A holidaymaker who suffered a dislocated hip will not have her medical bills covered after the dispute authority found the injury stemmed from a pre-existing condition.

The woman was injured last April while turning in bed, and was taken to hospital.  

NIB Travel Services (Australia) declined her insurance claim on the basis a pre-existing or chronic condition caused the loss.

It said its policy covered medical expenses arising only from a new illness or injury.  

The insurer referred to the woman’s medical records, which showed she had a hip replacement due to osteoarthritis in May 2021.

The records also showed she dislocated the same hip three times between August and December of that year, and was hospitalised twice.  

In June 2022, the woman saw an orthopaedic surgeon who identified instability in the hip and encouraged her to get an opinion from another doctor.  

The claimant said the surgeon’s notes were “totally erroneous” and the left hip issues had been resolved after she wore a brace for four months.

She said when she bought the travel insurance policy, her left hip “did not qualify as a notifiable pre-existing condition as it had been resolved”.  

In its decision on the dispute, the Australian Financial Complaints Authority says the policy terms clearly stated a condition would be considered chronic if it had occurred on more than two occasions.  

“I accept that when the complainant bought the policy, her left hip was not causing pain or weakness,” the authority’s ombudsman said. “However, it had dislocated at least three times.

“The policy says any medical issue that occurs more than twice is ‘recurrent’ and ‘chronic’. Therefore, the complainant’s left hip dislocations fit the policy’s definition of ‘existing medical condition’.”

Click here for the ruling.

From Insurance News magazine: RAA Insurance chief Tara Page on the SA personal lines insurer's post-2022 reset