A good outcome to a bad fall

Lorraine booked a trip to the South Island through her travel agent. Lorraine suffered from dizzy spells and pain in her left leg shortly before embarking. Lorraine’s doctor advised her not to travel. Lorraine cancelled her trip and claimed $1,600 in unrefunded deposits. 

The insurance company declined Lorraine’s claim. It argued that Lorraine’s dizzy spells and left leg pain were caused by an earlier accident. The earlier accident was a “pre-existing medical condition”, and “pre-existing medical conditions” were not covered by this travel insurance policy. 

A bad fall 

Lorraine fell and landed on her tailbone several months before she wanted to travel. Her fall caused localised pain for 5-6 weeks. Lorraine did not seek medical assistance, but she did take pain medication. By the time Lorraine booked her trip she considered herself fully recovered from her fall over two months earlier. She had no pain and had resumed all of her usual daily activities. On this basis, Lorraine complained to FSCL. 

Was the bad fall a “pre-existing medical condition”? 

FSCL’s CEO noted that “pre-existing medical condition” was defined in the insurance policy wording as a condition of which Lorraine must be “currently aware”. When Lorraine purchased her travel insurance policy she considered that she had fully recovered from her fall and had been well for several weeks. In Lorraine’s view, she no longer had any “medical condition” and was no longer “currently aware” of any signs or symptoms. FSCL’s CEO agreed with Lorraine’s view and negotiated with the insurance company. 

Resolution 

The insurance company agreed to refund Lorraine $1,600.

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