A claimant who complained about limited cover after a cancelled cruise lost his dispute following an Australian Financial Complaints Authority (AFCA) determination. 

The insured was prevented from boarding the cruise after his co-insured travelling companion tested positive for covid in August last year. He lodged a claim with Zurich Australia in September to recover costs amounting to $16,268, as well as additional accommodation and travel expenses. 

Zurich agreed to reimburse the complainant’s accommodation and travel expenses but limited its cover for the cruise cancellation to $5000, saying this was the maximum amount allocated for covid-related losses.

The policyholder has a visual impairment that prevents him from “reading anything electronically” and says he was not properly notified of the terms in the Product Disclosure Statement (PDS), which had been delivered to the co-insured’s email address. 

The claimant says he informed the insurer about his partial blindness over emails in June and July in relation to another policy and sought a physical copy of the PDS but was not provided one.  

Records from hand-written notes made by the complainant between June 2020 and May last year also show that the insured requested a policy booklet for a separate policy. 

The complainant referenced prior phone calls with the insurer to receive a hard copy of the PDS, but did not provide a date and time for these calls.  

The ruling acknowledged that the insured requested hard copies of previous policies but says there was inconclusive evidence to show that a request was made for a physical copy of the travel policy’s PDS after it was incepted. 

“I accept the complainant does have a history of seeking a hardcopy of the PDS and that he notified the insurer of the visual acuity issue in relation to another policy he held with it,” AFCA said. 

“The evidence however is unclear regarding dates he requested a hardcopy of the PDS for this policy after inception in April 2022, or if he also told the insurer of his visual acuity issues in reference to this travel policy.” 

AFCA accepts that the emails in July “should have led the insurer to flag that the complainant had a visual disability which could create accessibility issues in receiving electronic notice or communication” but says it was entitled to rely on its policy terms as no request for the PDS had been made.  

AFCA notes that the policy had been listed through the co-insured’s email address, as no residential address was provided, and says this led to an “inferred consent” for the policyholder to receive the PDS by email. 

It says this was done, as it is assumed that when an insured takes out a policy, they are “doing so as an agent of all insureds to be covered by the policy”. 

The decision entitles Zurich to settle the claim under its provided offer. AFCA required the insurer to increase its non-financial losses compensation to $2000, up from $1000, due to issues raised with its claims handling that caused “delay, stress and inconvenience for the complainant”. 

Click here for the ruling.