A traveller who suffered a hip injury during her holiday in Cairo will be awarded additional compensation after a dispute ruling found her insurer unnecessarily delayed its decision to accept the claim.

The complainant lodged the claim to cover medical expenses for required hip surgery after she fell on her back in August last year, which Zurich Australia agreed to cover. 

However, disputes arose over the insurer’s handling of the claim after the policyholder complained about delays, despite initally being told it would be resolved within a week.

The Australian Financial Complaints Authority (AFCA) heard Zurich received supporting information for the claim in September but requested the complainant sign a medical authority and have her GP complete a form regarding her medical history to help determine its decision. The claimant returned the records on October 26. 

AFCA says Zurich should have settled the claim within 10 business days of receiving the medical documents, but the claim continued into this year, with the insurer requesting ambulance invoice records in January and February. 

The complainant says the delays were unwarranted and required her to borrow funds from her sister to pay medical fees. She sought for the insurer to compensate her for the delays as well as losses relating to changing currency rates. 

Zurich acknowledged the delays but said the information was required to “clarify certain aspects of her claim” before it could be finalised. It also noted that it dealt with an influx of travel claims during this period due to the resumption of international travel. 

The insurer says the claim was settled based on the exchange rates of the dates of the invoices and says no further reimbursement is needed.

AFCA agreed that the claimant failed to show that the settlement was incorrectly calculated.

But the ruling says Zurich “could have managed the claim better”, noting that it could have been completed by mid-November if the insurer “proactively contacted” the policyholder for the additional information.

“Even though I accept the insurer may have been inundated with claims, at the times it did review the claim file, it could have done so wholly and not on a piecemeal basis,” AFCA said.

“This would have given the complainant realistic expectations on the claims progress and given her an opportunity to clarify any queries the insurer had about the supporting information.” 

The ruling required Zurich to pay interest on the settlement from November 14 to the date the claim was paid.

The decision also awarded the complainant $1500 in non-financial losses relating to the delays, saying she suffered “unnecessary stress, anxiety and inconvenience” during a difficult period of recovery. 

Click here for the ruling.