Insurance Claims May Be Rejected If Tourists Are 'Dangerously Drunk'
A man who sustained a head injury after a night of heavy drinking was correctly refused a payout by his travel insurer, an ombudsman has stated.
However, another man who hurt himself after slipping on a nightclub floor should have been given cover.
The differences between the two cases have been highlighted by the financial ombudsman so people are more aware of the small print of their travel insurance policies.
Holidaymakers do not need to be entirely sober in order to win a claim, the ombudsman said.
If a tourist has too much to drink before an injury, the burden of proof is on the insurer.
The majority of insurance policies stipulate that if an injury was sustained due to excessive alcohol consumption, a payout will not be awarded.
If a provider decides not to pay medical expenses, the insured can go to the ombudsman to request an independent ruling.
In order to underline some of the related issues, the ombudsman analysed almost 900 travel cover complaints in the last quarter of 2017.
Chief financial ombudsman Caroline Wayman, said, "Insurers may choose not to pay out if they believe someone's been drinking excessively, although this doesn't necessarily mean holidays should be totally alcohol-free.
"In each case, we'll need to carefully weigh up all the evidence to decide, on balance, whether the insurer has made the right call.
"Encouragingly, compared with recent years, we're generally upholding fewer travel insurance complaints. This suggests, while there is still clearly work to do, that many insurers are increasingly treating their customers in a fair and reasonable way."
In the case of the nightclub incident, the insurer was instructed by the ombudsman to award a payout for medical costs. The man claimed that while he had consumed alcohol, he was not inebriated.
In the other case, "acute alcohol intoxication" was involved, according to the attending doctor. The man was unable to fill in a form upon arriving at hospital. The ambulance reports also suggested the man had been drinking heavily. As a result, the ombudsman said he could not expect to be covered by his insurer.
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