The story
The party
Amy went to Thailand with her friends Toni and Megan to celebrate New Year. On New Year’s Eve Amy, Toni and Megan began celebrating in their hotel room. Between about 6.30 and 8pm Amy drank two vodka and sodas before travelling by taxi to the New Year party venue. On arrival at the party at 9pm Amy bought an ‘ice bucket’. An ice bucket is a child’s sandcastle bucket full of ice, 200mls of vodka, a can of red bull and a can of lemonade. After drinking the ice bucket, at about 10pm, Amy went back to the bar and bought a vodka, lime and soda. Amy took a couple of sips and collapsed. Toni and Megan carried Amy to a nearby hospital.
First hospital admission
Amy could not remember anything after collapsing in the bar. Toni and Megan said Amy was vomiting, falling in and out of consciousness, foaming at the mouth and screaming that she could not see or hear anything. The emergency room doctor gave Amy intravenous fluids. After two hours Amy had improved, was discharged and returned to her hotel with Toni and Megan.
By about 3.30am on 1 January Amy was back at the hotel but she was still vomiting, drowsy and unrousable at times. Toni and Megan were worried. Toni’s mother, Jane, was a doctor, so Toni called her for help. Jane was concerned Amy might be suffering from pesticide poisoning, so called the New Zealand poisons centre. On the poisons centre’s advice Jane called Toni and told her to take Amy back to hospital.
Second hospital admission
Amy was admitted to the same hospital at about 7am. Jane spoke to Toni at about 9.30am. Amy’s pulse was slow, she had tiny pupils, was unable to open her eyes and was responding to questions by squeezing a hand.
When Amy’s travel insurer spoke to Amy’s doctor in Thailand he said the cause of her illness was most likely either mushroom or pesticide poisoning. The doctor said the hospital did not have the facilities to test for pesticide poisoning, but thought the test would be inconclusive because the poisoning occurred the previous night, and had most likely moved through Amy’s body. The hospital did test for alcohol, but the doctor did not have the results of the test when he spoke to the travel insurer.
Third hospital admission
At about 4pm on 1 January Amy transferred to another hospital. By this time Amy said she was in excruciating pain, her stomach hurt, her skin was itchy, her face puffy and eyes sore. She now also had diarrhoea. The hospital tested for pesticide poisoning, but the results were inconclusive. Amy remained in hospital until 3 January when the diarrhoea was under control. The doctor’s notes recorded his opinion that gastroenteritis was the cause.
Amy continued on her three week holiday in Thailand, but said her stomach was sensitive and diarrhoea continued for the rest of the trip.
Dispute
When Amy returned to New Zealand she submitted a claim to her travel insurer for medical expenses of NZD4,025. The travel insurer declined the claim because Amy’s blood alcohol test returned a high reading of 199mg. The travel insurer referred to a clause in the policy excluding cover where the insured is under the influence of alcohol.
Amy acknowledged she had been drinking, but argued she was not admitted to hospital because of the amount of alcohol she had consumed. Jane supported her claim saying Amy’s symptoms could not be explained by alcohol, but were more consistent with pesticide poisoning.
FSCL’s review
This case was difficult to assess because the medical opinion was unclear about the exact cause of Amy’s hospital admission. There was no doubt Amy had consumed a considerable amount of alcohol in a short space of time, but for the policy exclusion to apply alcohol must be the proximate cause of the loss. The burden of proving the proximate cause rests with the insurer.
It was not possible to say that excess alcohol consumption was the proximate cause of Amy’s hospital admission. It may have been gastroenteritis, some kind of poisoning or excess alcohol, or a combination of all three. However we were satisfied excess alcohol contributed to Amy’s general state of severe unwellness requiring hospital admission and treatment.
Outcome
We considered a fair outcome in all the circumstances would be for the insurer to contribute $2,000 to Amy’s medical expenses. Both parties accepted our proposed recommendation and the complaint was resolved on this basis.
Lesson – don’t drink and claim!
Consumers should be aware that travel insurance policies include a general exclusion for any claim where the insured was under the influence of alcohol and/or an intoxicating drug at the time of the event giving rise to the claim.
