Lucy was on an overseas trip when she was hospitalised for Hyponatremia (low sodium blood level). She submitted a claim for medical expenses under her travel insurance. However, the insurer rejected the claim on the basis that her admission was caused by a pre-existing medical condition, which was excluded under the policy.

FINDINGS

The policy clearly states that the insurer will not be liable for any claim arising from an existing health condition that had occurred within one year before travel, including conditions that required treatment, medication, or showed symptoms that would have caused a reasonable person to seek medical attention.

Based on this clause, the insurer relied on hospital records, which showed that Lucy had been on Losartan with Hydrochlorothiazide (HCTZ), a medication known to be associated with low sodium levels. On this basis, the insurer concluded that her hospitalisation was related to a pre-existing condition and therefore excluded.

Lucy, however, explained that the low sodium levels that led to her admission were triggered by persistent vomiting, poor food intake, and an upper respiratory infection she experienced while travelling, and not due to her long-term medication.

Following a mediation session, two clarification letters were obtained from the treating hospital. Both letters confirmed that Lucy’s sodium levels had been normal for years while on HCTZ and that the episode was more likely caused by acute vomiting and inadequate fluid intake during the trip. The doctors further stated that HCTZ usually causes such complications shortly after starting treatment, and not after long-term use.

OUTCOME

Based on the medical clarification, we found that Lucy’s admission was not due to a pre-existing condition. As the insurer carries the burden of proving that an exclusion applies, and had not proven so in this case, the exclusion could not be invoked.

In accordance with established insurance principles and the policy terms, the Ombudsman adjudicated in Lucy’s favour.