Miro purchased tickets for a holiday in Australia with her credit card, triggering complimentary travel insurance cover. A couple of days before she was due to leave, she went to her dentist with toothache. The dentist told her she should go ahead with her trip, but gave her a prescription for antibiotics just in case the tooth flared up while she was away.
To be on the safe side, Miro started taking the antibiotics immediately. A couple of days after arriving in Australia the tooth was unbearably painful, so Miro went a dentist. The dentist extracted the tooth.
Miro submitted an insurance claim for the $380 it cost to have the tooth removed. The insurer declined the claim saying that because the tooth was a problem before Miro left, it was a pre-existing medical condition not covered by the policy. Miro felt the insurer was being unreasonable and referred her complaint to FSCL.
Dispute
Miro said she was in a ‘no win’ situation because the insurer was always going to decline her claim. If she travelled with toothache, the insurer would say it was a pre-existing medical condition. If Miro had cancelled the trip, because her dentist had said she was fine to travel, her insurer would have said that was her choice and would have also declined the claim.
The insurer replied that its policy was clear. Although it will cover overseas dental expenses, pre-existing medical conditions are excluded from cover. There was no doubt that Miro was aware of her toothache before leaving. The insurer said the tooth infection was a pre-existing medical condition and any related claim was not covered by the policy. The insurer would not be drawn on what would have happened if Miro had cancelled the trip.
Review
We advised Miro that the insurer was entitled to decline the claim, because it related to a pre-existing medical condition. We also said the insurer would probably have declined the claim if Miro had just cancelled her trip.
However, there was a third option available. The policy advised Miro to contact the insurer if her medical circumstances had changed since she bought the tickets. The insurer would then either agree to cover the pre-existing medical condition, and probably charge an additional premium, or decline to cover the pre-existing medical condition. At this point Miro would have had to decide whether to proceed with the trip. If she had decided to cancel the trip, the insurer would have covered her loss.
Resolution
Miro thanked us for our advice and agreed to withdraw her complaint.
Insights for consumers
If you develop a medical condition between the time you purchase your insurance and the date of your travel, you should contact your insurer for advice and to check you are covered for the new condition.
