An insurer which excluded a man’s health issues from his travel policy does not have to pay repatriation costs after he died in Greece. 

AIG denied the claim because the man’s death arose from his pre-existing medical conditions, and the Australian Financial Complaints Authority (AFCA) agrees. 

The policy wording is not ambiguous, nor is it unfair, says the AFCA dispute ruling. 

The man bought the policy for the trip to Europe last year. 

He had several long-standing medical conditions, including chronic obstructive pulmonary disease and congestive heart failure. 

He got medical clearance from his treating specialist confirming he was fit to travel and outlining his oxygen requirements, but AIG did not accept the issues for coverage as “specified medical conditions” under the policy. 

The man died while away, with the cause of death recorded as pulmonary oedema of ischaemic-type myocardial lesions and medical information confirmed it was directly related to his long-standing cardiac and respiratory conditions. 

His son-in-law contacted the insurer for guidance and support with repatriating his body. 

Once AIG had seen the medical information it denied the claim and the relative arranged repatriation himself at a cost of €5200 ($8500). 

The son-in-law complained to AFCA, saying death should not be treated as a complication of a pre-existing condition. 

The ombudsman notes the policy covered the return of mortal remains if the insured died unexpectedly while travelling but would only pay “if you were medically fit and able to undertake the planned travel when you commenced your trip”. 

It excluded loss related to, or connected with, any existing medical condition or complication arising from it, unless it was covered as a specified medical condition or under automatically covered conditions. 

However, the ombudsman says the insurer’s handling of the claim worsened an already difficult situation for the family. 

AIG had provided two different and inconsistent reasons for declining the claim on consecutive days, had sent the son-in-law documents relating to another deceased person, and repeatedly requested information that had been supplied. 

AFCA awarded the complainant $1000 in non-financial loss compensation as a result. 

See the ruling here.