A man who fell and hit his head after “drinking all night” was properly refused travel insurance, an ombudsman has said.
However, another man who spent above a night club in the baths after a drink, while on a vacation are covered.
The cases have been submitted by the financial intermediary in order to highlight the small print and rules around the travel insurance disputes.
It was said that tourists should not be expected to have been sober to win a claim.
The burden of proof was on the insurer to prove that drinking too much was the culprit.
Free drink for the holidays?
Many insurance companies have a clause in travel insurance policies which means cover is rejected if the holder of the policy the accident was caused by excess alcohol.
If the insurer refuses to pay for medical expenses, the customer may appeal to the financial ombudsman to make an independent decision.
The organization examined nearly 900 travel insurance complaints in the last three months of 2017, in order to highlight some of the issues involved.
“Insurers can choose not to pay if you believe that someone has been drinking in excess, although this does not necessarily mean that the vacation must be totally free of alcohol,” said chief financial ombudsman Caroline Wayman.
“In each case, we will have to carefully weigh all the evidence to decide, on balance, if the insurer has the right to call.
“It is encouraging that, in comparison with the past years, we are in general the defense less travel insurance complaints. This suggests, although there is still clearly work to be done, many insurance companies are increasingly treating their customers fair and reasonable manner”.
In the nightclub case, the ombudsman told the insurer to pay up for a man of cost of medical treatments. The man said that he had been drinking, but that he was not drunk at the time.
The ombudsman decided that, on balance, I do not think that the evidence showed that it was more likely than not that the excessive consumption of alcohol caused your accident.
However, in another highlighted case, an insurer sends the ombudsman’s medical records show that the emergency room physician diagnosed the injured man with “acute alcohol intoxication”.
These records also said that he had not been able to sign a form when he arrived at the hospital, and other records made during his trip in the ambulance suggested that he had said that he had been drinking all night.’Out of control’
The ombudsman said the figures show that more than 21.9 million people in the uk was in the summer holidays abroad in the year 2017.
In general there were 3,000 complaints about travel insurance the ombudsman in the past year. It ruled that the insurers had not treated their customers fairly in nearly four out of every 10 cases.
A spokesman for the insurance Association of British (ABI) said: “Travel insurance is a lifesaver for people who have problems abroad, with insurers paying over a million pounds of weight each day.
“More than half of the funds for emergency medical treatment to persons who have been severely injured or have fallen gravely ill. As with any insurance, customers have the responsibility not to behave inappropriately.
“The insurance companies know that people are probably going to want to drink alcohol while you are on vacation and they don’t expect you to stay sober all the time, but there is a danger of invalidating your cover if you drink too much of that makes you act dangerously, or means that you are out of control”.
In general, the financial intermediary managed 81,647 new cases in a variety of subjects, between October and December. The majority (54%) were complaints about the mis-selling of payment protection insurance.