A traveller who fell ill a few days into a planned year-long holiday has won his bid to have medical expenses and air ambulance costs covered after his insurer argued his pre-existing mesothelioma was the cause of the sickness.  

The complainant had a comprehensive multi-trip policy for travel between January 27 this year and January 26 next year.   

He fell ill in Bali and was hospitalised on February 1 with nausea and vomiting.  

The man was diagnosed with pleural effusion, a blood clot and pneumonia and was told he needed an air ambulance with a medical escort to return home.  

Nib Travel Services said the likely cause of the hospital admission was the pleural effusion – a build-up of fluid around the lungs – and the man had a history of the illness caused by his mesothelioma.

The insurer also suggested the man’s vomiting was associated with his mesothelioma, as a side effect of chemotherapy. It declined the claim.   

The complainant maintained he went to hospital because of the vomiting, which he attributed to a stomach bug. Hospital records showed he was transferred from an island with “weakness due to vomiting”, and the treating doctor diagnosed acute gastritis.  

The claimant said he had not had chemotherapy for mesothelioma and he provided submissions from his oncologist, who said the vomiting may have been caused by a urinary tract infection that was diagnosed on February 10.  

In a dispute ruling, the Australian Financial Complaints Authority says the insurer failed to explain “how, in the absence of chemotherapy treatment, the vomiting arose because of mesothelioma”.  

It says the treating doctor and oncologist’s diagnoses are a more likely explanation for the vomiting, which caused the hospital stay.

“I am satisfied the complainant has established a claimable loss and the vomiting was caused by a new illness,” AFCA’s ombudsman said.  

The complainant also argued he had been misdiagnosed with pneumonia and the blood clot, and that he should not have required an air ambulance to travel back to Australia. He noted information from his hospital that showed no shortness of breath or lung scarring.  

The insurer suggested antibiotics cleared the pneumonia during his stay in Bali and that mesothelioma caused a higher chance of blood clots.  

AFCA accepts the pneumonia was probably misdiagnosed and that there was limited information to show he had a blood clot. It says even if he had either condition, the insurer did not show how his mesothelioma caused it.  

Nib must cover all the complainant’s medical expenses and refund the cost of all expert reports. It is also required to cover all non-refundable cancellation fees incurred by the claimant.  

Click here for the ruling.

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