Some insurers have been facing some criticism for refusing to pay when a policyholder had been drinking on vacation.
Travel insurance companies in the United Kingdom have been turning down certain claims when they discover that the vacationers who had made them had been drinking alcohol before they suffered from the accident in question.
The Financial Ombudsman Service (FOS) has stated that a “high standard of proof” must be provided.
According to the FOS, the travel insurance company must be able to show quite solidly that the amount of alcohol that was consumed by the policyholder was great enough that it invalidate the policy. This has occurred because the number of claims for this type of insurance coverage that have been refused have been starting to grow. That said, at the same time, the number of claims of this nature that have been reversed by the FOS has also been growing over the last few years.
In 2013, the FOS upheld 53 percent of the complaints that were made with regards to travel insurance claims rejections.
Comparatively, in 2011, it had upheld 42 percent of the complaints. The ombudsman is the authority that settles disputes when a customer and a financial service company are not able to come to an agreement on their own.
The types of insurance claims that are most frequently turned down by insurers are those that involve accidents following the consumption of alcohol. For instance, a tourist’s medical bills were not paid by an insurer in one case when the vacationer had spent the evening at a bar in Sydney, Australia and later fell down some stairs and injured himself. In this accident, the policyholder suffered head injuries and a broken leg.
That said, according to the insurance company explained that it had obtained a witness account from the bar manager that said that a number of drinks had been purchased by that person. Moreover, the doctor stated that he detected the scent of alcohol on the man. Therefore, the travel insurance policy was deemed invalid due to an “alcohol abuse” exclusion clause. That said, the ombudsman determined that there wasn’t any evidence to show how much the policyholder had actually had, as he had purchased drinks for friends, as well, and the smell was from a drink that had spilled. The ombudsman is requiring that a clear definition of alcohol abuse must be provided or the insurer will need to pay the claim and any applicable interest.