No ambulance cover for pre-existing conditions

Pre-existing conditions are excluded, unless your insurer has accepted them in writing and charged an extra premium.

No ambulance cover for pre-existing conditions

Mae* took her daughter Eve* to Australia in August 2017 to see a nutritional expert about Eve’s food allergies, psychiatric disorder, and hyperventilation syndrome. On the last day of their 5-day trip, Eve collapsed at a restaurant, unable to breathe, and was taken to hospital. In October, Eve was diagnosed, by the nutritional expert, with mitochondrial/metabolic disorder. Mae made a travel insurance claim for $1,256, the cost of the ambulance ride from the restaurant.

The insurer declined, as the claim arose from a pre-existing condition. Mae argued the incident was a “one-off” reaction. She also argued Eve was diagnosed with the mitochondrial/metabolic disorder in October, so it wasn’t a pre-existing condition in August. However, Eve had a long history of doctor visits and hospital admissions for food allergies, psychiatric episodes, collapsing and hyperventilation issues. There was no evidence the incident was a one-off. The insurer was entitled to decline the claim due to the pre-existing condition exclusion.

Complaint not upheld.

*Names have been changed.

See the full case study.