A holidaymaker who was hurt in a swimming pool accident has failed to force her travel insurer to cover an upgrade to business class that she believed was necessary.

Lloyd’s accepted a claim in relation to the incident and reimbursed medical and travel expenses, but it refused to pay $5217 for the upgrade.

The woman suffered the injury the day before she was due to fly home. She paid extra for a business class ticket and boarded her scheduled flight but was removed by the airline. However, she was cleared to travel the following day and returned home.

She bought the upgrade because she believed she should not stay upright during the flight and should avoid crowded areas. She provided images of bruising and swelling to her eye, and a handwritten statement signed by her and a doctor, which said the upgrade was needed.

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But the insurer said when the doctor cleared the woman to fly, he did not specify any medical reason why she could not fly economy.

In a dispute ruling, the Australian Financial Complaints Authority agrees with Lloyd’s, saying the complainant upgraded the flight before seeking advice from doctors or the insurer, and there was no evidence that being in economy presented a risk.

“If being in a reclined position was medically necessary or recommended, it would have been recorded on the medical clearance provided by [the doctor],” AFCA said.

The authority notes the policy required additional expenses to be “reasonable”.

“I am not satisfied the complainant has shown that the flight upgrade was a reasonable travel expense, or due to medical advice,” an AFCA ombudsman said.

See the full ruling here.