Patricia and Kevin each arranged travel insurance with different insurers before travelling to Asia. Shortly after arriving, Patricia came down with a nasty vomiting bug and spent a night in hospital on a drip. Patricia was discharged and advised to take it easy and come back if she deteriorated. Although Patricia was not sick enough to require further medical attention, she had no energy and was unable to enjoy herself. After about five days into a three-week trip, Kevin and Patricia decided to return home.
After arriving home, Patricia and Kevin submitted insurance claims to their different insurers. Patricia’s insurer accepted the claim, agreeing to cover the cost of rearranging the tickets to return home early. Kevin’s insurer declined his claim saying the decision to return home was not made on medical advice.
Kevin disagreed and referred his complaint to FSCL.
Kevin said that Patricia was so unwell that they had no choice but to return home and he could hardly leave her to travel home alone. Patricia’s insurer had accepted her claim and Kevin said his insurer should do the same.
Kevin’s insurer said that it would only cover additional travel costs incurred as the result of ill health if those travel changes were made on medical advice. The insurer accepted that Patricia had been unwell, but said it was Kevin and Patricia’s decision to return home. The insurer declined the claim.
Under the insurance policy, Kevin’s insurer agreed that if he could not complete his journey due to circumstances beyond his control, it would pay any additional travel and accommodation costs. Ill health of a travelling companion would be considered a circumstance beyond his control.
However, the insurance policy also contained policy exclusions, for circumstances where the insurer does not agree to provide cover. The policy clearly stated that cover was excluded unless the changed plans were made on medical advice.
We agreed that Kevin’s decision to return home was understandable. His travelling companion was unable to enjoy the holiday because she was unwell. However, the insurer’s obligation to compensate Kevin for the associated loss is found in the policy. Without a medical opinion that evacuation home to New Zealand was necessary, the insurer did not have to accept the claim.
Although a different insurer had accepted Patricia’s claim, this did not create an obligation on Kevin’s insurer to accept his claim.
We told Kevin that the insurer was entitled to decline the claim. Kevin was disappointed with the outcome but agreed to discontinue his complaint.
Insights for consumers
If you are travelling overseas, become unwell, and decide to return home you must first obtain a medical opinion from a doctor that your return home is medically necessary and then contact your insurer for confirmation that it will cover the cost of your changed travel plans. If you do not take both these steps, your claim may be declined.