These case studies have been modified so as not to identify any actual cases at FIDReC. They are provided for purposes of learning and are not necessarily indicative of outcomes at FIDReC.
Mr and Mrs Hong travelled to Italy from Singapore for a holiday. At Rome airport on their last day, Mr Hong experienced severe pain. He consulted the doctor at the airport’s medical facility. The doctor advised that if pain persisted, he should not board the plane and seek hospital care. Mr and Mrs Hong did not board the flight.
Accompanied by Mrs Hong, Mr Hong went to a local hospital where he was diagnosed with kidney stones. When his condition stabilised three (3) days later, he booked a flight to return to Singapore with Mrs Hong. After arriving in Singapore, Mr Hong was admitted to Singapore General Hospital (SGH) for further treatment.
After his discharge from SGH, Mr Hong submitted claims for the fresh air ticket from Italy to Singapore and his medical expenses in Italy. Mrs Hong also submitted claims for: (1) her air ticket, (2) hotel accommodation while Mr Hong was hospitalised, and (3) the cost of the phone calls she made calling the insurer’s hotline for help.
The insurer reimbursed Mr Hong’s claims for the air ticket and hospital expenses under the “Trip Disruption” and “Medical Expenses” provisions of the travel insurance policy. But for Mrs Hong, the insurer declined her claims.
After further appeals to the insurer failed, Mrs Hong filed a claim at FIDReC. She chose to go for adjudication without mediation, and the insurer agreed to this.
The Adjudicator ruled in favour of the insurer. Mrs Hong, being a dutiful spouse, stayed behind with her husband as he underwent treatment. But she did not meet the requirements under the policy for “Trip Disruption”. The policy provided for different criteria when assessing a claim by the person who fell ill as opposed to a companion.
For the companion, the policy required that the one who fell ill must have suffered a “life-threatening condition”. Only then would the claims for a companion’s air ticket and accommodation be payable. Because Mr Hong’s condition was not “life-threatening”, Mrs Hong’s claims for air ticket and accommodation were not payable. Finally, the Adjudicator dismissed Mrs Hong’s claim for phone charges because the policy had an exclusion clause for phone charges.
Key Learning Points
Coverage under an insurance policy depends on the applicable terms and conditions. Although someone who stayed back in a foreign country because of a medical condition may have their claim paid out, this does not mean that the companion’s claims will be paid as well.
Insurance policies may exclude claims for certain items. An insurer may reimburse part of a claim, but not all parts of a claim. For example, assuming Mr Hong did suffer a life-threatening condition, the insurer may pay Mrs Hong’s claims for air ticket and accommodation. But her phone charges would still be unclaimable.
Be clear about what the policy covers, including details of policy coverage. If you are unsure what expenses the policy covers, reach out to your insurer to find out. It is good practice to have a digital or physical copy of your travel insurance policy with you when you travel. The policy will also include the insurer’s contact details.
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