VCAT – Budget Direct \ AUTO & GENERAL INSURANCE COMPANY For Not paying travel insurance policy

 

PARTICULARS OF CLAIM

1. On Thursday December 12th 2019 at 9:25 AM, International flights were purchased from Cebu Pacific Airline via their website https://www.cebupacificair.com/en-au XXXXXXXXXXXXXXXX (12:20PM)
2. On Thursday December 26th 2019 at 9:10 AM, Domestic Flights were purchased from https://www.kiwi.com/us/ foXXXXXXXXXXXXXX)
3. The Applicant purchased insurance directly with the Respondent on their online booking service https://www.budgetdirect.com.au/ on xxxx Policy Number xxxxxxxxfor Travel Dates to xxxxxxxxxx. The level of cover was comprehensive.
4. On xxxxxxxxx Applicant Checked on the Respondents website and found the below information from Respondents Website. Respondent has now removed this Text from their current Website. Website Service below gives a snapshot of website when Applicant checked ( https://web.archive.org/web/20190407012241/https://www.budgetdirect.com.au/travel-insurance/travel-insurance-faqs/trip-cancellation-cover.html#does-travel-insurance-cover-cancellation-due-to-a-disease-outbreak )

Particulars

Does travel insurance cover cancellation due to a disease outbreak?

Yes – all Budget Direct policyholders (except those with Last Minute cover) can lodge a claim for cancellation or amendment fees if, as a result of a disease outbreak, or epidemic, in a country on your itinerary:

travel restrictions are imposed for that country, or

the Australian Government raises the risk rating for that country to ‘Level 4 – Do not travel’.

1. Applicant also checked his Insurance Policy with respondent

Particulars

We will pay a benefit under this Section if the cancellation of your trip is necessary and unavoidable

as a result of:

4 Your unforeseeable death, injury, or illness;

4 The unforeseeable death, injury, or illness of your relative, business associate or travelling

companion; who is a resident in Australia and who is in Australia at the time the event occurs;

4 You having to go to court to be a witness or be on a jury (but not as an expert witness) or you are

put in quarantine;

4 An accident involving a vehicle you were planning to travel in, which happens within seven days

before the date you planned to leave and means you cannot use the vehicle. This only applies to

self-drive holidays;

4 You, your relative, or travelling companion are a member of the armed forces, police, fire,

nursing or ambulance services and you have to stay in Australia because of an emergency or you

are posted overseas unexpectedly;

4 You being made redundant, as long as you are entitled to payment under the current

redundancy payments law and, at the time of booking your trip you had no reason to believe you

would be made redundant;

4 It being necessary for you to stay in Australia after a fire, storm, flood or burglary at your home or

place of business within 48 hours before the date you planned to leave. We will need a written

statement from a relevant public authority confirming the reason and necessity;

4 You being unable to travel because of travel restrictions imposed on you after an epidemic,terrorist attack or natural disaster.

1. The Applicant checked https://www.smartraveller.gov.au/ on xxxxxxxto make sure the Australian government had no travel restrictions to the xxxxxbefore leaving.
2. On xxxxxxxxxx Applicant took scheduled flight xxxxxxxxxxxxxxx. During checkin Applicant was not warned by the airline of any travel restrictions or bans currently in place.xxxxxxxxxx. During checkin Applicant was not warned by the airline of any travel restrictions or bans currently in place.
3. On xxxxxxxxx Respondent updated their Travel Insurance Policy for new policies to add a new exclusion

Particular

29. Any claim directly or indirectly arising from an epidemic, pandemic or outbreak of an infectious

disease, virus or condition, including any derivative or mutation of such disease, virus or condition,

or the threat or perceived threat of any such epidemic, pandemic or outbreak.

1. 11th March 2020 – The WHO ( World Health Organisation ) changed the static of Covid-19 from an Epidemic to a Pandemic
2. 11th March 2020 Applicant booked Ferry for March 13th 6am from El Nido Island Philippines to Coron Island Philippines ready for Domestic flight to Manilla on March 15th.
3. 12th March 2020 12PM President of Philippines Rodrigo Duterte placed a ban starting at 15th March 2020 Midnight on all domestic travel to Manila Ninoy Aquino International Airport (MNL) , the Applicants airport for his return Domestic flight
4. Applicant took scheduled March 13th 6am Ferry to Coron ( no information displayed about travel restriction)
5. Applicant informed of Domestic Travel Ban upon checking to Hotel. Applicant spoke to Cebu office in Coron town March 13th 2PM confirmed my existing flight would be cancelled by Cebu
6. Applicant tried all avenues to get a return flight back to Manilla
7. District of Coron scheduled a Private Charter plane to fly tourists back to Clark International Airport ( 2 hour south of Manila Ninoy Aquino International Airport (MNL) )
8. Applicant purchased new international return ticket from Manila Ninoy Aquino International Airport (MNL)
9. The Applicant lodged an Insurance claim on Thu, Apr 9, 4:52 PM ( REF LU029608-01 ) for his losses of expenses and new return flight home for 1709.24$
10. Applicants Claim was denied on Thu, Apr 23, 4:31 PM

Particulars

Dear xxxxxxxxxx,

Outcome of assessment – Decision

We are writing with regard to the recent claim relating to CANCELLATION & LOST DEPOSITS that occurred on xxxxxxxxxx.

