A traveller who was forced to cancel his trip to Fiji after he became his grandmother’s primary carer has lost his claims dispute. 

The complainant had initially bought the tickets for the holiday in 2020, but due to covid-related delays, the trip was rescheduled multiple times until December last year. The man took out a policy with Mitsui Sumitomo Insurance on November 18 last year, a few weeks before the trip. 

The insured lodged a claim with the insurer after he had been assigned the primary carer of his grandmother and was required to look after her health. The claimant’s aunt had been the primary carer, but the duties were transferred to him after she had become ill. 

Mitsui Sumitomo Insurance acknowledged the difficult circumstances of the complainant but denied the claim after it said the grandmother’s illness had not been “unforeseeable” before he purchased the travel policy. 

The insurer notes that in the claim form explaining the reason for the cancellation, the man had admitted that he became “aware of the need to cancel” the holiday in July, months before he incepted the policy. 

The policyholder says he could not have foreseen his grandmother’s illness when he first booked the trip in 2020, but the Australian Financial Complaints Authority (AFCA) says this was not relevant as the policy only operated from the date it was purchased. 

“The complainant’s grandmother’s medical assessment completed on April 21 2022 notes she required constant care due to suffering from several injuries/illnesses,” AFCA said. 

“The complainant does not dispute he was aware of his grandmother’s various medical conditions before policy purchase.” 

The claimant also argued that his aunt’s illness had been unforeseen and that this was why the trip was cancelled, as he was forced to take over her duties. 

AFCA acknowledged the circumstances surrounding the aunt’s illness but said it could not review the issue due to limited evidence. 

“I accept an aunt falls within the definition of a relative under the terms of the policy,” AFCA said.  

“The complainant however is unable to obtain any medical records to support this claim as his aunt is not willing to release her medical records to the complainant or the insurer.” 

The ruling determined that Mitsui Sumitomo Insurance was entitled to deny the claim based on the applied policy exclusions. 

“The outcome is fair because the policy does not extend cover for trip cancellation due to medical conditions that were known at the time the policy was issued,” AFCA said. 

Click here for the ruling.