CONSUMER: Couple face fight to claim on holiday insurance after Australia accident after firm says cover is not valid after a glass of wine

For Cosham couple Maureen and Eric Ambrose, 2017 was set to be an unforgettable year.

Thursday, 22nd March 2018, 6:00 am
Updated Thursday, 22nd March 2018, 3:10 pm
Good times - but alcohol consumption can be a factor in holiday insurance claims

They’d been looking forward to the holiday of a lifetime meeting up with their son Peter and the family in Sydney, Australia.

But when Maureen accidentally tripped on the stairs in a harbour restaurant during a night out together breaking an ankle and suffering spinal and head injuries, her insurance company dealt her an indelible blow.

They accused her of excessive alcohol consumption and refused to meet her claim of more than £17,500 for emergency hospital treatment.

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Maureen had been rushed to hospital and had an emergency operation to remove a life-threatening blood clot. It was six weeks before she was fit enough to travel back home.

The couple’s holiday nightmare began last September, just five days into the family get-together.

The 68-year-old retired shop assistant explained: ‘We’d had a lovely day out with the grandchildren at Toronga Zoo just across the harbour, and returned to a circular quay restaurant close to the opera house for our evening meal.

‘We were there for almost two hours, enjoying the magnificent waterside view while sharing a bottle of wine with Peter and his wife Charlotte over dinner.

‘When I went for a toilet break I missed my footing and fell backwards on a rather awkward bend in a short flight of stairs.

‘The next thing I remember was the trauma of waking up in hospital connected up to a battery of monitors and a distraught Eric by the bedside.

‘I can’t fault the excellent medical treatment and care I received, but was in shock in my hospital bed for weeks after the terrifying experience.’

Instead of a happy reunion all the family were left sick with worry.

Worse was to come. Maureen’s passport was held by the Sydney hospital authorities while a stunned Eric got onto their HSBC bank insurance to alert them to the accident claim.

Eric’s initial conversation with the insurer went well, but he was gutted when the hospital’s administration department told his son Peter a few days later that the claim had been thrown out.

Peter agreed to act as guarantor to foot the final bill, while Eric’s plea with the bank to temporarily raise the credit limit on his card to cover the unexpected expense was also turned down.

On their arrival home in mid-November Eric felt he was banging his head against a brick wall with the insurance company when he pleaded with them to reconsider the circumstances of Maureen’s accident.

At his wits’ end with worry he asked Streetwise to intervene on their behalf. We quickly came to the conclusion the insurer had been unreasonable and Maureen had been treated unfairly.

Like many holidaymakers they’d been caught out with inappropriate standard template holiday insurance sold as an added extra to millions of bank card customers.

Streetwise took the view that if a consumer makes a claim on their holiday insurance it’s for the insurer to prove they’d imbibed to excess, and not just had a modest tipple with a meal.

Maureen’s holiday mishap wasn’t by any means unusual.

The Financial Ombudsman Service (FOS), which adjudicates on consumer complaints, had previously warned that insurers were increasingly accusing customers of ‘alcohol abuse’ in order to wriggle out of paying accident claims.

The FOS said they’d received more than 3,000 complaints about holiday insurance in 2017 and alcohol exclusions were a common feature of travel insurance policies.

A FOS spokesperson confirmed that if an insurer thinks someone’s accident was down to excessive alcohol consumption, it may not pay out.

Their adjudication statistics confirmed the extent of the problem.

The ombudsman ruled in favour of the claimant in four in ten cases, deciding the insurer had unreasonably discriminated against their customer by jumping to conclusions about their alcohol consumption.

Armed with this background information Streetwise agreed to ride to the rescue, and help the couple draft a complaint to the FOS about the dismissive way Maureen’s serious accident claim had been handled.

We asserted Maureen’s right to be considered unblameworthy unless the insurer could prove she’d been drinking excessively. It wasn’t for her to prove her innocence.

Within weeks of submitting the complaint to the FOS much better news was on its way.

The ombudsman had come down firmly on Maureen’s side and ordered the claim be paid in full.

An ombudsman spokesperson said: ‘It’s up to the insurer to show that their alcohol exclusion applies in any specific case, not for their customer to show that it doesn’t.

‘In each case we look at, we carefully weigh up the evidence to decide, on balance whether the insurer has made the right call.

‘Just because excessive drinking invalidates a claim, that shouldn’t mean that only teetotal holidaymakers are covered.’

The couple reacted with unbridled relief that they weren’t going to take a massive hit to their finances.

Maureen said: ‘I just can’t thank you enough for the sound advice and help you gave us.

‘We were in the depths of despair not knowing which way to turn and how we could afford to pay our son back for settling the hospital bills.

‘We’re meeting up with the family again in August, but this time they’re planning to visit us and make this year our reunion to remember.’