AIBU to think travel insurance should cover drunk injuries?

[FabiaCostello]

www.bbc.co.uk/news/business-42878841

How can insurers know someone’s too drunk?

FabiaCostello and with travel insurance it depends how you got that head injury. For example what if you where taking part in an extreme watersports activity not included on your policy?

it's pretty clear that the insurer needs to provide evidence that being too drunk caused the injury - like the patient being too drunk to sign his name.

"I wasn't drunk, I was never asked to even sign a form"
"My hand was hurting so I couldn't sign a form"
"I did sign a form, that is a different one"

(I actually agree with many of the comments here that people drinking themselves into oblivion is a huge issue in its own right, causing way too many nasty injuries and needless deaths. I just don't think it can be insured against in this way.)

shotsfired did you read the ombudsman's summary?

They sent us medical records showing the emergency doctor diagnosed Mr N with “acute alcohol intoxication” – alcohol poisoning. These records also said Mr N hadn’t been able to sign a form when he arrived at the hospital – with the reason given that he was “under the influence of an intoxicant”. Other records made during his trip in the ambulance suggested he’d said he’d been drinking all night.

There are other cases listed they found in the claimant's favour, but I think the evidence here was sufficient to show it was caused by excessive alcohol.

But drinking is only one factor affecting risk of accident or illness when on holiday and I know major ones such as participating in dangerous activities are already risk rated. However what about the chances of having an accident at a water park or swimming , why should I cover that when all I want to do is sit on a sunbed? or the risks from doing a lot of waking on roads where there are no pavements or visiting monuments with lots of stairs and uneven surfaces?

Was your treatment covered by insurance op? Did you agree to being discharge? There is a difference between being subject to an accident involving a 3rd party and being so drunk you make irrational decisions such as fights, jumping from balconies, undertake risky activities while under the influence. Some policies won't cover skiing after drinking for example.

"The burden of proof was on the insurer to prove that too much drinking was to blame."

That is the key statement and not completely unreasonable. If you use unregulated Quad bikes etc then you also aren't covered.

I do wonder how this will pan out once out of the EU. Young Adults go on Malaga/Kavos and older, Bulgaria, type holidays to get completely wasted. They could end up stuck out there.

Sometimes accidents are caused by other people and you should still be treated even if completely off your face.

I'm glad that my Adult children are out of that phase.

"If you swill until you can't stand then you are a dirty skank who needs to take responsibility."

If you are under 25 then you are just a bit stupid, nothing dirty about it.

"Those so pissed they think they can fly between balconies should not be insured. And should pay at a and e."

Teen and just out-of-teens, lads make stupid decisions, especially in groups, they don't deserve to die or end up permanently disabled because of a lack of care, across the EU anyway.

An extra policy could be an idea, similar to what we have to extreme sports/activities, you'll get some insurers offering it for free.

I think that we have to bear in mind that Insurance companies aren't going bankrupt because of drinkers before we take a tough stance. Some resorts advertise themselves as places to go wild and wouldn't exist otherwise.

I also think that if anyone is up for criticism it is all the Tattoo parlours that are happy to tattoo completely wasted people, who then often need antibiotics/dressings.

He has a drink, with the amount he drinks (despite not being drunk) on holiday would he then be perfectly fit to drive a car?

Well that's beside the point as he wouldn't drive a car after having a drink anyway. Why should he pay more because he's had a couple of pints? You'd never know it if you spoke to him. And what happens if something happens to him that's not his fault? For example I'm driving a car and someone hits us. Wouldn't he be treated?

What are they going to to, breathalise everyone before deciding on whether to treat them? And what would the tolerance level be? Zero wouldn't work as some things contain alcohol and would skew the results.

@Hereward1332 shotsfired did you read the ombudsman's summary

I accept that in that case the "emergency doctor diagnosed Mr N with “acute alcohol intoxication”". But that is one case of one person at one time. I am talking about how you implement such a policy for everyone on holiday everywhere, every day. The "excuses" I listed were just a few off the top of my head.

It was in Spain so I used my European Health Insurance card - didn’t have a separate policy.

Like the case study though, my medical notes said I was very drunk (they didn’t do any tests). In fact, I had severe concussion and a skull fracture. It seems I did sign the discharge form but I don’t remember it.

You went abroad with no travel insurance? Count yourself lucky that's all that happened.

Uninsured medevac , alive or dead, usually means someone has to sell a house.

I totally agree with premiums for risky sports, not being covered if you’re doing something illegal etc, but the opinion of one doctor doesn’t seem like sufficient evidence to me.

I do actually have year-round cover, but didn’t claim on it as I had my EHIC card. I gave that at the hospital and they didn’t ask for anything else.

The Ombudsman's point is that the onus is on the insurer to show it has sufficient evidence to apply the exclusion. It has to show that there was impairment due to alcohol and that the accident was caused by the impairment. In the absence of this evidence, an insurer cannot avoid liability. They cannot refuse to pay as you had a glass of wine earlier, and I imagine the evidence will be hard to find in the majority of cases, but they are saying that where it exists, they do not have to pay out.

In my case then, if I’d been using a private policy, the insurer could have refused to pay out, because the discharge notes basically said I was drunk and had a bruise.

Presumably after I’d been properly diagnosed in the UK, I’d have had to sue the Spanish hospital for misdiagnosis to get the money back?

In your case I would imagine the insurer would have to show that the accident happened because you were drunk. You say someone pushed you - in that case you could have been stone cold sober and still would have had the same injury, so I don't think they could have reasonably rejected your claim.

That doesn't mean they wouldn't try of course, but that's why there is an ombudsman.

Hmm. But Mr N could have tripped whilst sober, and said his friends would back up that he wasn’t excessively drunk. My medical notes said nothing about the accident itself, just that I was drunk. It was late and I’d been at a festival with lots of drunk tourists, in a city with an unveiled contempt for tourists, so I don’t think the doctor was prepared to consider I was anything more than a drunk fool.

I think it’s quite scary actually. I think it’ll lead people to lie about whether they’ve been drinking (or taking drugs) in fear of invalidating their insurance.

As Birds says, I expect there’ll be serious repercussions with young people when we leave the EU.

I would expect blood tests to be used in this kind of situation to show how drunk a person was - similarly to how blood tests are used in court when someone is accused of drunk driving.

I thought that skowvegas but then, what if, for instance, someone is really drunk then trips over a broken paving slab? A sober person could also have tripped, though would be more likely to have seen it. Or drunkenly wanders down a dark alley which they’d have avoided sober, and gets mugged?

Again I think it comes down to what caused the accident. Was it the drunkenness or was there another factor?

Blood tests show person is very drunk, person leaps off balcony into pool - deny claim.

Blood tests show person is very drunk, person trips on paving slab or gets mugged - do not deny claim.

Hereward the person who pushed me was a friend (it was an accident!) so presumably there’s a personal injury claim there between our two insurance companies?

Obviously this is all hypothetical because I didn’t pay anything (good old EU/NHS) but it seems this ruling could signify the start of a lot of claims being rejected.

But the case study - Mr N - tripped and fell in his hotel room. He wasn’t doing anything outrageous but still came to have.

Is there a medically agreed blood alcohol level, past which a person is drunk and deemed at risk? If so, I expect this would be very low, like the driving limit.

*still came to harm

I’m not drunk honest