We look at Tom's complaint after his claim for medical expenses incurred on holiday was turned down by his insurer.
While Tom was on holiday in Tenerife, he collapsed and was taken to hospital as an emergency case. He was then repatriated to the UK.
Tom’s insurance company rejected his claim for medical and associated expenses. It cited an exclusion clause in the policy that said it would not meet ‘any claim resulting from being under the influence of or in connection with the use of alcohol or drugs’. Tom felt this was inaccurate and unfair and brought his complaint to us.
Tom said his illness hadn’t been caused by alcohol or drugs, but by a prawn curry he’d eaten. He said he’d suffered a severe stomach upset, breathing difficulties and then collapsed. At this point he was taken to the hospital.
The medical evidence from the doctors who’d treated Tom in Tenerife indicated that his illness had been caused by his severe and chronic alcoholism. They said he’d been bingeing on whisky for five days while on holiday which had led to acute alcoholic pancreatitis. We were satisfied that there was a direct causal link between Tom’s alcohol abuse and his claim.
We rejected his complaint.