Insurer not required to cover tourist's alcohol-induced hospitalisation

A traveller who was hospitalised in Thailand due to alcohol intoxication will not be compensated after losing his claims dispute against his insurer.

The complainants, referred to as S and B, held a travel policy for their trip between February 24 and March 10 last year and lodged a claim to cover medical costs and the tours they could not attend.

The travellers said they went to a bar at 8:30pm on February 26, where they each drank “three bottles of beer and two shots of tequila”.

B reported feeling unwell around 11:45pm and had to be carried to his room by security upon returning to the hotel. S asked the hotel to call an ambulance after he began to foam from his mouth and suffer breathing issues.

S contacted their insurer, Zurich, while the ambulance was on its way, informing it that B was in “a very bad situation” due to what she believed had been ethanol poisoning. She later told the insurer that he had been “drinking tequila all night at a bar” and was now being transferred to a hospital.

Zurich contacted the hospital several times throughout the night to receive updates on the man’s condition. The treating medical officer said alcohol poisoning was a likely diagnosis but did not rule out the influence of other drugs. A test result showed his recorded blood alcohol concentration (BAC) to be 0.193%.

S contacted Zurich on March 2 and 3 with a toxicology report that showed morphine in B’s system, which she said had not been provided by the hospital. She alleged that B’s drink had been “spiked with liquid morphine”, causing his body to suffer an extreme reaction.

An insurer-appointed forensic medical consultant noted that the blood sample for the BAC recording was taken at 1:15pm the next day. They hypothesised that the complainant drank alcohol equivalent to “19 to 30 bottles of beer or 17 to 27 shots of tequila” between 7 and 11pm.

The medical consultant said that the recorded BAC level “could not possibly be explained” by the claimants’ stated amount of alcohol consumption. They also rejected the idea that B’s drink could have been spiked with morphine, given the “bitter, unpleasant taste [which] would normally be difficult to ignore”.

The complainants told the Australian Financial Complaints Authority (AFCA) that the blood sample had been taken at 2:35am, not 1:15pm, as they had been discharged from the hospital at around 8am.

The medical consultant said that based on the revised time, B drank an alcohol amount “equivalent to 14 to 19 bottles of beer, or 13 to 17 tequila shots,” which would have accounted for significant alcohol poisoning. They said it would have been inconceivable for him to drink morphine and not notice unless he was “already profoundly intoxicated”.

The claimants argued that the blood sample may have fermented, which would have caused its concentration to increase between when it had been taken and when it was tested.

AFCA acknowledged that the test could have been compromised but said there was no evidence to prove it was inaccurate.

It said that the recorded BAC of 0.193% had been consistent with symptoms reported by S when she first called the insurer rather than the amount later suggested.

“Having considered the information provided by both parties, I am satisfied B’s consumption of alcohol was the main or only cause of his hospitalisation,” AFCA said.

“I am not satisfied B’s consumption of morphine, or a related chemical contributed to his hospitalisation.”

The complainants argued that Zurich breached section 54 of the Insurance Contracts Act 1984 (cth), which limits an insurer’s ability to deny a claim based on the policyholder’s actions.

AFCA said that the insured’s actions in drinking the alcohol were found to have contributed to the loss and that Zurich was entitled to decline the claim.

“The policy excludes cover for claims arising from an insured person drinking too much alcohol,” AFCA said.

“Section 54 does not prohibit the insurer from applying this exclusion. The insurer is entitled to deny the claim.”

Click here for the ruling.