A holidaymaker who unexpectedly found out she was seven weeks pregnant just three weeks after buying travel insurance has lost a claim dispute after she cancelled an overseas trip.

The woman bought a Mitsui Sumitomo policy on September 23 2019 to cover a two-week holiday with her partner the following February.

Three weeks after acquiring the insurance, her doctor determined she was pregnant and would be over 29 weeks at the time of the return trip. The GP said flying was not advisable.

The woman cancelled the holiday and claimed for costs.

Mitsui declined the claim, saying its policy only responded if the insured was more than 32 weeks pregnant during a trip, or where a doctor advised she was unfit to travel because of specific complications of pregnancy and childbirth outlined in the policy.

Mitsui said neither of these circumstances was the cause of the cancellation.

The Australian Financial Complaints Authority (AFCA) agreed the trip was not cancelled because of a covered reason. The Mitsui policy was clear that it did not provide a broad range of cover for claims arising from pregnancy, it said.

“While the pregnancy was unexpected, and the cancellation was necessary, the circumstances of the cancellation are not covered by this policy,” AFCA said. “The policy does not cover cancellation costs in all circumstances. It only provides cover for cancellation costs caused by one of the specifically listed reasons.”

A letter from the woman’s GP said flying was not advisable and the woman said the doctor told her the long flight time, and frequent air travel required, could cause premature labour and health issues and so she had no choice but to cancel the trip as she would be at significant risk of loss of pregnancy if the holiday continued as planned.

She provided another letter from the GP dated July 2020 confirming she had “found to be suffering from high risk pregnancy” from 28 weeks as her baby was in a breech position. At 38 weeks into the pregnancy, the woman had an emergency caesarean section birth.

The Mitsui policy defined ‘complications of pregnancy and childbirth’ in a dedicated separate section. This did not include breech babies but listed toxaemia, gestational diabetes or hypertension, pre-eclampsia, ectopic pregnancy, molar pregnancy or hydatidiform mole (a tumour developing from the placental tissue), post-partum haemorrhage, retained placenta membrane, placental abruption, hyperemesis gravidarum, placenta praevia, stillbirth, miscarriage, emergency caesarean section, termination for medical reasons or premature birth.

AFCA said the policy required that the woman suffer one of those defined conditions at the time of the cancellation in order to successfully claim costs.

“This is separate and distinct to being unfit to travel due to any other risks associated with pregnancy,” AFCA’s ruling says. “I accept the complainant’s doctor confirmed she was unfit to travel due to risks associated with the pregnancy. However, the policy … will only include the complications listed. The list is exhaustive.”

AFCA said that while the breech baby gave rise to the need for an emergency caesarean section at 38 weeks, and an emergency caesarean was a listed complication, the birth occurred after the trip had already been cancelled and would have finished.

“On this basis, I cannot accept the trip was cancelled because the complainant was suffering from this complication,” the ombudsman said.

The Mitsui policy included the line: “please make sure you read the definition of ‘complications of pregnancy and childbirth’ in the definitions section”.

“Given the clear purpose of the policy, I am satisfied it is fair and reasonable for the insurer to rely on the defined terms when assessing the claim. The complainant has not established a valid claim within the terms of the policy for cancellation caused by a covered reason,” AFCA said.

See the full ruling here.