Last fall, the CBC brought widespread public attention to the case of a Canadian who, while visiting relatives in the US, fell down a flight of stairs after drinking alcohol, required treatment in hospital for a brain injury, and ultimately had his travel insurance claim denied, purportedly, because he had too much to drink.
The response from some in the media was mainly critical of the insurer for not having “warned” the traveller ahead of time that an accident caused by alcohol impairment could invalidate his coverage
That should not have come as a surprise to anyone as every travel insurance policy issued in Canada excludes coverage for medical emergencies caused or contributed to by alcohol—or other intoxicants—just as it excludes coverage for known unstable pre-existing conditions, terminal diagnoses, and failure by those insured to disclose their true medical conditions when applying for products. Travel insurance was never designed to be a substitute for comprehensive, tax-funded, provincial government health insurance.
And every travel insurance policy I have ever seen has clear “warnings” upfront that the purchaser should read his or her policy as it contains exclusions. Reading one’s policy is not a suggestion, it’s a responsibility.
Insurers struggle with definitions
What has not yet been achieved by travel insurers is a uniform and consistent definition of what constitutes the point at which alcohol (or, for that matter, any other intoxicant) becomes a factor in denying a claim. Definitions vary … a lot. It would help to have more uniform definitions.
One such definition explains that the insurer will not pay “for any loss, injury or death related to intoxication, the misuse, abuse, overdose of, or chemical dependence on medication, drugs, alcohol or other intoxicant.”
OK: so what is “misuse,” what is “abuse,” and how do you measure “intoxication?” Drinking alcohol is something most adult Canadians enjoy and do responsibly. But at what level does it become misuse? What is safe and modest consumption by one drinker might be total misuse or abuse by another.
In Canada it is a criminal offence to drive with a blood alcohol concentration (BAC) of 0.08, or 80 milligrams of alcohol in 100 milliliters of blood. True, there are people who can be quite impaired at even less than 0.08, while others can be in perfect control. But there have to be some measures to apply over whole populations to help establish acceptable guidelines and keep them in the public consciousness.
There are some travel insurance policies that use BAC to define misuse or abuse as a factor in denying claims. But most use other guidelines that are usually designed to describe levels of impairment. One insurer explains that it will not pay for losses if “evidence supports that the medical condition causing the loss was in any way contributed to by: your abuse of alcohol…” There again is the word “abuse,” loaded with subjectivity. What if the loss was caused by an 18-year-old high school graduate drinking his first beer? Hardly a seasoned “abuser,” but potentially lethal all the same.
One of the most even-handed, balanced, and non-judgmental definitions of how the use of alcohol relates to loss is one by a prominent Canadian insurer whose policy says it will not pay for “loss, death or injury, if at the time of the loss, death or injury, evidence supports that you were affected by, or the medical condition causing the loss was in any way contributed to, the use of alcohol, prohibited drugs, or another intoxicant.” (We’ll get to the issue of other drugs in a forthcoming article.)
Bottom line: that the loss was “in any way affected by the use of alcohol.” Simple, clear, and the best warning an applicant for insurance can have when purchasing a policy.
Travel insurers are not anti-alcohol, or against their clients enjoying themselves while they travel, vacation, experience new places and cultures.
But their products have limitations and exclusions for behaviours that are just as high risk whether they occur abroad or down the street from their own homes.
Reading the policy will show that.
Preparing for your next trip? Start browsing your travel insurance options.