Travel insurance policies refusing to pay out if you’ve had two or three drinks on holiday?

24 September 2014

beer-300x225Sensible travellers know that, when you go abroad, in addition to your EHIC if travelling in Europe*, you make sure you get travel insurance with medical cover because, after all, anyone can have an accident. However, the Financial Ombudsman has noted a growing trend for insurers to refuse to pay out at all if there has been alcohol consumed - even if that is as little as two or three drinks.

While travel insurance cases make up only 2% of the Financial Ombudsman’s work, insurers seems to be getting cheekier with the amount of cases upheld by the Ombudsman rising from 42% to 53% last year. And many of the cases involve a denial of relief, owing to alcohol consumption.

The reason many health claims on travel insurance are denied is because of undisclosed previous medical conditions, and failure to inform an insurer of alcoholism could fall under that category. However, the Ombudsman is now seeing cases denied on the grounds of “alcohol abuse” or “excessive alcohol consumption”, terms which are often undefined and therefore open to the insurer’s interpretation.

Some examples given by the Ombudsman include a woman who needed stitches after banging her head on a bedside table whilst on holiday in Greece. She freely admitted to having drunk two or three drinks over the course of the evening, which rendered her blood alcohol level over the legal limit for driving in the UK. The insurer claimed the injury was as a result of excessive drinking, although they had not defined what ‘excessive’ might be. The Ombudsman felt that two or three drinks over a long evening whilst on holiday and not intending to drive was not, in fact, excessive, and that “people can be clumsy and have accidents even when they’re sober.”

They also found that insurance companies make assumptions, based on age and location. A young man in his twenties was admitted to hospital after collapsing while out at a popular European resort. The reason assumed by the doctor was given as alcohol consumption, so the insurer rejected the claim for medical expenses on the grounds that they had arisen “directly or indirectly from using alcohol”.

However, the Ombudsman does not think it is reasonable for any insurer to assume people will not drink at all on holiday, so the onus was to show whether the admission was caused by alcohol, not merely incidental to it. The medical evidence showed that the young man in question had, in fact, drunk less than the UK driving limit on the night in question, and that an alternative explanation for his collapse could have been down to dehydration. His claim was upheld.

Although, ideally, insurance companies would just settle reasonable claims, it is important to know that the Ombudsman requires the insurance company to prove that an exclusion applies (eg for excessive alcohol consumption), it is not down to the traveller to prove it does not apply. But nor does the Ombudsman uphold every case. Cases that have required hospital treatment to treat alcohol withdrawal were upheld in the insurer’s favour, as the claim clearly resulted from alcoholism notwithstanding the fact that no alcohol had been consumed on holiday. Another case where a traveller sadly died while falling down the stairs was also found in favour of the insurance company when post mortem tests showed blood alcohol levels were sufficient to have caused “severe ‘ataxia’ (problems with balance and coordination) and poor judgement.”

So next time you get blasted on holiday, check your policy exclusions and make sure you don’t injure yourself, or those fishbowls could end up costing more €uros than you thought…

*European Health Insurance Card, previously known as E111. Link to get a free card for the uninitiated is here

TOPICS:   Insurance   Restaurants   Travel   Economy

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