A claimant who suffered a serious ankle injury while boarding a plane has lost his bid for a permanent disability benefit after the dispute authority found the injury does not meet his travel policy requirements.

The 60-year-old said he suffered a permanent injury while climbing a mobile stairway, where a crowd rush caused him to trip. He said his right foot rotated back towards his leg.

The man’s orthopaedic surgeon, referred to as MS, said the man suffered severe cartilage damage and he developed post-traumatic arthritis.

The injury “resulted in a long-term permanent disability to the right ankle”, the surgeon said.

The claimant said he was still wearing a moon boot two years after the accident, to relieve pressure on his ankle, and he required an urgent operation to minimise further damage. 

Travel insurer AWP Australia referred to policy wording that stated the benefit would apply if the insured suffered a permanent disability within 12 months of the injury. That disability would have to persist for another 12 consecutive months and be medically considered “beyond hope of improvement”. 

The insurer said the medical information provided showed the man’s ankle injury could be managed with protective shoes, a stabilising splint and cortisone injections. 

AWP’s chief medical officer said although the claimant would probably experience a limp and ongoing pain, he would still have use of his ankle. The officer was willing to reassess the case based on updated progress reports.  

The Australian Financial Complaints Authority accepts that for the policy benefit to apply, the man had to show he suffered a complete loss of use of his foot at the ankle, which he had not.  

It acknowledges he suffered severe pain and the condition of his ankle would continue to worsen. But it notes information in MS’ report that some of the permanent damage was caused by the man’s decision to delay treatment until he returned from his holiday.  

It also says MS recommended the claimant continue to bear his weight in normal shoes. 

“To be eligible for cover under this benefit, it is important for the complainant to show that he had permanent loss of ‘all’ the use of the foot at or above his ankle,” an AFCA ombudsman said. “This means the complainant should have complete loss of use of the foot at the ankle.

“I am not satisfied the complainant’s medical records show that as a result of the injury, he had suffered from a permanent loss of all the use of a foot at or above the ankle, for the purposes of the policy.

“It follows the complainant’s injury is not a permanent disability within the meaning of the policy.”  

Click here for the ruling.