Open and shut case: insurer denies claims for lost luggage, dental work

A traveller who lodged claims relating to a lost suitcase in Switzerland and dental treatment in Morocco will not be covered after the Australian Financial Complaints Authority (AFCA) ruled that his insurer acted fairly.

The complainant said he placed his suitcase “just inside the door” of a train at a Swiss railway station while he stood outside to have a cigarette. He said he noticed the door closed and knocked on it to alert someone but could not reach the case before the train departed.

Zurich Australia relied on an exclusion within the travel policy regarding leaving items “unattended in a public place,” saying the luggage should have been within his “sight and reach”. The claimant said he was within 25cm of the doorway and could see the suitcase the entire time.

The insurer disputed the man’s story of events as “unreliable”, saying that the smoking area had been “well away from the train” and that the train would not have departed without warning.

AFCA agreed that the traveller may have been able to see the suitcase but said it was unlikely that the item was “within reach”. It acknowledged that the policy had made no specifications that defined “within reach” but said the circumstances of the event could be fairly interpreted.

“There is no doubt that whatever the physical distance, once the door closed, the suitcase was no longer within reach of the complainant,” AFCA said.

“As a result, I find that the exclusion applies to the facts of the case.”

The claimant also sought cover for dental treatment in Morocco. Work was done on several of his root canals and teeth after he reported pain in his upper jaw and teeth, with costs for the treatment amounting to over $8000.

Zurich acknowledged the policy did cover emergency dental treatment if the complainant suffers a “disabling injury, sickness or disease which first shows itself during the Period of Insurance and which requires immediate treatment by a qualified medical practitioner or dentist”.

But the insurer relied on a report from an unnamed “external dentist expert,” who said the treatment exceeds what “was required on an urgent basis, namely to alleviate pain”.

The expert said the initial stage of the root canal therapy “would have been sufficient to get the complainant out of any pain and that further prosthetic treatment was not emergency dental treatment”.

AFCA noted that the claimant received the treatment more than six weeks after he obtained a dental x-ray, which Zurich said showed that the complainant did not require “immediate treatment.”

The ruling also referenced a phone call between the complainant and insurer which suggested that he had “decided well in advance” to have dental work done in a location cheaper than Australia.

The decision allowed the insurer to decline the claims, saying it had proven that the policy held applicable exclusions to the lodged events.

Click here for the ruling.