If you were to question somebody about whether or not they drank or drank excessively on holiday, providing they are legal to do so, you would be safe to assume their answer would most likely be a yes – after all they are on holiday.
What they may not be able to answer though, is if they know whether or not their insurance cover is affected should they injure themselves when intoxicated. According to a spokesman from One Sure Insurance, we got told, “This might not be a situation to cross the minds of many when they are perhaps enjoying themselves to excess on their travels, but recent reports from the Financial Ombudsman Service or FOS, which settles disagreements with consumers and insurers, have revealed that some insurers are rejecting customer claims because of alcohol-related exclusion clauses.”
Had a bit too much?
This has caused many to ask the question, ‘how much is too much?’ and debate how such claims can be qualified or disputed. What is clear though, is that such clauses do exist in some policies.
The FOS made reference to one case where a man in a nightclub in Sydney, Australia suffered a broken leg and severe head injuries from falling down some stairs while drunk, who had his claim rejected by his insurer.
The policyholder’s complaint at being rejected was upheld by the FOS who discovered the grounds for rejection was based on the bar manager’s testimony regarding the amount the man had bought rather than consumed, which didn’t warrant the ‘alcohol abuse’ terms of his policy small print.
‘A high standard of proof’
The FOS explained their expectations regarding the evidence for claim decisions: ‘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.’
They also called for more clarity regarding how exclusion policies are defined: ‘In some cases, we find that terms describing alcohol consumption aren’t clearly defined in the policy – or have been unfairly applied by the insurer to reject a claim. For example, we see cases where insurers accuse their customers of “alcohol abuse” or “alcoholism”, even though medical evidence shows they only had one or two drinks.’
The reality for those wanting to travel though, is that they need to have insurance and that such exclusions are in place to deter people from the dangers of excessive drinking. Not every insurer will include these stipulations but the fundamental advice is to check the small print and find out exactly how your cover works before you go on holiday.