We wish to advise you that we have completed the assessment of the claim, and unfortunately it has been identified that the claim does not fall within the terms and conditions of the policy.

We recommend that you carefully read the information below as this outlines the basis for our decision.

Circumstances of the claim

You were on a trip however it was disrupted by COVID-19. Your domestic and international flight home was cancelled because the government reduced flights out and you had to wait 3 days for a charter flight back to Manila. You then had to purchase a new flight home.

Policy terms and conditions

We have reviewed the circumstances of the loss and refer to the Product Disclosure Statement (PDS) which states:

Part 6 – General Exclusions

General Exclusions apply to all sections of this policy. We will NOT cover the following:

3. Any claim relating to an incident which you were aware of at the time you took out this insurance and which could reasonably be expected to lead to a claim.

Section C2 – Additional Expenses

What you are covered for

We will pay up to the amount shown in the Table of Benefits (pages 8-11) for your reasonable and necessary additional accommodation, meals and travelling expenses (including emergency personal

telephone calls), incurred after departure, that are over and above what you had originally budgeted to pay, if your trip is disrupted, or you are required to return to your home in Australia, because of:

1. Your treating medical practitioner certifying that you, or your travelling companion, are unfit to continue with your original itinerary;

2. The unexpected death of, or sudden serious injury or illness of, your, or your travelling companion’s relative who is a resident in Australia and who is in Australia at the time the event occurs, or of your business associate who is a resident in Australia and who is in Australia at the time the event occurs;

3. Your passport or travel documents being lost or stolen (Please note: This section does not apply if you have Last Minute or Domestic Cover);

4. You innocently breaking any quarantine regulation;

5. Serious damage to your home or business premises in Australia;

6. An accident involving your means of transport (pre-booked flights, cruise and regularly scheduled buses or coaches only); or

7. The cancellation, delay or diversion of your scheduled transport caused by riot, strike or civil commotion, but only those expenses that you cannot claim from someone else.

Section D – Travel Delay Expenses

What you are covered for

We will pay up to the amount shown in the Table of Benefits (pages 8-11) if your outward or return trip by air or sea, is delayed due to poor weather conditions, natural disaster, strike, industrial action or mechanical breakdown.

We will pay your reasonable extra meals and accommodation expenses for each completed periodof time as specified in the Table of Benefits – that you are delayed as long as you eventually go on the holiday.

Basis of our decision

We note that you purchased your policy after 30 January 2020 and your loss is in relation to COVID-19 which was considered a world known event at the time. Based on the information noted within your claim, it is clear that your loss relates to an incident which you were aware of at the time you took out this insurance and which could reasonably be expected to lead to a claim. Therefore, your claim meets the exclusion noted under General Exclusion 3 of the policy. In addition we note that your claim circumstances do not meet any of those listed under section C2 or D of the policy. Unfortunately, you would fall outside the scope of cover of the policy as your event doesn’t correlate with those listed.

 

Given the above information we are unable to accept this claim. This decision was based upon information available to us and this information is available to you upon request.

Please note that you can also request copies of any Service Suppliers’ or External Experts’ reports that we have relied on in assessing your claim.

Please be assured that every effort has been made to assess the claim correctly and this decision has not been made lightly.

We are sorry we have been unable to assist you on this occasion. If you would like to discuss this matter further or provide us with further supporting information, please contact us as soon as possible.

Please refer to the attached document for details relating to the complaints process.

How to get in touch with us

Do not hesitate to contact us if you have any questions. Remember to quote the claim number in all correspondence with us.

You can call us on 07 3012 3060 or email us at [email protected]

You can also contact us via post or fax. These details are noted below for your reference.

Yours faithfully,

Darius Chiu

Claims Consultant

P: 07 3012 3060

Attachment Summary:

Budget Direct IDR Complaint Dispute Brochure.PDF

1. Applicants response to Claim being Denied

Particulars
3. Any claim relating to an incident which you were aware of at the time you took out this insurance and which could reasonably be expected to lead to a claim.

