Travel insurers refusing accident claims on alcohol grounds

Published:  23 Sep at 6 PM
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A warning from the UK’s Financial Ombudsman Service (FOS)has accused travel insurers of turning down medical claims using a reference to alcohol in their small print.

Expats who have private health insurance restricted to their country of residence and book travel insurance online for their overseas holidays are warned to read the small print before making payment. Warnings from the UK authority indicate that occasional or normal alcohol consumption is being used as an excuse to refuse a claim.

Travel insurance policies exclude alcoholics and alcohol abuse from cover whilst overseas, but the number of claims being refused if even one drink has been taken has increased over the last several years. Over half of the customer complaints received in 2013 were upheld by the FOS due to unfair refusals by the insurer, a considerable increase on the 2012 figures.

One insurer denied a claim from a visitor to Sydney who’d fallen down a flight of stairs in a bar. His injuries included severe head trauma and a broken leg, and emergency surgery had been necessary to remove a life-threatening blood clot.

The insurer claimed evidence showing that he had been drinking to excess, blaming his fall on drunkenness and rejecting his claim. However, the FOS ruled that the evidence produced was not sufficient to back up their decision, allowing the claim as a result and adding interest to the payment.

According to the Ombudsman, it’s up to the insurer to prove the case for an exclusion, rather than putting the onus on the customer to prove the claim is justified. The Ombudsman added that, year on year, the same issues are raised when accidental injury and hospital treatment are part of a disputed non-payment of a claim.
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