SERVICE: Travel
OUTCOME: Settled
Issues: Policy exclusion, Misselling/ misleading information/ misrepresentation
Summary: Mr B’s complaint was settled, because the insurer reviewed its application of the policy wording to Mr B’s circumstances and offered to settle the claim.
Mr B had travel insurance for an overseas trip.
In September 2023, Mr B’s flight was delayed and he was subsequently booked on a different flight the following day. Mr B needed to arrange a new connecting flight to reach a wedding on time (the additional flight).
Mr B made a claim to the insurer for the additional flight.
The insurer declined the claim, on the basis that the cancellation exclusions applied to the additional flight.
Mr B made a complaint about the declined claim. He said that the insurer had included information on its website that suggested he would have cover for this type of situation and the insurer had misrepresented the policy cover to him.
The case manager’s assessment
When an insured makes 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.[1]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.
The case manager reviewed the policy wording and queried the specific provisions of the policy the insurer had relied on to decline the claim. The case manager highlighted that Mr B was travelling to a wedding and booked the additional flight to make the wedding on time. The insurer gave consideration to Mr B’s circumstances and confirmed that it would settle the claim under the alternative transport to attend an event cover of the policy.
The case manager also reviewed the insurer’s website and did not believe it had misrepresented the cover available to Mr B.
Mr B accepted the insurer’s settlement offer in full and final resolution of the complaint.
*Name has been changed
Complaint No: 00230711
[1] This is known as a prima facie claim.