Travel Insurance claim rejected (Alcohol)

ashp_2

zagfles wrote: »

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.

I have been on lots of holidays over the years but never looked into this specifically. I like a drink on holiday so I will in future!

I feel this insurers exclusions are quite clear. It does say under the influence as an exclusion but it has next to it in brackets the alcohol levels as mentioned above. I'm not sure how they could define alcohol abuse but have seen a case study from the financial ombudsmen where a claim was rejected on this term where someone who had not drunk much had a claim rejected on this basis and the ombudsmen checked the GP records for anything to do with alcohol and found nothing so upheld the complaint!

ashp_2

Ganga wrote: »

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

It has not been mentioned as far as I know but she was definietley not stupidly drunk as far as i know anyway and was obviously hysterical at the time of the accident when speaking to the authorities.

sheramber

The circumstances of the accident will also be relevant as to whether his judgement was affected.

Did he walk into the road without looking?

Did he stagger into the road?

Was the car driver driving dangerously or speeding?

NoodleDoodleMan

The circumstances of the accident will also be relevant as to whether his judgement was affected.

Absolutely, in every case.

budgetflyer

Getting Turkish police to suggest it was the drivers fault and not the tourist will be a challenge I reckon.

NoodleDoodleMan

The Turkish driver may be totally blameless, and the British national is at fault - or vice versa, or both parties contribute to the accident, who knows ?


The defense case of the holidaymaker is compromised should the following admission be true

"The insurance company have rejected the claim on the basis his partner said he has been drinking"

Let's hope he recovers fully and it turns out favourably.

ashp_2

Thanks for the replies.

Just wanted to update this. The reason for the rejected claim is alcohol related. We are not sure of the exact reason yet. We should hopefully have the written reason from the insurance company tomorrow. The only exclusions in the terms as i mentioned above are "alcohol abuse" and "alcohol above 200mg/100ml blood.

It seems the insurance company has rejected the toxicology report based on the hospital saying they didn't do it initially then saying they did. We now have a copy of the toxicology report which shows the blood was taken at 00:07 which is a couple of hours after the accident and shows 14mg/100ml blood (around 14 times lower than the exclusion limit!)
It seems they are rejecting the claim based on his what his partner said he had drunk and completely disregarding the toxicology report from the hospital!

Seems crazy to me but we will hopefully have a letter from the insurer tomorrow and we can then begin the process of contesting the decision which we must do before taking the case to the financial ombudsmen.

zagfles

ashp wrote: »

Thanks for the replies.

Just wanted to update this. The reason for the rejected claim is alcohol related. We are not sure of the exact reason yet. We should hopefully have the written reason from the insurance company tomorrow. The only exclusions in the terms as i mentioned above are "alcohol abuse" and "alcohol above 200mg/100ml blood.

It seems the insurance company has rejected the toxicology report based on the hospital saying they didn't do it initially then saying they did. We now have a copy of the toxicology report which shows the blood was taken at 00:07 which is a couple of hours after the accident and shows 14mg/100ml blood (around 14 times lower than the exclusion limit!)
It seems they are rejecting the claim based on his what his partner said he had drunk and completely disregarding the toxicology report from the hospital!

Seems crazy to me but we will hopefully have a letter from the insurer tomorrow and we can then begin the process of contesting the decision which we must do before taking the case to the financial ombudsmen.

That's lower than the limit to fly a plane!! Completely ridiculous to reject the claim with that tiny amount of alcohol, even allowing for the couple of elapsed hours. Unless they are suggesting he has a super-human liver that can process alcohol 100 times faster than everyone else :rotfl:

ashp_2

zagfles wrote: »

That's lower than the limit to fly a plane!! Completely ridiculous to reject the claim with that tiny amount of alcohol, even allowing for the couple of elapsed hours. Unless they are suggesting he has a super-human liver that can process alcohol 100 times faster than everyone else :rotfl:

I don't know how they can reject evidence from a laboratory because they had conflicting information from the hospital regarding if the blood tests had been done or not! The report clearly shows the times the bloods were sent to the labs and the times it was tested etc.

The insurers said yesterday they would not pay out because they wanted a report from the ambulance staff and the hospital said they would only give this report to family. I spoke to the hospital and they said they have supplied everything the insurers have requested :question:

my feeling is they are trying any way possible to get out of paying. I'm sure the ombudsmen will agree that the toxicology report is indisputable and rule in our favour if it comes to that.

I am confident they will pay out one way or another I just find it incredible that they would put a family through this to try and get away from paying.