A man who travelled overseas for dental treatment has lost a claim dispute after saying he sustained a jaw injury during his outbound flight.

The Allianz Worldwide Partners policyholder said his jaw suffered “compression” during the journey in January last year. It became worse after he landed, he said, and he submitted a claim for medical treatment.  

The traveller, a beneficiary under a complimentary credit card travel policy, told the Australian Financial Complaints Authority the dental work he had planned was separate to the jaw injury and the travel insurer should cover his medical costs.  

The insurer declined the claim under the policy’s emergency medical expenses section because the man had not established he sustained an injury, and because he had planned to undergo surgery while overseas and the policy excluded treatment for pre-existing medical conditions.

AFCA has ruled in favour of Allianz Worldwide Partners, saying the man has established only that he had a procedure while overseas and not that he had it due to an injury sustained on the flight.

He has not shown the expenses claimed are unrelated to the dental procedure he was travelling for, AFCA says, because no information on the other procedure has been provided even though it was pre-planned.

“The complainant has not provided any information from a treating doctor which outlines what the injury was, or how and when it occurred. Rather, the complainant has provided untranslated medical invoices and a certificate from the treating doctor, which outlined the procedure was for a mobility issue which required plates and screws,” AFCA said.

That information was dated more than two weeks after the flight.  

“Given the length of time between the initial flight and the procedure, supporting information should be available. The absence of supporting information or reasons why it is unavailable does not assist the complainant,” the ombudsman said.  

“I am not satisfied the complainant has established he was injured while on the trip. Accordingly, I am not satisfied the complainant has established a valid claim ... to which the policy responds. It would be unfair to make the insurer pay the claim in the circumstances.”

See the ruling here.