You take my breath away

Murray bought travel insurance for a trip to the UK and Singapore. He completed a pre-existing medical condition assessment and paid an additional premium for the conditions he disclosed (which included heart-related conditions).

 

About a month before his trip, Murray saw a cardiologist about breathlessness that had been progressively worsening since his pacemaker was installed two years earlier. By the time he saw the cardiologist, Murray’s shortness of breath was such that he had all but given up the extensive running he used to enjoy, in favour of extensive walking.

 

The cardiologist determined that the breathlessness was heart-related, and advised Murray to cancel his trip so that it could be investigated and treated. Murray followed his cardiologist’s advice, and cancelled the trip. He submitted a claim to the insurer for the non-refundable costs of the trip.

 

Dispute

The insurer declined Murray’s claim. Murray had not disclosed his heart-related breathlessness when he purchased the travel insurance. The insurer said if it had known about it, the insurer would not have agreed to provide cover. The breathlessness revealed that Murray’s other heart-related conditions were more serious than it had thought. It offered to refund the premium Murray had paid for cover for the other pre-existing medical conditions.

 

Murray said that the breathlessness developed slowly and that it was not sufficiently advanced at the time he purchased travel insurance for him to have to disclose it as a pre-existing condition. However, Murray was unable to provide medical evidence that supported this.

Murray complained to FSCL.

Review

We reviewed all the medical evidence provided by Murray, together with his travel insurance policy and claim form. We considered that it was more probable than not that Murray was experiencing some heart-related breathlessness at the time he applied for his travel insurance policy. We noted that Murray had said on the claim form that he first became aware of his symptoms one month before he purchased the travel insurance.

 

Outcome

We gave Murray our preliminary view that the insurer had made a reasonable decision that was supported by the available medical evidence. We encouraged him to accept the insurer’s settlement offer. Murray did so.

 

Key insights

An insured must fully comply with the insurer’s disclosure requirements, so that the insurer can make an informed decision about the risks of it agreeing to provide cover.

Search case studies