Travel Cancellation Due to Illness
Ms Preema (not her real name) had a planned trip to Australia which she had to cancel as she was admitted to a hospital and diagnosed with cancer. Ms Preema subsequently submitted a Travel Cancellation claim to Insurer C but was rejected on the basis that the cancellation was due to a “pre-existing condition” which is excluded under the policy.
Investigation and Findings
The Case Manager noted the following:
a) It was not in dispute that Ms Preema was diagnosed with cancer 19 years ago. However, she was relatively fine since 2000.
b) Last test done in 2018 did not indicate any relapse.
c) Policy definition of Pre-existing Condition states as follows:
“Pre-existing Condition – means disabilities that the Insured Person has reasonable knowledge of in the twelve (12) months prior to the inception Period of Insurance. An insured person may be considered to have reasonable knowledge of a pre-existing condition where the condition is one which:
a) The Insured person had received or is receiving treatment; or
b) Medical advice, diagnosis, care or treatment has been recommended; or
c) Clear and distinct symptoms are or were evident; or
d) Its evidence would have been apparent to a reasonable person in the circumstances.
d) The Case Manager then requested Insurer C for any documentary evidence indicating that Ms Preema had met the above (a) to (d) in the twelve (12) months prior to inception of policy.
Insurer C accepted the findings and observations by the Case Manager and revised their decision. They made an offer which was accepted by Ms Preema and the case was resolved.