A man who became sick with severe sepsis in Thailand, after his insurance expired two weeks earlier, has lost a dispute over a $130,000 claim for medical costs.

The traveller took out cover with Zurich Australian Insurance from November 13 last year to December 12, but stayed in Thailand longer than intended and did not extend the policy.

He fell ill on December 27 and was admitted to Bangkok Hospital the next day. A subsequent claim was then denied as the incident was outside the cover period.

The complainant, represented by his father, argued to the Australian Financial Complaints Authority (AFCA) that the policy expiration had been disclosed to the third-party emergency medical services agency, a claim number was issued and regular requests were received about the man’s condition.

The man was also a long-time client of the insurer and had a history of making late amendments to travel policies.

AFCA reviewed transcripts of telephone calls between the medical services agency and the complainant’s parents before determining in favour of the insurer.

The adjudicator found the issuing of a claim number doesn’t indicate acceptance of a claim; the medical service was not able to confirm acceptance or denial immediately as it needed clarification and instruction from the insurer; and its phone calls were to act as a medical support mechanism.

“A reasonable person would not infer the claim was going to be accepted based on the content and the context of those calls,” AFCA says.

The decision says it is not reasonable to say customer loyalty or claims history should persuade the insurer to accept a claim where there is otherwise no coverage, and a history of late amendments to policies is also not relevant.

“Given the complainant was a frequent overseas traveller and had extended policies previously, it would be fair to assume he was familiar with the relatively easy process of extending his cover and simply failed to do so in this instance,” the decision says.

AFCA says the underwriter advised there was a seven-day period of grace with the policy, meaning the man would have had the benefit of cover up to December 19 – eight days before he fell ill.

The decision is available here.