Insurers have been criticised for turning down some claims from holidaymakers who had been drinking alcohol before having an accident.July 19, 2015 2:23 pm
The Financial Ombudsman Service (FOS) said it expected a “high standard of proof” from insurers that the amount consumed made a policy invalid. A rising number of rejected travel insurance claims have been reversed by the ombudsman in recent years. It upheld 53% of complaints last year, up from 42% in 2011. The ombudsman settles disputes when a financial services company and a customer cannot agree.
A number of holidaymakers have had their claims turned down by insurers. In one example provided by the ombudsman, an insurer refused to pay a tourist’s medical bills after he fell down some stairs during a night out at a bar in Sydney, Australia. He broke a leg and suffered head injuries in the accident, but the insurer said that it had a witness account from the bar manager saying the man had bought a number of drinks, and the doctor said he smelled of alcohol.
The insurer refused to pay out owing to an “alcohol abuse” exclusion clause in the policy. However, the ombudsman found there was no evidence of how much the man had drunk, as he said he had been buying drinks for friends. The smell, he said, was from a spilt drink.
A lack of a clear definition about alcohol abuse was also highlighted by the ombudsman, which ordered the insurer to pay the claim and additional interest. “The majority of travel insurance policies exclude cover for events that happen after excessive alcohol consumption – but that doesn’t mean holidaymakers will only be covered if they don’t drink at all,” the ombudsman said. “As with all insurance cases, it is up to an insurer to show that an exclusion applies, not for their customer to show that it doesn’t. We expect a high standard of proof from insurers – proof that’s consistent with other evidence. We generally put more weight on evidence from blood tests and less on one-off remarks by a doctor at the time of any accident.” The ombudsman said that small print should make clear when alcohol would make a claim invalid.
A spokesman for the Association of British Insurers said that insurers did not expect holidaymakers to make a vow of temperance, but an exclusion clause was justified if people deliberately put themselves directly at risk. All insurance was based on the policyholders taking reasonable care, he added, but insurers would take on the ombudsman’s concerns.
Categorised in: Travel Insurance