Travel Insurance claim rejected (Alcohol)

ashp_2

Hi,

If anyone has any experience or advice it would be much appreciated.

A family member was hit by a car in Turkey last week. He suffered serious injuries including many broke bones and bleeds on the brain. He is currently on life support.

The insurance company have rejected the claim on the basis his partner said he has been drinking. I believe he had a few beers and a wine which his partner told someone I'm assuming the police so the insurers have this information.We are waiting to see the exact wording of the reason of the rejected claim but my feeling is even if they reject it we can go to the ombudsmen who will hopefully uphold our complaint.

The hospital toxicology shows 0 alcohol as it was not done until sometime after the accident. The insurance terms and conditions state exclusions for "alcohol abuse" and blood alcohol levels above 200mg/110ml of blood.

Personally I can't see how either of the exclusions apply based on the reason they are rejecting the claim.

Any advice would be great.

Thanks.

mgdavid

ashp wrote: »

.........
The hospital toxicology shows 0 alcohol as it was not done until sometime after the accident. ..........

how long is 'some time'?
an hour?
12 hours?
next day?
2 days?

MovingForwards

Majority of claims are rejected if alcohol was consumed prior to the accident occurring, it's seen as a contributing factor sadly.

Tigsteroonie

MovingForwards wrote: »

Majority of claims are rejected if alcohol was consumed prior to the accident occurring, it's seen as a contributing factor sadly.

So presumably everybody should stay sober on holiday just in case of some random freak accident that they cannot foresee, such as a car hitting them?

ashp_2

mgdavid wrote: »

how long is 'some time'?
an hour?
12 hours?
next day?
2 days?

That's a question we are awaiting an answer for! I assume it's long enough for the insurance to disregard the results.

ashp_2

MovingForwards wrote: »

Majority of claims are rejected if alcohol was consumed prior to the accident occurring, it's seen as a contributing factor sadly.

You are correct. It's pretty stupid though. People go on holiday to have a good A nice time and relax.
I was reading the financial ombudsmen receive many complaints relating to alcohol related claims. They state on their website they have upheld 53% of complaints in the last year. They give all kind if reasons for the upheld complaints and a few examples where the insurance conditions are not clear enough.

I think the insurer he was insured with is reasonably clear in the terms and conditions. The only exclusions regarding alcohol in this case are "alcohol abuse" and blood alcohol over 200mg/100ml of blood. As the toxicology shows zero they can only reject the claim based on "alcohol abuse". I'm quite sure this term could not be applied in this case!

ashp_2

Tigsteroonie wrote: »

So presumably everybody should stay sober on holiday just in case of some random freak accident that they cannot foresee, such as a car hitting them?

Its crazy really. I for one will be closely checking the terms and conditions regarding this next time I get insurance for a holiday.

I'm quite sure the financial ombudsmen will agree that a few beers and a wine does not constitute "alcohol abuse".

zagfles

ashp wrote: »

Hi,

If anyone has any experience or advice it would be much appreciated.

A family member was hit by a car in Turkey last week. He suffered serious injuries including many broke bones and bleeds on the brain. He is currently on life support.

The insurance company have rejected the claim on the basis his partner said he has been drinking. I believe he had a few beers and a wine which his partner told someone I'm assuming the police so the insurers have this information.We are waiting to see the exact wording of the reason of the rejected claim but my feeling is even if they reject it we can go to the ombudsmen who will hopefully uphold our complaint.

The hospital toxicology shows 0 alcohol as it was not done until sometime after the accident. The insurance terms and conditions state exclusions for "alcohol abuse" and blood alcohol levels above 200mg/110ml of blood.

Personally I can't see how either of the exclusions apply based on the reason they are rejecting the claim.

Any advice would be great.

Thanks.

That's a large amount of alcohol, well over twice the UK drink driving limit, maybe 6 or 7 pints of beer, had he drunk that sort of amount?

And also as above when was the BA level reading taken, if within 12 hours or so would definitely detect some alcohol if he'd had a skinful.

This site is useful to convert drinks and time elapsed into a BA levels

https://www.drinkdriving.org/drink_driving_information_bloodalcoholcontentcalculator.php

zagfles

Tigsteroonie wrote: »

So presumably everybody should stay sober on holiday just in case of some random freak accident that they cannot foresee, such as a car hitting them?

Some policies say "under the influence", even half a pint would have an "influence" so such policies are presumably only suitable for teetotallers. Others say if your judgement is severely impaired or words to that effect. Others like the OP's are more explicit.

ashp_2

zagfles wrote: »

That's a large amount of alcohol, well over twice the UK drink driving limit, maybe 6 or 7 pints of beer, had he drunk that sort of amount?

And also as above when was the BA level reading taken, if within 12 hours or so would definitely detect some alcohol if he'd had a skinful.

This site is useful to convert drinks and time elapsed into a BA levels

https://www.drinkdriving.org/drink_driving_information_bloodalcoholcontentcalculator.php

I believe he had had 3 pints and a glass of wine. His partner was obviously very shocked and drunk herself when she gave this information so I don't know howy can take everything she said as if it's 100% accurate.

We should know when the bloods for toxicology were taken tommorow it's hard to get information from the hospital or insurers to be honest!

Thanks for the link I will have a look.

Ganga

ashp wrote: »

I believe he had had 3 pints and a glass of wine. His partner was obviously very shocked and drunk herself when she gave this information so I don't know howy can take everything she said as if it's 100% accurate.

We should know when the bloods for toxicology were taken tommorow it's hard to get information from the hospital or insurers to be honest!

Thanks for the link I will have a look.

Did the authorities note she was drunk and presumed that her partner would be the same:eek: