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Unwell traveller loses dispute over non-disclosure by representative

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An Australian who suffered a self-harm emergency overseas and was flown home by air ambulance with nursing and financial aid from the government has lost a claim dispute because someone else who bought the travel insurance on her behalf did not disclose that she had pre-existing medical conditions.

The patient’s GP in Australia reported preexisting anxiety, depression, post-traumatic stress disorder and borderline personality disorder, and that she was on medication and had been referred to a psychiatrist.

She had seen the doctor in January and February last year for treatment of continued symptoms and prescribed medication. Her treating psychiatrist confirmed as of June last year there was a history of overdosing in the recent past as well as the prescribed medication.

The policy commenced July 1 last year.

The buyer of the policy, named as “CR” and described as a representative in the Australia Financial Complaints Authority (AFCA) ruling, sought a travel insurance policy on behalf of the policyholder who was already overseas working at a university. Existing travel insurance was due to expire and could not be renewed.

CR bought an Axa Bare Essentials policy providing cover for overseas medical expenses, described as “a plan for budget conscious travellers,” which included a limited amount for medical evacuation and repatriation and emergency medical, hospital and ambulance expenses arising from “a new illness or injury”.

It was purchased online via an agent. CR also contacted Axa to ask about medical cover overseas and the policy ending if the policyholder returned home. Call recordings showed no questions relating to medical history were asked.

CR told AFCA that at the time of taking out the policy she did not know the traveller had existing medical conditions. She did not disclose any because she was not aware of any.

Axa declined the claim, which CR made on the traveller’s behalf as further medical episodes had left her sedated and unable to communicate.

AFCA ruled Axa pay $1000 in compensation after “some discussions which could have been considered insensitive”.

However, it ruled the insurer handled the claim “reasonably well” and that the condition treated overseas was related to the condition for which she had obtained treatment prior to the policy commencing.

“The medical information shows that the complainant has, at the time the policy was taken out, a medical condition that is either chronic, displaying symptoms and is or under investigation that also needs follow-up consultation and that in the six months prior to the time of policy purchase the complainant has had treatment by a medical practitioner and medication prescribed,” the ruling said.

Axa was entitled to apply its exclusion, AFCA said, noting documents had clearly set out the duty of disclosure, and that the policy selected did not provide cover for existing medical conditions.

“CR says she had no knowledge or information to declare. I acknowledge that causes problems for CR in taking out the policy. However, this does not mean that CR was not required to check with the complainant prior to taking out the policy,” the ombudsman said.

"CR could not disclose what she did not know. However, the onus is upon the person to know such matters when taking out insurance for another person.”

AFCA acknowledged the circumstances presented to CR were difficult, “especially given ... CR not having knowledge of the complainant’s medical condition and because the complainant was overseas when this happened.”

Axa’s emergency assist team often contacted CR, who eventually travelled overseas to sort the matter out as the policyholder was incapacitated.

She found it difficult trying to get information locally and from overseas, with Axa “seemingly insisting” on talking to the traveller and “not accepting the condition she was in,” which "created a difficult situation” for CR which led to her going overseas and seeking the involvement of the Australian government.

AFCA singled out comments made by Axa about a “Go Fund Me” site as inappropriate.

“Whilst I appreciate the emergency assist team’s involvement and trying to assist CR in a difficult time, there were some discussions which could have been considered insensitive in the circumstances,” it said.

“The insurer has acknowledged this and thought they were assisting CR.”

See the full ruling here.