A cruise passenger from SA who was airlifted by emergency helicopter to the Royal Hobart Hospital after suffering multiple heart attacks has failed to fully recover substantial costs despite being sold inappropriate insurance.

A credit union acting as an insurance intermediary knew the man was seeking cover for medical expenses incurred at sea but sold him a policy that “did not match his requirements,” the Australian Financial Complaints Authority (AFCA) said.

The Department of Health charged the man $26,789 for deployment of an emergency helicopter and ambulance travel, as well as $2,352 for treatment at Port Arthur and in-flight paramedics.

“I sympathise with the complainant’s position,” the AFCA ombudsman said. “This determination is partially in favour of the complainant.”

The insurer, which was not named in the ruling, denied the man’s claim for $29,092 in medical expenses as the travel insurance policy did not cover medical and evacuation expenses in Australian waters.

If the man had international cover, the policy would likely have covered the expenses, AFCA said.

The cruise goer, who did not hold private health cover or private ambulance cover, said the Australian Central Credit Union misled him into purchasing an insurance policy that did not suit his needs.

The credit union was told by AFCA to pay $1,000 to compensate for “an unusual degree of inconvenience and stress because of misrepresentation” as well as $3,088 for medical expenses incurred on board the ship.

The policy sold to the man stated “if you are cruising in Australian waters, Medicare or your private health fund may not cover you. Select a plan for overseas travel if you want cover for medical and dental expenses.” The credit union representative “should have been aware of the details”, AFCA said, adding that a suitable policy had been available as an alternative.

The credit union knew the complainant “was vulnerable” and should have been aware the policy being sold was not adequate to meet his requirements, AFCA ruled, noting English was not his first language.

“I am satisfied the bank misled the complainant to believe that he would be covered for Medicare benefits for medical expenses incurred whilst in Australian waters,” the ombudsman said.

Although the return cruise was from Adelaide to Hobart, the Australian Central Credit Union should have advised the man to take out international travel cover, AFCA said.

The credit union admitted the man was incorrectly advised Medicare would apply to his travel while in Australian waters.

“Generally Medicare will not cover you even though you are still in Australian waters,” AFCA said.

The man had sought a policy to cover him and his wife for “all eventualities” on the cruise. He had trouble understanding the details of the policy by telephone and went to a branch in person, where the travel insurance policy was eventually purchased.

Cruise information presented by him to the bank said fully comprehensive insurance providing health cover for pre-existing conditions and the cost of medical reparations was essential. The man did receive advice that the insurance policy he bought would not cover medical expenses but at the same time he was incorrectly told Medicare would apply in Australian waters.

“If the complainant had overseas international cover, the policy would likely have extended to cover the expenses incurred,” AFCA said.