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Ambulance applicant loses travel insurance dispute

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A father who took out travel insurance while his child was being taken to hospital by ambulance and an hour before their flight left for North America won’t have his claim paid.

The Australian Financial Complaints Authority (AFCA) has ruled Zurich was entitled to deny the father’s claim because his 11-year-old daughter’s illness was not due to unforeseeable circumstances.

About an hour before the family was scheduled to fly from Australia, the complainant took out the Zurich travel insurance policy while his daughter was being taken by ambulance to a hospital emergency department.

The next day, the complainant ticked “no” in a claim form box asking whether he could travel on different dates, and wrote: “Depends on recovery of child and available leave at work.”

That showed the complainant knew the illness might lead to the cancellation of the trip, AFCA ruled.

“The cancellation was not due to circumstances that were unforeseeable when the complainant activated the policy,” AFCA said. “Therefore, the complainant has not established a claimable loss.”

Early on the day of the planned April 22 trip the girl was taken to hospital by ambulance and it was clear the family would not make their 10.10 am departure. Just before 9am the complainant called Zurich and took out the travel insurance policy. Hospital records show the daughter was diagnosed with pneumonia just before 5pm that day.

The complainant said he knew when he took out the policy that his family would miss their flight, but he planned to reschedule it and continue with the trip. He argued he did not decide to cancel the trip until April 29, and his claim was not for the original missed April 22 flight but for this later date.

The policy stated it only covered trip cancellation for circumstances that were “unforeseeable at the time you activated this policy”, and excluded existing medical conditions.

AFCA ruled the pneumonia was an existing medical condition as defined in the policy, and the insurer was entitled to deny any claim arising from it.

There was no dispute from either party that the complainant cancelled his trip because of his daughter’s pneumonia, but the complainant argued only fever existed before he activated the policy. The pneumonia, which was diagnosed later, was the reason he cancelled the trip.

“I do not accept that the fever and pneumonia were separate conditions,” the AFCA determination says.

Although the pneumonia was diagnosed after the policy was purchased, it was causing fever from April 17 and was a symptom of the pneumonia, AFCA says.

“I am satisfied that when the policy was activated the pneumonia was under investigation and awaiting diagnosis. Therefore, it fit the policy’s definition of an existing medical condition.”

Click here to see the full ruling.