A traveller who said he had to visit Thailand to be treated for a rash after raising concerns about care received in India has lost a bid have his insurer’s payout increased.

The claimant contacted Zurich Australia’s emergency medical team about 4pm on November 18 2023 over a rash that developed while he was staying in India.

The insurer emailed about two hours later with recommendations for a hospital to attend for treatment and testing.  

After a few hours, the man contacted Zurich again to say the rash had worsened and he intended to travel to the nearest medical facility of international standard, “irrespective of whether insurance covers”.  

The claimant later told the Australian Financial Complaints Authority he had “lost faith” in the Indian medical system and that, with no immunologist available, he had to travel to Thailand.  

He provided a referral from a doctor to a Thai hospital and said Zurich should cover the medical costs – about $15,000.  

The man also noted the insurer did not provide a panel doctor to assess him at his accommodation, which he said was “common practice in India”.

Zurich accepted that the man required treatment but said its team’s recommendation was appropriate.

It offered to settle the claim for $5000 based on an estimate of treatment costs in India.  

The claimant noted the cost estimate was based on a different hospital to the one he was told to attend. 

In a dispute decision, AFCA acknowledges the man’s concerns about quality of care in India but finds “no information to show the complainant needed to travel to Thailand for hospital treatment”.  

The authority notes the referral to a Thai hospital does not appear to be from a doctor based in India or Thailand, and therefore cannot be from someone who examined the man.

It also says the referral did not explain why suitable treatment was unavailable in India.

“The complainant was entitled to make the decision to [go to Thailand],” AFCA said. “However, there is no fair or reasonable basis to require the insurer to pay any additional costs associated with (or arising from) the complainant's choice to travel to Thailand instead of getting treatment in India.”  

It rejects the argument that Zurich should have arranged a visiting doctor, because the claimant required “hospital-level treatment”.  

AFCA accepts the insurer’s settlement amount. See the ruling here.