Raelene travelled to Australia for a coach tour in September 2016. During her return flight home to New Zealand, while eating her inflight meal, Raelene bit into a raw broccoli stalk and her tooth broke.
Raelene visited her usual dentist and her tooth was repaired for $150.
Raelene had purchased a comprehensive travel policy for her trip and made a claim to her insurer for the cost of the dental work she received in New Zealand.
The insurance company’s position
The insurance company said that under its policy, it would only cover emergency dental treatment during the journey and it would only cover ‘natural teeth’.
The insurance company defined natural teeth as teeth that had no fillings or been subjected to restoration work. Raelene’s tooth that broke had received a filling.
Further, the policy excluded all dental expenses incurred in the insured’s home country.
Raelene’s position
Raelene said that she purchased a comprehensive policy because she wanted to be covered for anything that might happen to her. In Raelene’s view, ‘comprehensive’ meant ‘complete, inclusive and general’. Raelene said that she was surprised that the policy could be called a comprehensive policy when it contained so many exclusions.
Raelene also said that had her tooth broken while she was in Australia, she would have had the tooth repaired immediately in Australia. However, she was on the plane home when her tooth broke. Raelene said it was not possible to get the plane to turn around and it would have cost more for her to return to Australia for dental work than what she paid in New Zealand for the tooth to be repaired.
Our view
The insurance company had already looked at the complaint through its internal claim process but, when Raelene contacted FSCL, the insurance company offered to pay 50% of her claim ($75) as a goodwill gesture.
We explained to Raelene that no travel insurance policy will cover every event that might happen to a person while they are overseas. All travel insurance policies contain conditions and exclusions.
We told Raelene that it appeared the insurance company was entitled to decline her claim for two reasons, the natural teeth condition and the home country exclusion.
Raelene accepted the insurance company’s offer to pay her $75.
Lesson
Most travel insurance companies will sell more than one type of travel insurance policy, often a ‘basic’ policy and a ‘comprehensive’ policy. While the comprehensive policy will provide you with more cover, the policy will still contain exclusions and conditions your claim will need to satisfy.
