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Berkshire Hathaway Specialty Insurance
Berkshire Hathaway Specialty Insurance

Insurer wins dispute after declining relative cover for UK mother

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A NSW man who said a QBE travel policy restricting cover for relatives to those living within Australia and New Zealand was discriminatory, did not reflect the nation’s diversity and was a “human rights issue” has lost a claim dispute.

The man was forced to forfeit a US cruise payment of $11,320 when his UK-based mother became gravely ill just prior to the trip. Doctors advised she had a few hours to live and he rushed there to be with his family and mother, who died.

The Australian Financial Complaints Authority (AFCA) said the man failed to show QBE’s policy provision was unlawful, as set out in the Anti-Discrimination Act 1977.

QBE could deny the claim, AFCA said, because of the mother’s place of residence, and also that she had reached the age of 80 when the policy was issued – another stated cover exclusion in the Product Disclosure Statement.

“This provision would apply to anyone,” AFCA’s ombudsman said. “For instance, this would apply to an Australian-born citizen who resides overseas. I cannot therefore be satisfied there is any basis to conclude the man has been unlawfully discriminated against.”

The man held a travel insurance policy with QBE for a planned overseas cruise from the US in late 2018 and learned his mother was terminally ill a month before departure.

“I was unable to travel due to the potential passing of my mother,” he said. “While the doctors initially gave a few hours they said she may take a few weeks to pass.”

The man lodged a claim which QBE denied, saying his mother did not meet its coverage which limited “relative” to a person who resides in Australia or New Zealand.

AFCA agreed the policy did not respond to the circumstances of the loss.

“The policy clearly and unambiguously explains who is a relative is for the purposes of the policy,” AFCA said. “The available information does not show the provision offends any antidiscrimination legislation. It is therefore fair in all these circumstances for the insurer to deny the claim.”

The policy terms specified cover “where you are unable to start or finish the trip because of the death, sudden serious illness or serious injury arising before or during the trip of you, or a member of your travelling party; or a relative, who is a resident in Australia or New Zealand.”

AFCA said that by framing its definition in that way, QBE limited the cover it was willing to offer if a claim was made due to an illness suffered by a relative.

The policy also excluded losses arising from the illness of a person who is not a member of your travelling party and is 80 years of age or over at the time the Certificate of Insurance was issued. This applied to the man’s mother, who was born in 1937 and was 80 years old at the time the policy was issued in January 2018.

“The circumstances did not meet the qualifying provision for cover under the terms of the policy,” AFCA said. “The complainant’s claim does not fall within any of the listed events.”

See the full ruling here.