A woman has won a claim dispute after her husband died of a heart attack overseas and their travel insurer refused to pay out over an alleged misrepresentation of pre-existing conditions.

The wife lodged a claim for costs, including repatriation, when her partner died during their trip between May and July.

The man had declared several heart issues to Zurich when buying the policy. They included cardiomyopathy with heart failure, impaired contractility, arrhythmia and hypertrophic cardiomyopathy – the thickening of heart muscles.

But Zurich argued the man failed to declare other medical conditions such as ischemic heart disease, mitral valve regurgitation and high blood pressure.

It said it would not have covered the man if it had been aware of these conditions.

The husband’s death certificate stated he died from heart failure, enlargement of the heart, tricuspid valve failure and acute bilateral pulmonary oedema.

The complainant said her partner told Zurich he had obstructive hypertrophic cardiomyopathy and was pending surgery, possibly involving a mitral valve repair.

She said the specifics of the surgery were not reported to the insurer because it had not asked questions about it.  

In its dispute ruling, the Australian Financial Complaints Authority says based on the man’s declaration of his hypertrophic cardiomyopathy, the insurer should have been aware he suffered mitral valve regurgitation.  

It says the man correctly answered a question relating to ischemic heart disease – also known as coronary artery disease – because he had been advised by his specialist that he did not have it.

It notes a lack of supporting information from the man’s treating cardiologist to show he had a history of ischemic heart disease, despite the insurer’s protests.  

The decision acknowledges that the man did not tell Zurich he suffered high blood pressure, for which he was taking medication. But it says this is not enough to show he breached his duty to take reasonable care not to make a misrepresentation.  

The authority notes the insurer’s website stated some medical conditions were automatically included, and says it was “not sufficient” for it to ask the policyholder to declare all conditions.

“The insurer has not provided any evidence by way of screenshots of the application process in support of its position that [the man] declared that he suffered from no further existing medical conditions,” the authority said. “In those circumstances, silence does not amount to a misrepresentation.”  

It says the man “did not have a positive obligation to disclose [high blood pressure] but a duty not to make a misrepresentation in relation to any specific question about [it]”.  

AFCA is not satisfied Zurich would have declined cover if it was aware of the high blood pressure, given it offered the policy despite the man’s other heart issues.

The man “had already disclosed significant health issues ... which required surgery, cardiomyopathy with heart failure, impaired contractility and arrhythmias. These are significant health issues, yet approval ... had been given.”

The wife will also be paid $2500 in compensation for the insurer’s poor claims handling, including delays in communication, and distress caused by emails being sent in her husband’s name.

Click here for the ruling.