Dana travelled to the United States with her 14-year-old son, Seth. During the flight to California, Seth drank half a bottle of tequila, and took some sleeping tablets. Seth became very ill on the flight and was taken by ambulance to hospital.
Seth was medically cleared and Dana and Seth then travelled on to Texas. After arriving in Texas, Dana discovered Seth had ingested 1150ml of cough medicine and 9 sleeping pills. Seth was hospitalised, assessed by a psychiatrist and released the following day.
Dana submitted a claim to her travel insurer for the medical expenses incurred and other associated costs of changing some travel arrangements (about $3,700 USD).
The insurer’s reasons for declining the claim
The insurer said the circumstances of the claim meant the insuring clause (the clause providing cover), was not satisfied. The costs had to arise from a sickness or an injury. The claim did not arise from Seth having a sickness, and the definition of injury meant the injury had to be accidental. The insurer said Seth’s consumption of the alcohol and other substances was not accidental.
In addition, the insurer said an exclusion clause saying there was no cover where the claim arose from intentional self-injury, or any illegal act by an insured person, also applied to exclude cover.
The insurer said the costs incurred in California arose from Seth consuming alcohol on the flight from New Zealand, which was an illegal act (because Seth was below the legal drinking age). The insurer also said both sets of costs (in California and Texas), were because of Seth’s substance abuse, which was an intentional act of self-injury.
The insurer pointed to Seth’s medical notes which recorded that he told Dana he was not trying to kill himself, rather, he had researched on the internet the number of sleeping tablets he could take without killing himself. It was also recorded that Dana was worried about Seth and thought he might be suicidal.
In addition, the insurer said the act of consuming the substances was a conscious decision by Seth, and so it had to conclude that the self-injury was intentional and that Seth was aware of the likely consequences of his actions. Lastly, because Seth had been hospitalised in California he must have been aware that consuming substances in the same manner might lead to him going to hospital again.
Dana accepted that the costs in California could not be covered because they arose from Seth’s illegal act of consuming alcohol. However, Dana thought that the costs incurred in Texas should be covered because Seth did not consume alcohol there, and she did not believe Seth would have known the consequences of his actions.
Dana complained to FSCL.
We agreed the insuring clause had not been met. Although the medical notes showed that Seth’s actions could have resulted in him suffering an accidental injury, the insuring clause spoke to accidental cause, not an accidental result. We did not accept that Seth accidentally consumed the substances. This meant there was no cover for the claim.
We also looked at whether the exclusion clause applied. Dana argued that adolescents understand the risks of taking drugs but their brain development means they do not possess the ability to decide not to take such risks. We did not accept this because Seth had Googled the amount of the substances he could consume without killing himself.
Seth said his reasons for taking the substances were to ‘get high’, to ‘feel good’, because ‘being sober is boring’, to ‘experience psychedelic properties’, to ‘embrace life’, and described feeling ‘out of it’. Dana had also said to the doctors that Seth wanted to ‘escape from his problems momentarily’. It appeared Seth intentionally wanted to alter his state of mind to the point where he was not fully conscious of what he was doing. We said this constituted him intending to injure and harm himself.
We also agreed that after being hospitalised in California, Seth must have been aware he may have to go back to hospital again if he took the substances in the same way again. Moreover, we were of the view that Seth had the capacity to understand that it is very serious to be taken to hospital, and that he must have hurt himself to a certain degree in California, and may again in Texas.
Although she did not agree with our decision, Dana did not have any further information to provide us in support of her view and we discontinued the investigation of the complaint.
This was a very unfortunate case, and we were very sorry that Dana and Seth had this experience. However, we must consider the insurance policy’s terms and conditions to see whether it provides cover in the particular circumstances of a claim and in Dana’s case, the policy did not provide cover for her claim.