There was no travel ban in place and the Australian Government recommendations were still that I could travel without issue.

Particulars

We note that you purchased your policy after 30 January 2020 and your loss is in relation to COVID-19 which was considered a world known event at the time. Based on the information noted within your claim, it is clear that your loss relates to an incident which you were aware of at the time you took out this insurance and which could reasonably be expected to lead to a claim. Therefore, your claim meets the exclusion noted under General Exclusion 3 of the policy. In addition we note that your claim circumstances do not meet any of those listed under section C2 or D of the policy. Unfortunately, you would fall outside the scope of cover of the policy as your event doesn’t correlate with those listed.

Applicant was not made aware of this information before signing up to the policy and was not added to the policy.

Applicant also states the WHO did not change the status of Covid-19 from epidemic to Pandemic until March 11th 2020 so this statement is irrelevant and disingenuous

1. Applicant asked from Respondent on Thu, Apr 23, 5:28 PM via response email to “

[email protected]” Particulars Can I please request copies of any Service Suppliers’ or External Experts’ reports that we have relied on in assessing your claim I have had legal advice to state that the claim about the’ 30th January ‘ statement does not match your policy wording , so will be referring this as evidence Thanks

1. Applicant followed the below advice from Respondent received via email on Denied ClaimParticulars

As part of our commitment to the Code, we have an IDR Department, and Dispute Resolution Officers

who will impartially review any decision that our customers disagree with.As part of our commitment to the Code, we have an IDR Department, and Dispute Resolution Officers

who will impartially review any decision that our customers disagree with.

They can be contacted by :

phone on 07 3012 3060

email at [email protected]

post at GPO Box 14, Brisbane QLD, 4001

1. Applicant Emailed [email protected]

Particulars

Hello,

I negate the below statement made by you, if the below statement was true, you would have updated your Product Discloser to reference this when I took out the contract with you.

” We note that you purchased your policy after 30 January 2020 and your loss is in relation to COVID-19 which was considered a world known event at the time. Based on the information noted within your claim, it is clear that your loss relates to an incident which you were aware of at the time you took out this insurance and which could reasonably be expected to lead to a claim. Therefore, your claim meets the exclusion noted under General Exclusion 3 of the policy. In addition we note that your claim circumstances do not meet any of those listed under section C2 or D of the policy. Unfortunately, you would fall outside the scope of cover of the policy as your event doesn’t correlate with those listed. “

My Product Discloser and my contract with you state clearly

“You being unable to travel because of travel restrictions imposed on you after an epidemic,terrorist attack or natural disaster.” , Covid-19 was an epidemic during my time of travel

You updated the Product Discloser 4 days after I traveled, with new wording, for new people taking out insurance, which specific new exclusions for Epidemics and Pandemics. My legal representation feels now due to both of the above there is litigation to be had on this matter.

Please also see this screenshot from the Budget Direct Website on the 7th of April ( which has now been removed ) , which I referenced while I took out your policy ,

This also falls under trading standards misleading advertising

I will await your formal reply in 15 Days so I can start the next steps

Thanks

 

1. By reason of the conduct described in paragraph 4 the Respondents have breached Australian Competition and Consumer Commission in particular “Advertising and selling guide” specifically defined here https://www.accc.gov.au/accc-book/printer-friendly/29527

Particulars of contravention

ensure that you can deliver services as advertised and not make any false or misleading claims about the services

1. By reason of the conduct described in paragraph 5, the Respondents have not

Particulars

We will pay a benefit under this Section if the cancellation of your trip is necessary and unavoidable as a result of:

You being unable to travel because of travel restrictions imposed on you after an epidemic,terrorist attack or natural disaster.

1. By reason of the conduct in Paragraph 8 , the Respondents addition of new exclusions to their Insurance Policy , is an example that the applicants policy was covered by epidemics and pandemics previously.As the respondent states since January 30th Covid – 19 was a World Event , however the respondent only updated their Policy on March 5th.
2. Applicant Lodged complaint with Australian Financial Complaints Authority (AFCA) xxxxxxxxx
3. Applicant has had no response from Respondent from actions in Paragraph 25, 19 or 21
4. The Applicant has suffered financial loss due to Insurance Claim being Denied
5. The Applicant claims –
   1. The cost of the Insurance Claim
   2. Costs in chasing the claim
   3. Interest on claim Amount

29th May 2020

Outcome

• Auto and General decided to overturn my decline of compensation upon receiving the Vcat summons, however, only decided to pay half my costs which I refused
• Auto and General never submitted a defense to VCAT
• A week to our VCAT summons they offered 75% of the sum which I again refused and said I would only accept 100% which they finally accepted