Background
Barry and Wendy Springel bought Generali travel insurance in February 2022 for a July Arctic cruise costing $38,658. Barry, then 79, had longstanding back issues and received diagnostic and pain-management treatment before the policy took effect. He nevertheless remained active, bicycling and going to the gym, and the couple took another cruise in March.
On March 28, after coverage began, a neurosurgeon told Barry that he needed spinal-fusion surgery and that delaying it risked loss of bowel and bladder control. He underwent surgery on May 17. At a June 28 postoperative visit, the neurosurgeon advised against the July cruise because Barry had not recovered sufficiently. The Springels canceled and sought trip-cancellation benefits, but Generali denied the claim as arising from a pre-policy sickness and a pre-existing condition.
The Court’s Holding
The Fourth District affirmed the county court’s judgment requiring Generali to reimburse the Springels for the canceled cruise. Competent, substantial evidence supported the finding that the covered sickness commenced during the policy period, when the neurosurgeon first advised Barry that surgery was immediately necessary and the resulting postoperative recovery prevented travel.
The court also upheld findings that the loss was unforeseeable when the policy was purchased and that the pre-existing-condition exclusion did not apply. Although Barry had earlier back symptoms and treatment, the court treated the condition requiring prompt surgery and the disabling postoperative recovery as distinct from those earlier issues. Generali therefore did not establish that an exclusion barred coverage.
Key Takeaways
- An insurer bears the burden to prove that a policy exclusion defeats otherwise available coverage.
- Earlier symptoms or treatment do not necessarily make a later disabling condition a pre-existing condition under the policy.
- In a bench trial, appellate courts defer to factual findings supported by competent, substantial evidence.
Why It Matters
The decision illustrates that travel-insurance coverage can turn on the specific condition that caused cancellation, rather than a broad characterization of a policyholder’s prior medical history. Insurers assessing pre-existing-condition exclusions must connect the earlier treatment to the condition that actually produced the covered loss.