An insurer has lost a travel cover dispute centring on whether a medical event resulting in a miscarriage occurred during its policy’s 72-hour waiting period.

One of the policyholders experienced spotting on December 8 last year. She visited her midwife on December 11 and underwent an ultrasound that showed a non-viable pregnancy, and she was certified unfit to travel. A miscarriage was confirmed on December 15.

The claimants rescheduled a planned trip and sought cover for amendment fees and lost deposits under the pre-departure sections of their HDI Global Specialty travel policy.

The certificate of insurance issued on December 7 featured a waiting period ending on December 10, with cover for cancellation fees or lost deposits excluded for events taking place during that time.

The insurer, declining the claim, said the claimable event under the policy was the onset of the spotting, which was during the excluded period.

It said medical evidence supported that the vaginal bleeding on December 8 was most likely the first clinical manifestation or symptom of the same medical condition that resulted in the diagnosis of a non-viable pregnancy.

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The claimants said women in pregnancy experiencing spotting – but without pain, cramping or other concerning clinical features – do not necessarily present with a clinically apparent non-viable pregnancy.

In its dispute ruling, the Australian Financial Complaints Authority agrees with the complainants in finding the claimable event occurred after the waiting period.

“The complainant was not diagnosed with a medical condition which needed immediate treatment from a medical adviser or certified as unfit to travel until December 11,” it said.

“The spotting is, by itself, not sufficient to trigger the cancellation or amendment cover under the policy.”

The insurer should settle the claim as per the policy terms and conditions, the ombudsman says.

See the decision here.