Hari had an ablation (heart surgery) fourteen days before his planned trip to China. At his post check-up, Hari’s general practitioner cleared him for travel.
Hari then decided to purchase travel insurance. His travel agent advised him to contact the insurer within ten days to declare any pre-existing medical conditions.
Unfortunately, a couple of days before travel, Hari became nauseous and unwell. Hari’s heart specialist advised him against travelling for six weeks.
Hari visited his travel agent to cancel his flights and purchase extra cover for his pre-existing medical condition. He was charged an additional premium for his pre-existing heart condition.
However, when Hari sought a refund of his cancelled journey, the insurer declined his claim. The insurer said being unfit to travel fourteen days after heart surgery is not an unexpected circumstance that the policy would cover.
Hari sought a full refund of his ticket and complained to FSCL. He did not think it was fair that he was charged a premium for his pre-existing medical condition but did not receive any cover.
Review
Upon review, we agreed with the insurer. We found that Hari was not faced with an “unexpected circumstance” when he had to cancel his travel arrangements fourteen days after having heart surgery. He was aware of his inability to travel before purchasing additional cover for his pre-existing medical condition. He did not disclose his inability to travel or recent unwellness to the insurer.
However, we found that the insurer had not corresponded with Hari in a timely manner and had breached the Fair Insurance Code. We recommended that the insurer compensate Hari $100 for stress and inconvenience.
Outcome
Hari did not accept our view initially, noting that the cancellation of his travel was unforeseen because he only booked his travel after receiving clearance from his doctor and he had not been advised against travelling until the day before his departure.
We were not persuaded to change our view. It was clear that Hari purchased his tickets after surgery and did not disclose his pre-existing medical condition until after he was aware he could not travel. While Hari’s general practitioner had cleared him for travel, Hari had not sought his specialist’s advice before or after surgery, despite the pre-admission hospital sheet noting that international travel within a few weeks of the procedure was not recommended.
Hari accepted $100 in compensation for the stress caused by the delays in the claim review process.
Insights
As the insurance policy forms the contractual basis between parties, it is the insured’s responsibility to read their policy and make any necessary disclosures. An insured cannot seek cover for a pre-existing medical condition that has not been declared and accepted by the insurer. It is important that consumers declare all pre-existing medical conditions prior to purchasing insurance. Similarly, an insured cannot expect to receive cover for travel arrangements that they already know they cannot undertake at the time of buying travel insurance.
The Fair Insurance Code requires insurers to act fairly and respond to complaints within ten working days.
