Claimant loses dispute over travel cover eligibility

Claimant loses dispute over travel cover eligibility

24 March 2023

A traveller who suffered a heart attack overseas will not be compensated after an Australian Financial Complaints Authority (AFCA) determination backed his insurer’s decision to deny the claim.

The complainant had been an eligible credit card holder and a third-party beneficiary of the complimentary travel policy with AWP Australia.

The insurer said it denied the claim because the policyholder had not met specific eligibility requirements for the cover.

It said that one of the conditions required the insured to have a return travel ticket arranged before they left the country.

The traveller said he did not purchase a return ticket because he was unsure when he would return to Australia. He said the provision was not “fair and logical” and questioned its lawfulness.

AFCA disputed the complainant’s arguments, saying there was no evidence that the insurer was not allowed to place conditions for the complimentary policy. It said that the provision was “neither onerous nor difficult to meet,” noting that other cardholders were able to comply with it.

The ruling acknowledged the claimant’s circumstances of not knowing when he would return to the country, but said that provision had been expressed clearly in the policy terms.

“I accept the complainant’s circumstances may have precluded him from purchasing an overseas return ticket when leaving Australia,” AFCA said.

“However, he had the option of choosing a different policy that may cater to his specific circumstances.”

AFCA said AWP Australia was entitled to deny the claim as the complainant did not meet the required policy conditions.

Click here for the ruling.