When Kate booked and paid for a trip to Vietnam for her family, she also arranged travel insurance.
Shortly before travelling, Kate became aware that shrimp paste is in many Vietnamese dishes and she remembered that her daughter, Grace, had experienced a minor reaction when eating prawns 6 years earlier. The skin around Grace’s mouth became red and Grace had not eaten prawns since.
Kate consulted an allergy specialist who diagnosed Grace with a severe crustacean allergy. The doctor advised against travelling to Vietnam as the allergy was so severe that even if Grace ate food from a wok that had been previously used to cook with shrimp paste, she would likely have a life-threatening anaphylactic reaction.
Kate cancelled the family’s trip and submitted an insurance claim to her travel insurer on the basis that she had been forced to cancel the trip due to unforeseen circumstances beyond her control.
The travel insurer declined Kate’s claim referring to a clause advising it would not accept a claim arising from Kate’s disinclination to travel, or personal wishes. From the travel insurer’s perspective, the cancellation was precautionary as there was no actual sickness preventing Grace from travelling. The travel insurer acknowledged there would be a greater risk for Grace to travel, but considered this was risk the family could manage.
Kate did not accept the travel insurer’s decision and referred her complaint to FSCL.
Kate did not accept that she had cancelled the trip because she had changed her mind. The family very much wanted to travel to Vietnam, and only cancelled the trip on medical advice. Given the severity of Grace’s allergy, the prevalence of shrimp paste in Vietnamese food, and the language barrier, Kate did not think it was reasonable for the family trip to continue.
The travel insurer maintained its decision to decline Kate’s claim reiterating that the trip was not cancelled as a result of illness or injury, but rather to prevent a possible incident. The travel insurer went on to say it considered the allergy to be a pre-existing medical condition that should have been disclosed when the policy was purchased. The travel insurer also referred to a clause in the policy allowing it to decline a claim if there are ongoing signs or symptoms which are undiagnosed.
We reviewed the complaint and suggested to the travel insurer that it might like to reconsider its approach, and settle Kate’s claim.
We did not agree that the insurer could decline the claim on the grounds that Kate had changed her mind about the trip. Kate cancelled the trip on medical advice. If Grace had travelled against the advice of her doctor and experienced an allergic reaction, we considered it possible that the insurer may have declined her claim under another clause in the policy.
In our view, the more relevant question was whether Grace’s medical condition was pre-existing. When Kate booked the trip, she knew that Grace had a prawn allergy that was significant enough to exclude prawns from Grace’s diet. However, until Kate consulted a specialist, she had no idea the allergy was life threatening.
If, when purchasing the insurance, Kate had wondered whether Grace’s reaction was a pre-existing medical condition, she would have gone through the online pre-existing medical condition questionnaire. One question asked whether Grace had had a major allergic reaction. We asked the insurer what it would consider to be a major allergic reaction and the insurer said:
· a hospital admission
· diagnosis from a doctor
· needing to carry an epi-pen or other medication.
We considered the redness around the mouth would not qualify as a major allergic reaction, and, even if Kate had mentioned it, the insurer would not have been concerned.
The online pre-existing medical condition questionnaire also asked if Grace had any undiagnosed ongoing signs or symptoms. If Grace had eaten prawns again and had another reaction, this might have qualified as an ongoing sign or symptom. However, we considered this question was really aimed at people who are sufficiently concerned about a medical condition to have consulted a doctor, but have not yet had a diagnosis. We did not think Kate would have thought the question applied to Grace.
The travel insurer reconsidered its position and agreed to accept Kate’s claim, saying this case fell into a grey area which had slipped through the online questionnaire. Kate was very happy with the outcome.
Insights for consumers
Sometimes your individual circumstances may not fit neatly into insurer’s online questionnaire boxes. This complaint is a reassuring example of the insurer ‘doing the right thing’ when it comes to claim time.