Indulging in a glass of wine or two is a part of a relaxing holiday for many. But, in a fresh warning to travellers, the industry watchdog has reminded holidaymakers their insurer may look dimly on indulging too much.
Buried within most travel insurance policies is an alcohol exclusion clause but the wording of each policy differs greatly and can be very vague.
The Financial Ombudsman Service warned travellers this week that excessive drinking could lead to a claim for medical costs being rejected.
Citing the recent case of a man who fell in a nightclub toilet, it also said your insurer should not reject your claim outright on the basis that you had been drinking.
The man in question fell while on holiday and, after experiencing dizzyness and speaking to his insurer, he visited hospital for some medication. His insurer promptly rejected his claim on the grounds he had been drinking.
This decision was overturned by the watchdog and his insurer was ordered to pay the claim plus interest.
However, the ombudsman recently rejected an appeal by a man who fell in his hotel room, as medical records showed “acute alcohol intoxication”.
The ombudsman said: “If someone’s been honest about the fact they’d had a drink, we wouldn’t just assume they’d been drinking to excess – or that their drinking was necessarily the reason for their claim.
“We sometimes need to remind insurers that it’s for them to show that any exclusion applies, rather than for their customer to show that it doesn’t.”
Martyn James from Resolver, the complaints website, said the cheaper the policy the more ambiguous the clause – and the more unfair it is for consumers.
“The whole point of terms and conditions is to let people know where they stand,” he said.
“I’ve spoken to a number of providers who say they don’t apply the exemptions – but then why are they there in the first place? There’s no earthly reason: they’re basically “morality contracts.”
The burden of proof
There have been a number of cases where insurance companies have refused to pay a claim where they believe alcohol has been involved.
But the obligation is on the firm to prove that policyholders were being reckless due to drink, said Mr James, and to do so they need a toxicology report from the hospital or reference to this in the police report.
Insurers have more potential evidence, however: they may check your activity on social media which could reveal how you’ve been behaving on holiday.
This isn’t enough to prove you’ve been reckless, and if the provider turns down a claim because of “Facebook evidence” Mr James said the Financial Ombudsman Service is likely to rule in the policyholder’s favour.
However, he did say it’s in your interest to not to brag about how much you’ve been drinking and to keep your profile locked down.
The ombudsman said it has dealt with a number of cases involving travel insurance and alcohol exclusions where providers have been unclear with their terms or have applied them unfairly to reject a claim.
It said it expects a high standard of proof from insurers to show the exclusion applies, not for the consumer to show it doesn’t. More weight is put on evidence from blood tests than one-off remarks by a doctor.
Telegraph Money contacted a number of insurers to find out how clear their terms are and when they might turn down a claim when alcohol is supposedly involved.
Aviva said it does not cover any claim for death, injury or disability resulting from misuse of alcohol or drugs.
Neither will it pay out if your consumption of alcohol or drugs leads to “immediate or long-term physical or mental harm, or where your judgement is affected causing you to take actions you would not usually take; or any exacerbation of an accepted medical condition.”
This is the case unless drugs have been taken under medical supervision and not for the treatment of alcohol or drug addiction.
Aviva said it assess each claim , including those involving alcohol, “on its own merits”.
It said it would not decline a claim “simply because the customer had been drinking alcohol”. Rather it would assess whether or not the alcohol was, “on the balance of probabilities”, the cause of the incident.
An Aviva spokesman said if a customer was driving abroad having consumed alcohol and crashed, it would work to the legal limit of whatever country they were in. If they were over the relevant limit, it would decline.
But if someone fell over and hurt their ankle and the medical report simply stated they’d been drinking while wearing high heels, it would “conclude (in the absence of evidence to the contrary) that they could have fallen in any case” and would pay the claim.
Direct Line has an exclusion relating to “excessive” alcohol consumption which is said it applies in a “reasonable and proportionate way”.
Under the general exclusions section of the policy relating to deliberate harm and recklessness, Direct Line states it will not pay any claim made “as a result of you drinking so much that your judgement is seriously affected.”
Direct Line said it does not include a blood alcohol level in its policy as “there is no way for a customer to know what their level is or to comprehend what that means in terms of the amount they can drink”.
It also said in many countries, spirits are not measured and controlled as they are here.
LV= outlines its alcohol exclusion on page 15 of its terms and conditions.
It says: “There is no cover for any claim caused by or relating to: you or a travelling companion having drunk enough alcohol to seriously affect your or their judgement and any direct or indirect effect of so much alcohol.
This is also the case for “any medical conditions or symptoms that are directly or indirectly linked to the abuse of alcohol.”
LV= said it doesn’t expect travellers to avoid alcohol on holiday but expects them to be responsible.
It said it would pay a claim, for example, if someone had a few drinks with dinner and fell over on the way back to the hotel, injuring themselves.
However if someone drank heavily all afternoon, which could be proved by witness statements, CCTV footage or a toxicology report, and then broke their legs jumping off a balcony, it would turn it down.
If evidence such as the above wasn’t available LV= would assess the claim using the “evidence at hand”.
Allianz will refuse to pay out if you hurt yourself or deliberately put yourself at risk.
This is the case unless you are trying to save someone’s life.
Allianz said it would pay where the consumption of alcohol was not the key contributing factor to the accident for example if a customer injures themselves at a bar. As the customer has not put themselves in a dangerous situation the claim could still be approved.
However if a customer drank alcohol and acted recklessly, such as diving into a shallow hotel pool, then their claim could be declined.
The Allianz Global Assistance UK claim handlers will use multiple sources of evidence when processing a claim such as witness accounts, hospital reports, police reports and hotel records.
Insure and Go
Insure and Go said: “We do not expect you to avoid alcohol on your trips or holidays, but we will not cover any claims arising because you have drunk so much alcohol that your judgement is seriously affected and you need to make a claim as a result.
For example any medical claim where in the opinion of the treating doctor, excessive alcohol consumption has caused the illness or injury.
On page 14 of Leisure Guard’s 22 page policy it says: “We will not pay anything directly or indirectly caused by…being under the influence of drink or drugs (unless prescribed by a doctor).”
Leisure Guard said if a doctor believes the incident was caused by alcohol then this would be attributed to being under the influence.
Holidaysafe said it cannot provide cover to “you or your close relative or business associate” under the influence of drugs (except those prescribed by your registered doctor, but not when prescribed for treatment of drug addiction).
It will also not pay a claim if your blood alcohol level exceeds 0.19pc – approximately four pints or four 175ml glasses of wine).
It did not specify when claims would not be paid but said that it could potentially turn down claims for medical treatment while abroad as well as cancellation and curtailment claims that can also be attributed to alcohol.
Holidaysafe said when it has “concerns” that claims are related to drink it will speak to the treating doctors and request a copy of all medical records and toxicology reports which will help us determine if there is a connection or not.
The Post Office
Declined to comment.