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Determination
Case number | 1073072 |
Financial firm | AWP Australia Pty Ltd |
Case number: 1073072 7 June 2024
The complainant and his family were covered for a cruise under a complimentary travel insurance policy issued by the financial firm (insurer).
The cruise was from 7 to 15 February 2023 and was originally meant to include stops at certain locations in New Caledonia and Vanuatu. However, the cruise provider altered the original itinerary on the morning of departure due to adverse weather conditions. It replaced the originally planned stops with stops at locations in Queensland and Cairns instead.
The complainant and his family went ahead with the cruise but claimed for its cost ($2,270) on their return. The complainant also seeks compensation for:
The complainant says the cruise did not go to where it was originally meant to go, so he should be reimbursed for the above costs.
The insurer says the complainant has no claim under the policy. It says:
No. The complainant has not established a claim for loss under the policy. The claim was also not handled in a manner that warrants any compensation to be paid.
The complainant does not have a claim for loss under the policy. Nor was his claim handled in a manner that warrants compensation to be paid. Given this, it is not fair to require the insurer to pay any compensation.
This determination is in favour of the insurer.
The insurer is entitled to decline the claim and is not required to take any further action in relation to the claim or complaint.
No. The complainant has does not have a claim for loss under the policy. The claim was also not handled in a manner that warrants any compensation to be paid.
The complainant has the initial onus to show a claim for his claimed losses under the terms of the policy. Once established, the onus is then on the insurer to prove an exclusion or limitation applies if it seeks to deny or limit its liability for the claim.
The relevant policy extracts for the complainant’s claim are set in section 3.2 of this determination.
In summary, the policy covers several types of losses if the complainant’s journey was cancelled, disrupted or rescheduled because of unexpected or unintended circumstances beyond his control, such as, adverse weather. This can include:
However, the policy has terms that exclude or limit its cover and some types of losses. Amongst others, the policy excludes a person’s loss of enjoyment or opportunity.
There is no dispute the complainant’s original travel plans were disrupted by adverse weather conditions. However, the cruise still went ahead as scheduled with the cruise provider making alterations to its original itinerary. There is also no dispute the complainant and his family still went ahead with the cruise despite the itinerary changes.
Since the complainant and his family went ahead with the cruise, there was no unused and unrefunded cruise cost for the policy to respond to. They have used the cost that was paid for their cruise by going ahead with it, albeit with an altered itinerary.
There is also no basis for the complainant to claim for his parking and internet costs. The parking cost was for his vehicle’s parking while he was on the cruise, while he says he incurred internet costs because he had to work while on the cruise. Given this, the complainant would have incurred these costs whether the cruise had proceeded with its original or alternate itinerary.
What the complainant and his family essentially lost was an opportunity to enjoy the cruise based on its original itinerary. However, the policy does not respond to this as it clearly excludes loss of opportunity and enjoyment.
Given this, I am not satisfied the complainant has established a claim for loss under the policy. It follows that the insurer is entitled to decline his claim.
I am also not satisfied the claim was handled in a manner that warrants compensation to be paid. While I acknowledge the complainant found it stressful to the deal with the insurer, the information shows it did not unreasonably handle the claim.
The insurer decided the claim correctly. It also did so within 20 days of lodgement, which is not an unusual timeframe. Its internal dispute resolution decision was then issued 15 days later, which is also not an unusual timeframe.
The complainant does not have a claim for loss under the policy. Nor was his claim handled in a manner that warrants compensation to be paid. Given this, it is not fair to require the insurer to pay any compensation.
AFCA has determined this complaint based on what is fair in all the circumstances, having regard to:
The respective parties have completed a full exchange of the relevant information, and each party has had the opportunity to address any issues raised. I have reviewed and considered all information the parties have provided.
While the parties have raised several issues in their submissions, I have restricted this determination to the issues that are relevant to the outcome.
International Travel Insurance (For persons aged under 81 Years)
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General Exclusions
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To the extent permitted by law we do not cover you for any loss, damage or expense caused by or arising from:
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Section 2.1 Cancellation
2.1.1 What we cover
If, during the period of cover available, your journey is cancelled, disrupted or rescheduled because of circumstances that were not expected or intended by you and are outside of your control (including if you or your travel companion are positively diagnosed as suffering a sickness recognised as an epidemic or pandemic, such as COVID-19, which reasonably prevents you from travelling), we will reimburse you:
Unused travel and accommodation arrangements
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Rescheduling your journey
If you have a claim under sub-sections 2.1.1 a), 2.1.1 b), 2.1.1 c) or 2.1.1 d) and, while on your journey, you have to reschedule your journey, we will also pay you up to the maximum total limit specified in Part C – Benefit Limits – 2.1.1 d) Rescheduling your journey for your reasonable additional meal, internet and telephone costs to rearrange your journey.
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Conditions
If you want to claim under the cover available, you should do the following as soon as reasonably possible after the happening of the unexpected event causing your claim:
• cancel any pre-arranged travel and accommodation scheduled to be used during the period of cover available for your journey that you are now unable to use; and
• recover any refund that you are entitled to.
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Section 3.1 Additional Expenses
3.1.1 What we cover
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Additional travel & accommodation expenses due to specified events
• your scheduled or connecting transport being cancelled, delayed, rescheduled or diverted because of a strike, riot, hijack, civil protest, weather, natural disaster or accident affecting your mode of transport;
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we will reimburse your reasonable additional travel and accommodation expenses…
Whenever claims are made by you under this section and Section 2.1 Cancellation for cancelled services/facilities or alternative arrangements for the same or similar services/facilities, we will pay for the higher of the two amounts, not both.
