In October 2018, the female policyholder booked a trip to Europe for the following summer. However, she cancelled the trip on the advice of her doctors after she was diagnosed with antisynthetase syndrome. Her claim on her travel insurance policy was denied by Allianz as the company cited that the woman’s bout of pneumonia, which she had suffered in August 2018, constituted a ‘sign’ or ‘symptom’ of the syndrome, which made it a pre-existing condition and thus wasn’t coverable.
The case was originally seen by Financial Services Complaints Limits in April 2021, which criticised the behaviour of the insurer but found that it was entitled to deny the claim. The policyholder then took it to the Disputes Tribunal.
Disputes Tribunal adjudicator Phena Byrne ordered the insurer to pay the claim and compensation – totalling $28,353, saying that the insurer had acted ‘without reasonable care and skill’ that policyholders expect. Byrne also noted that Allianz had not dealt with the claim in a reasonable timeframe and was slow to respond to requests for information from the policyholder. The issue for Payne was Allianz’s decision to refuse the claim based on the pre-existing condition. Payne ruled: “As the phrase ‘signs or symptoms’ does not form part of the relevant definition of a pre-existing medical condition, I do not need to consider further whether a bout of pneumonia in 2018 was a sign or symptoms of antisynthetase syndrome.”
An Allianz Partners spokesman said: “Allianz Partners acknowledges it could have done better when handling this claim. Allianz Partners carefully reviewed and reflected on the Disputes Tribunal’s decision. It has undertaken careful checks to ensure this case was an isolated incident that was confined to its particular facts.”