In January 2016, Bob purchased travel insurance for his and his wife’s trip to Norfolk Island for their 50th wedding anniversary in September 2016. In May, Bob had to go to the hospital for treatment of a heart condition. He declared all pre-existing medical conditions to the insurer and took out extra cover (at a higher premium) because of his heart issues.
On the day of departure, Bob was on the plane for 15 minutes before he started to overheat. He moved to an aisle seat, took off his shirt and turned the air conditioning up. The flight attendant called paramedics.
After consultation with the airline’s doctor, the paramedics determined that Bob was not allowed to fly because of the risk that altitude would present to his associated heart problems. No record was kept of the conversation between the paramedics and the airline doctor, or the specific reason why he shouldn’t fly.
The day after the episode on the plane, Bob saw a doctor who noted that it was ‘most likely’ Bob had suffered a panic attack. Once he was back home, Bob saw his GP who disagreed. His GP believed the cause of the episode on the plane was atrial fibrillation (one of his known heart issues), rather than a panic attack. Bob then submitted a claim to his insurer for the non-refundable costs of his trip ($2,158.)
This case turned on competing medical evidence. The insurer wouldn’t pay the claim because it didn’t provide cover for panic attacks. On the other hand, Bob, with the support of evidence from his GP, believed the condition related to his atrial fibrillation.
Bob complained to FSCL about the declinature of his claim.
Bob’s policy included cover for cancellation expenses. It stated that If Bob had to cancel due to unforeseeable circumstances beyond his control, the insurer would pay for irrecoverable travel and accommodation expenses
However, the insurer declined his claim on the basis that Bob had a panic attack. The insurer relied on an exclusion clause that stated
the policy does not cover loss caused by or arising from dementia, depression, anxiety, stress or other mental or nervous condition
Bob believed the insurer should pay for his cancelled holiday because he had specifically taken out extra cover for his heart and the episode on the plane was a symptom of atrial fibrillation. Bob’s doctor said (in support of a review of Bob’s claim) “the reason for his removal from his flight was cardiac and not a mental or nervous condition.” He stated further, even if a panic attack had been present concurrently, this was a consequence of heart irregularities. The panic attacks had only occurred since Bob was diagnosed with atrial fibrillation.
Bob said he had not felt anxious in the 15 minutes he had been on the plane and the panic attacks he had previously experienced had not occurred whilst flying. The year before he had taken many flights with no panic attacks. Bob felt that even if the initial reason he was seen by paramedics was in regards to a panic attack, the airline’s decision not to let him fly at altitude was a decision to do with his heart problems.
The insurer relied upon the patient report form produced by the paramedics which noted “hot flush and panic attack,” as well as information from the doctor who examined Bob the day after and believed that the cause of removal from the flight was a panic attack. This was because Bob had a history of experiencing panic attacks in claustrophobic environments.
Upon a review of Bob’s doctor’s consultation notes, the insurer noted that there was no associated chest pain during the episode on the plane, nor in the episodes which followed in the days thereafter. The insurer said that there was no evidence to suggest that the episode was cardiac in nature.
The insurer’s in-house doctor had advised that even in the absence of Bob’s cardiac history, it was unlikely that Bob would have been able to fly because he had received medical attention immediately prior to departure.
A panic attack is a sudden overwhelming feeling of acute and disabling anxiety and therefore fell within the policy’s exclusion clause.
The documents provided by airport paramedics, the doctor in Hamilton and his initial visit to his GP indicated that Bob’s claim had arisen as a result of a panic attack. There had been no evidence of chest pain from the paramedics or at the two doctors’ visits and Bob had a history of panic attacks in claustrophobic environments. At Bob’s meeting with his GP in October, two medicines were prescribed to deal with anxiety and panic.
An ECG is essential when diagnosing atrial fibrillation. Because an ECG wasn’t undertaken at the time of the medical event and the paramedics listed their attendance in regard to a ‘minor event,’ there was no evidence to find that Bob’s event on the plane was a result of atrial fibrillation.
We found that the insurer had correctly declined Bob’s claim and recommended that he discontinue his complaint.
Key insights for consumers
Declaring all pre-existing medical conditions (and paying the associated higher premiums for cover) is advisable to mitigate the risks of unexpected and costly medical care or cancellation costs while you are away. However, it is by no means a ‘silver bullet,’ as all insurance policies contain exclusions.