Travellers must verify their travel insurance
Ombusman rules against medical claim due to pre-existing symptoms
Planning on taking a trip to unwind this festive season? Better be sure what your travel insurance covers and what it excludes. A good case study is a matter the ombudsman for short-term insurance recently dealt with of a rejected claim that relates to pre-existing medical conditions.
John Jacobs* purchased travel insurance as he was travelling to Thailand with his wife. They departed South Africa on October 8 2018 and the policy commenced on the departure date and terminated on October 17 2018.
Jacobs had a small sore in his nose, which, according to him, was not unusual due to the changing seasons.
He said the sore healed well in advance of the departure date and he did not experience any discomfort on the departure date. However, while on the flight to Thailand, he noticed that he had a pimple inside his nostril. By October 12, after arriving in Thailand, the condition had escalated into what Jacobs described as a boil.
This saw him seeking medical assistance at two Thai medical institutions.
At his first consultation on October 13 2018, he informed the treating doctor about the small sore he had in his nose before he left South Africa.
The doctor referred him to a hospital for treatment by a specialist. The specialist examined Jacobs and wanted to admit him for three nights for observation and to continue with treatment.
Jacobs and his wife flew back to South Africa on the evening of October 14 2018. The following day he was treated by a local specialist. The infection stopped almost immediately after the specialist incised and drained a small abscess.
In his report, the South African specialist said: “It is not impossible that the infection that started in Thailand was a different or a second one, and the initial complaint is, therefore, not necessarily the start of what he had in Thailand.”
Jacobs then submitted a claim for medical fees and curtailment under the travel insurance policy. His claim was rejected by the insurer on the grounds that it arose, directly or indirectly, as a result of a pre-existing medical condition that was not covered. He then approached the ombudsman for recourse.
However, the ombudsman ruled in favour of the insurance company, finding that on the available evidence, it is “abundantly clear” that Jacobs was aware of those symptoms and did not cover them before his trip.
It is not impossible that the infection that started in Thailand was a different or a
second one