A travel insurer can deny a mother’s claim after an infection linked to cancer treatment forced her to cancel a trip overseas, the Australian Financial Complaints Authority has determined.

The claimant sought a payout for cancellation expenses under a Europ Assistance policy covering her, her husband and their son, arguing the son’s infection was unforeseeable and did not exist when the insurance was purchased.

However, AFCA finds the condition arose from the son’s pre-existing bile duct cancer, which was excluded under the policy.

The insurer was entitled to reject the claim because the placement of an abdominal drain, which caused the infection, was required due to the cancer.

While the drain was inserted after flights were booked and the policy purchased, AFCA finds the medical evidence establishes a connection to the pre-existing condition.

A treating oncologist confirmed the son had previously received inpatient treatment for bacterial infections related to his cancer.

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AFCA acknowledges the complainant’s argument that the infection was a new illness and that the insurer’s reasoning relied on assumptions rather than medical evidence.

But it finds the underlying cancer met the policy’s definition of a pre-existing medical condition.

The cover excluded claims arising from pre-existing conditions unless they were automatically covered or separately accepted following medical screening and payment of an additional premium.

The son was not listed as covered for his screened pre-existing conditions, and no additional premium had been charged on that basis.

The complainant said she was told cancellation cover would apply, but AFCA has found no evidence favouring either party’s recollection of the in-person policy sale, so has relied on the written terms.

Europ Assistance offered to refund the $1769 premium as a goodwill gesture, recognising the family’s difficult circumstances. AFCA finds the offer fair.

See the ruling here.