday, David had visited his GP about pain on his left-hand side. After booking their holiday, but before departure, David’s pain returned, so he went back to see his GP. He was referred to hospital where kidney stones were identified in both kidneys.
Hospital doctors told David that the kidney stones were small, and he did not need further treatment at this time. David understood this to mean that there was nothing more that could be done for his condition. He assumed his symptoms would resolve on their own and did not tell his insurer, as he believed his health issue didn’t require further treatment.
Unfortunately, David’s symptoms flared up again during his overseas holiday, this time on his right-hand side. His symptoms were severe enough that he was admitted to hospital where a procedure was carried out on his kidney. His trip was cut short, so he made a claim for his medical and additional travel expenses through his insurer.
David’s insurer declined the claim, stating that his policy excluded pre-existing medical conditions. The couple had to pay several thousand dollars for David’s international medical bills and additional travel expenses.
The couple complained to FSCL.
What were the parties’ views?
The couple said they did not intend to hide David’s kidney stone condition from their insurer. Rather, they genuinely thought his condition was not worth mentioning due to the information the hospital had given him about the size of his kidney stones.
The couple said they were educated, yet simple, people and felt their claim was being declined because of complex terms and conditions designed by a large travel insurer. They pointed out they had disclosed other pre-existing medical conditions to their insurer and happily paid the additional premium for those. They said they were prepared to pay the additional premium for the kidney stone condition today and asked the insurer to reconsider their decision to decline.
The insurer said the policy excluded cover for pre-existing medical conditions unless the insurer had agreed to the additional risk. The policy required the couple to tell them about ’known circumstances’ and ‘changes in health’.
The policy required the couple to:
- tell the insurer about all of David’s pre-existing medical conditions,
- pay the additional premium, and
- tell the insurer about changes to David’s health.
Because the couple had not done all these things, the insurer declined David’s claim, but offered to refund the premiums the couple had paid for their other disclosed pre-existing medical conditions, as a gesture of goodwill.
How did FSCL help?
We identified this as a case of innocent non-disclosure and asked the insurer to increase their goodwill offer. We suggested that, had David disclosed the kidney stones, the insurer would likely have covered the condition for an increased premium.
The insurer declined to increase their offer.
What was the outcome of FSCL’s investigation
We agreed that the insurer was entitled to decline the claim on the basis that David had received treatment for a pre-existing medical condition that he did not disclose to the insurer.
The policy’s definition of ’pre-existing medical condition’ included David’s symptoms and the changes to his health. Because David did not tell the insurer about his symptoms or his kidney stone diagnosis, the policy did not cover David’s medical condition.
We did not uphold the complaint.
