Pre-approval process incomplete

Karen and Maxine, both in their 80s, were planning their last big European trip. Both considered themselves in good health. Karen had a touch of angina and Maxine’s knees gave her a bit of difficulty from time to time, but they were sure they were up to the challenge.

Karen disclosed she had a heart condition on the online travel insurance application form and Maxine disclosed the arthritis in her knees. Neither went through to the medical assessment line. As travel approached, Maxine’s knees became more of a problem and she decided to have a double knee replacement. Although the operation was completely successful, Karen reminded Maxine to call the insurer to make sure it was aware of the update in her health condition.

Karen and Maxine left on their trip, safe in the knowledge they were properly insured.

Although Maxine’s knee surgery had been successful, she still found all the walking exhausting and they made use of the complimentary wheelchair provided by the tour company. Karen found pushing the chair a bit much, but the others on the tour were very helpful. Unfortunately, one day Karen and Maxine found themselves alone in an unfamiliar part of Venice. Karen had no choice but to push the wheelchair alone. By the time they got back to the hotel, Karen was feeling extremely unwell.

The tour operator called a doctor who diagnosed congestive heart failure. Karen’s angina pills just were not up to the challenge. Fortunately, they were returning home to New Zealand in two days. Karen went to her doctor, who suggested she increase the prescription dosage, and Karen has not experienced a problem since.

Karen submitted a claim to her travel insurer. The travel insurer declined the claim, saying the heart condition was pre-existing and although Karen had disclosed it, she had not completed the process. The travel insurer said that if Karen had wanted cover for her angina, she would have needed to complete the process and pay an additional premium.

Karen did not accept the travel insurer’s decision and referred her complaint to FSCL.

 

Dispute

Karen said she took insurance very seriously and would never have intentionally failed to disclose a medical condition. Karen told the insurer that she had reminded Maxine to report her surgery to the insurer before travel. Karen had simply failed to notice the prompt directing her to the insurer’s medical assessment line.

The insurer agreed that Karen had disclosed the heart condition, but without completing the medical assessment line questions, it could not extend cover.

 

Review

It appeared to us that Karen had simply overlooked the final step in the insurance process and that if she had realised the insurer needed more information about her heart condition, she would have complied. We asked the insurer what would have happened if Karen had completed the process. The insurer said it would have agreed to cover Karen’s angina, but would have charged a $850 premium.

Karen’s medical costs were $1,500, by the time we took the excess and the premium into consideration, Karen’s loss was only $450. We asked the insurer whether it would be prepared to make a goodwill settlement to Karen.

 

Resolution

The insurer offered, and Karen accepted, compensation of $450 on the basis that this was a goodwill settlement and did not indicate any liability on the part of the insurer.

 

Insights for consumers

When completing insurance online it is extremely important to complete the entire process. While it was pleasing to see this complaint resolved so amicably, if Karen’s loss had been considerable, as can often happen with a heart condition, she may not have been so lucky.

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