Jess had a trip to Jakarta planned for early 2020. But a few months before she was due to leave New Zealand, she was diagnosed with a herniated disk in her lower back. Jess’s doctor told her she needed surgery and would have to cancel her trip.
Jess lodged a claim with her travel insurer, but the claim was declined. The insurer said Jess had failed to disclose some ongoing lower back pain when she purchased her policy. That lower back pain turned out to be a symptom of the herniated disk, so the claim was not covered.
Dispute
Jess disagreed with the insurer’s decision. She said that, when she purchased her policy, she had no reason to believe that her back pain was anything significant enough to disclose.
She said she had visited her doctor about the back pain about a month before she purchased the policy, and had been told that the pain was almost certainly nothing to worry about. Jess was 65, and she said that anyone her age will have pain in their back and joints every now and again. She said she had no reason to believe this pain was related to anything serious, or to disclose it to her insurer.
Jess did not think the insurer’s reasoning was fair, and she complained to FSCL.
Review
We reviewed Jess’s complaint, and agreed with the insurer.
Jess’s insurance policy required her to disclose all her pre-existing medical conditions when she purchased her policy – this included any signs or symptoms which were under investigation or awaiting a diagnosis. And we were satisfied that Jess’s back pain fit that definition.
After reviewing Jess’s medical notes, we saw that Jess’s doctor had said the pain was most likely temporary, and told her it was probably nothing to worry about. However, that diagnosis was conditional. The doctor told Jess that if the pain did not clear up within a week, she would need to visit again, and they would need to do some further tests.
By the time Jess purchased her insurance policy, nearly a month later, the pain had not cleared up. Jess had information which showed the pain might be more than ordinary, temporary discomfort, and that the pain would require further investigation. So, in our view, Jess should have disclosed the pain to her insurer.
Resolution
We found that it was reasonable for the insurer to decline Jess’s claim, and recommended that Jess discontinue her complaint. Jess did not accept this decision, maintaining she had no reason to disclose the pain to her insurer. She decided to take her complaint to the Disputes Tribunal.
Insights for consumers
Most travel insurance policies will require you to disclose any pre-existing medical conditions. And the definition of ‘pre-existing medical condition’ is usually very broad. If you are experiencing any signs or symptoms when you purchase your policy, you will need to disclose them to your insurer, or you will run the risk of having a claim declined in future.
