A traveller who suffered dengue fever during a Bali holiday will be covered for her medical expenses, despite her insurer’s protests that she became unwell before her policy’s waiting period had ended. 

The woman bought the travel policy with Nib Travel Services (Australia) on March 19 while on holiday. The policy had a 72-hour waiting period for purchases made outside Australia, which ended on March 22, the day before she was diagnosed with dengue fever and received treatment. 

The insurer said the policy did not cover the loss because the woman began to show symptoms during the waiting period. It said she had reported a headache and fever for at least two days before receiving the claimed treatment.

The complainant acknowledged she had been unwell but said she sought treatment only after she experienced worsening pain on March 23.

In a dispute ruling, the Australian Financial Complaints Authority says hospital notes indicated the woman was “weak” and had “severe pain”.

It says it would be “reasonable to consider if the complainant had the same level of pain in previous days, she would have sought medical assistance then”. 

It agrees the woman suffered from the illness during the waiting period, but says the claim was made for overseas medical expenses, which it views as the trigger for the loss. 

“Considering the cover provided by the policy ... the relevant event is the medical treatment that caused the complainant to incur costs claimed under the policy,” the authority’s adjudicator said. “While the information provided shows the complainant was unwell for up to two days prior to seeking treatment, being unwell of itself is not an event claimable under the policy. 

“If her condition hadn’t declined, the complainant would not have needed medical treatment and there would have been no claimable event.” 

The authority says the policy provisions did not refer to symptoms arising during the waiting period but rather to “events first occurring”. It says this definition was not clear enough to decline the claim because it had “potential to be interpreted very broadly, as any happening could be considered an event”.

“The complainant did not incur any loss during the waiting period and has not sought cover for any event occurring during that time. The event for which she seeks cover is medical treatment for a sudden onset of pain. This occurred after the waiting period had ended, and all costs claimed were incurred after this time.” 

Click here for the ruling.