SERVICE: Travel
OUTCOME: Settled
Issues: Policy Exclusion
Summary: Mrs H’s* complaint was settled and the insurer agreed to pay the claim.
Mrs H held travel insurance with the insurer for her family’s trip to Japan in July 2023.
Mrs H made a claim to the insurer, because Mr H* had been 10 minutes late to check-in for their flight home to New Zealand and, as a result, was unable to board and had to pay for a new flight home. Mrs H also claimed for a lost cell phone.
Mrs H said that Mr H missed the flight, because of a series of events. When they left their hotel for the airport, they realised that she had lost her cell phone. Mrs H and their children continued their trip to the airport, while Mr H went back to the hotel to look for the cell phone, but was unable to find it. He then caught a train, but lost his bag on the train and was delayed while he found someone to whom to report the loss. Mr H then tried to get a taxi to the airport, but realised that the traffic was too heavy to get there in time, so he went back to catch another train, resulting in his late arrival at the airport.
The insurer accepted the claim for the lost cell phone, but declined the claim for the new flight based on a policy exclusion for claims arising from “[a]ny change of plans”.
The case manager’s assessment
When making a claim under an insurance policy, the law says that it is up to the insured to prove that they have suffered a loss, which is covered by the policy (a prima facie claim).
The insurer can then choose whether to apply a policy condition or exclusion to limit or decline a claim. If the insurer does choose to do so, it must prove the condition or exclusion applies.
In this case, the insurer believed that Mr H’s decision to return to look for the phone was a change of plans, meaning it could apply the exclusion to the claim. The insurer did not believe the series of events that followed were “unexpected or unintended”, as a result.
The case manager did not agree with the insurer and believed that Mr H missed his flight because of unexpected events causing a delay, not because he changed his plans. The case manager noted that many other travel insurance policies specifically exclude claims caused by a failure to check-in on time, but the policy did not contain such an exclusion.
After considering the case manager’s view, the insurer agreed to settle the complaint and pay the claim.
*Names have been changed
Complaint No: 00230754