Insurers are using small print to wrongly turn down claims from holidaymakers who have had an accident.
They include terms such as "alcohol abuse" or "alcoholic" in their exclusions but then refuse claims from people who may only have had a drink or two.
That’s wrong, reckons the Financial Ombudsman Service which has revealed today that it upheld 53 per cent of cases against travel insurers last year. Its figures suggest the problem is getting worse after climbing from just 42 per cent of cases being upheld in 2011.
“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,” the Ombudsman reported.
It has today published the story of Mr J, who was forced to turn to the Ombudsman for help after his insurer refused to pay out for medical bills incurred when he fell down stairs in a bar in Sydney.
He broke a leg and suffered severe head trauma and was taken to a hospital where he had emergency surgery to remove a potentially life-threatening blood clot.
But his insurer said it had evidence that he’d drunk an excessive amount of alcohol – and blamed his fall on the amount he’d had to drink.
The Ombudsman ruled the insurer didn’t have enough evidence to back up its rejection of his claim and told it to pay up, with interest.
“It is up to an insurer to show that an exclusion applies, not for its customer to show that it doesn’t,” the Ombudsman said.
“Each year we see the same issues crop up time and again within travel insurance complaints. Travel insurance policies exclude cover for events that happen after excessive alcohol consumption, but that doesn’t mean holidaymakers will only be covered if they don’t drink at all.”Reuse content