- within Insurance topic(s)
- with Finance and Tax Executives and Inhouse Counsel
- in Asia
- in Asia
- in Asia
- in Asia
- in Asia
- with readers working within the Environment & Waste Management, Insurance and Law Firm industries
When navigating the landscape of travel insurance in Australia, policyholders must understand the crucial role of disclosing pre-existing medical conditions before they take out insurance cover. This obligation is central to ensuring that travel insurance claims are valid and claims processes are smooth. Here's a detailed exploration of why and how policyholders should manage this duty of disclosure.
Understanding the Duty of Disclosure
In Australia, the duty of disclosure is governed by the Insurance Contracts Act 1984 (Cth). This legal framework mandates that policyholders must disclose all relevant information to their insurer, particularly when it pertains to pre-existing medical conditions. Pre-existing conditions are those health issues that exist prior to the commencement of the travel insurance policy. These can range from chronic illnesses like diabetes or heart disease to recent injuries or ongoing treatments.
Why Disclosure is Crucial
The reason for this stringent requirement is rooted in the principle of utmost good faith, or "uberrimae fidei," which underpins all insurance contracts. Insurers rely on accurate and comprehensive information to assess risk and determine coverage. If a policyholder fails to disclose pre-existing conditions, it can lead to complications. In the event of a claim, if the insurer finds out about undisclosed conditions, they may reject the claim or cancel the policy, potentially leaving the policyholder without coverage when they need it most.
The Impact of Non-Disclosure
Non-disclosure can have severe ramifications. For instance, if a policyholder suffers a medical emergency that is linked to an undisclosed condition, the insurer may argue that the condition was material to the risk assessment of the policy. This could result in the insurer refusing to pay for medical expenses, trip cancellations, or other related claims. In some cases, insurers might even void the policy entirely, which can create significant financial strain on the policyholder.
How to Disclose Pre-Existing Conditions
To ensure compliance with the duty of disclosure, policyholders should follow these steps:
- Full Disclosure: When applying for travel insurance, provide comprehensive details about any pre-existing conditions. This includes any recent changes in health, ongoing treatments, or medications. Be proactive and thorough in sharing information with the insurer, even if the condition seems minor.
- Understand Policy Terms: Read the insurance policy carefully to understand how pre-existing conditions are treated. Some policies may offer coverage for pre-existing conditions if additional premiums are paid or if specific conditions are met.
- Seek Clarification: If unsure whether a condition should be disclosed, contact the insurer for guidance. It is better to over-disclose than under-disclose to avoid potential complications later.
- Keep Records: Maintain documentation of all medical conditions and treatments. This can be useful if the insurer requests further information or if there is a dispute over coverage.
Handling Claims with Pre-Existing Conditions
When making a claim related to a pre-existing condition, be prepared to provide detailed information and documentation. Insurers may require medical reports or proof of ongoing treatment. Cooperating fully with these requests can facilitate a smoother claims process.
Conclusion
The duty to disclose a pre-existing medical condition must be taken seriously. Properly disclosing all relevant health information ensures that coverage remains valid and that claims are processed without undue complications.
The consequences of failing to disclose a pre-existing medical condition can be significant. Travel insurance is intended to give travellers peace of mind when they do not have access to the Australian healthcare system. It is important, therefore, that you understand the extent of coverage before you travel overseas.
If you are unsure of the coverage, you should seek clarification from the insurer before travelling. Keep records of these conversations.
If your claim has been denied on the basis of a failure to disclose a pre-existing medical condition, you should contact Carroll & O'Dea Lawyers for advice.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
