Undiagnosed cancer enough to decline insurance claim

Awoman who did not know she had cancer when she took out a travel insurance policy had her claim declined because the insurer said it was a pre-existing condition, even though it had not been diagnosed.

This case was one of 46 complaints and 220 complaint inquiries relating to travel insurance received by the Insurance and Financial Services Ombudsman over the past financial year.

Almost 40 per cent of the complaints, and 13 per cent of inquiries, related to preexisting conditions.

The issue of pre-existing conditions and travel insurance has been highlighted this year by the death of New Zealander Abby Hartley in Bali. Her travel insurance claim was turned down because she did not disclose a bowel condition when she took out the cover.

Insurance and Financial Services Ombudsman Karen Stevens said it was not uncommon for claims to be declined because information had been left out of an application, even when there was no suggestion of dishonesty.

In one case dealt with this year, a woman went to her doctor with a history of abdominal discomfort eight days before she arranged a travel insurance policy.

The doctor referred her for an ultrasound and she was diagnosed with cancer two months later. She cancelled her travel but her insurer would not pay because she had reported symptoms before she arranged the policy.

The Ombudsman’s scheme noted the policy excluded claims arising from preexisting conditions.

‘‘The policy defined a pre-existing condition as an illness (including symptoms), for which the insured had sought medical attention, regardless of whether or not the illness was diagnosed.

‘‘Unfortunately, although [the woman] was not aware she had cancer when she went to her doctor, she was suffering from a symptom of an undiagnosed illness before the policy start date, which meant it was a pre-existing condition under the policy and the insurer was entitled to apply the exclusion to the claim.’’

Her complaint about the decision was not upheld.

In another case, a man arranged travel insurance to visit New Zealand to see his family.

He was admitted to hospital with chest pain and diagnosed as having suffered a heart attack.

His son tried to claim on the policy for his father, who later died.

The insurer declined the claim because it said his pre-existing hypertension and diabetes were indirectly related to the heart attack.

His son was unhappy about the decision because he said his father had no knowledge of any existing heart problems.

The Ombudsman’s office also declined his claim because it said that though he did not have a known heart condition, his diagnosed problems were considered to have contributed to his death.

Stevens said it was important that travellers checked their policies and asked questions to understand what they were and were not covered for.

Travel insurance is often sold direct via websites, without human intervention to point out terms and conditions to customers.

Stevens said that meant customers would sometimes have to do their own research on the products.

‘‘Check the policy wording for how a pre-existing condition is defined.

‘‘The definition can be very wide, and include symptoms, even if you haven’t yet been diagnosed with a condition or illness.

‘‘All pre-existing conditions must be disclosed.

‘‘Pre-existing conditions are usually excluded from travel insurance cover, unless the insurer has accepted them in writing and charged an extra premium.’’