Travel Insurance Dispute Highlights Pre-Existing Condition Clause

The information on this website is general in nature and does not take into account your objectives, financial situation, or needs. Consider seeking personal advice from a licensed adviser before acting on any information.

The situation began when the policyholder purchased travel insurance for a family holiday scheduled to begin on December 12, 2023. Shortly after arriving in the U.S., the man was informed of his sister-in-law's critical health decline due to metastatic colorectal cancer. He returned home to be with her in her final days, later resuming his vacation on December 23.

However, upon claiming for the abrupt change in travel plans, the insurer, AWP Australia, denied the claim. They stated that the policy explicitly excluded coverage for incidents related to pre-existing medical conditions of the insured’s relatives. The sister-in-law’s diagnosis of cancer and a pulmonary embolism had been established for nearly a year prior to the start of the policy coverage.

The case highlights a common oversight among travelers: not accounting for family members' significant medical histories while planning their travels. Even though the policy allowed for early return and resumption of journey benefits, these did not apply as the sister-in-law's health condition predated the travel insurance policy.

The policyholder argued that the policy had not explicitly required him to disclose his sister-in-law’s medical background, which he felt was unfair. He also mentioned experiencing substantial financial hardship due to the rejection of his claim. Nevertheless, AFCA supported the insurer's decision.

In summarizing the decision, the AFCA ombudsman stated, “I acknowledge the complainant was not aware that [his sister-in-law] may fall seriously ill and pass away when he commenced his holiday. However, I am satisfied the exchanged information shows death was caused by her pre-existing medical conditions for the purposes of the policy. In the absence of any other information, I am satisfied the insurer is entitled to deny the claim.”

This resolution accentuates the criticality of reading and comprehending the exclusions present in travel insurance policies. Policyholders should be fully aware of what constitutes a pre-existing condition and how it may impact claim eligibility. The case serves as a cautionary tale for travellers to ensure all potential scenarios are accounted for in their insurance coverage. For further details, you can refer to the ruling as noted by Australian Financial Complaints Authority.

Published:Wednesday, 22nd Jan 2025
Author: Paige Estritori

Please Note: We do not endorse any specific products or companies. Some content is sourced from third parties, including press releases, and may not be independently verified for accuracy or completeness.

Share this news item:

Insurance News

Clear

What Bushfire Resilience Ratings Mean for Farmers

07 Jul 2026: Paige Estritori

More Australian insurers are now recognising household bushfire resilience ratings, a development rural and regional property owners should watch closely as risk-based pricing becomes more visible across the insurance market. NAB and CommBank insurance brands have joined the program, alongside existing participants including NRMA Insurance and Suncorp, meaning a significant share of the home insurance market is now engaging with assessed bushfire mitigation. - read more

Cyclone Pool Delivers Relief, But Farmers Still Need to Check Cover

30 Jun 2026: Paige Estritori

The Australian Competition and Consumer Commission�s final monitoring report on the cyclone reinsurance pool has delivered a mixed message for rural and regional northern Australia. The pool appears to have helped ease some premium pressure for medium to high cyclone-risk areas, including reductions across home, strata and small business building and contents cover. For farm families and agribusinesses in cyclone-exposed regions, that is welcome news after years of rising costs and limited choice. - read more

El Niño Outlook Puts Farm Risk Planning Back in Focus

23 Jun 2026: Paige Estritori

Australia’s latest El Niño declaration has turned seasonal risk planning into an immediate priority for many rural and regional businesses. The Bureau of Meteorology confirmed El Niño conditions in mid-June, with forecasts indicating the tropical Pacific is likely to keep warming through the coming months and remain a factor until at least the end of the year. - read more

NRMA's Departure from Farm Insurance: What It Means for Australian Farmers

16 Jun 2026: Paige Estritori

In a significant shift within the Australian insurance landscape, NRMA has announced its withdrawal from the farm insurance market, ceasing the sale of new policies as of July 1, 2025. This decision affects both Hobby Farm Insurance and Rural Farm Insurance offerings, leaving many farmers in search of alternative coverage options to safeguard their livelihoods. - read more

New Partnership Strengthens Risk Management in Australia's Protected Cropping Sector

16 Jun 2026: Paige Estritori

Protected Cropping Australia (PCA) and Achmea Farm Insurance have announced a strategic partnership aimed at bolstering risk mitigation and resilience within Australia's protected cropping sector. This collaboration seeks to empower growers by providing tailored insurance solutions and promoting best practices in risk management. - read more

ABARES Report Highlights Insurance as a Key Tool for Managing Agricultural Risks

16 Jun 2026: Paige Estritori

The Australian Bureau of Agricultural and Resource Economics and Sciences (ABARES) has released a comprehensive report examining the role of insurance as a risk management tool for Australian farmers. The report emphasises that while insurance cannot protect against inevitable events like climate change, it can be instrumental in managing the variability and unpredictability inherent in farming. - read more

Click for more Insurance News