British backpacker who broke her neck jumping into pool in Thailand describes her recovery

[Ventenio]

i will give insurance to anyone and cover everything* and it's only 100 baht a week if i get 1 million members.  don't worry, you will be covered if you do anything* and everything* and we care about your money.  

[007 RED]

34 minutes ago, Sheryl said:

P.S. The company was "Insure and Go".

 

But pretty much all travel insurance (and even general health insurance) policies have general exclusions for injuries suffered due to negligence or intoxication. The following is from Insure and Go's list of General Exclusoons (which are not in small print):

 

"8. Any claim arising directly from you, your partner, relative or your travelling companion consuming alcohol"

 

18. Any claim arising from you being involved in any deliberate, malicious, reckless, illegal or criminal act."

 

As soon as any insurance company sees something like diving on the premises of a bar in the middle of the night, red flags would go up and they'd look more closely.

 

While these quotes are specific to Insure and Go you will find similiar in the General Conditions of any policy. None will insure you for injuries that occur as a direct result of being drunk or high nor for injuries that result from recklessness usually defined as something an ordinary prudent person would not do.  Now obviously there is some subjectivity with both of these things. The alcohol consumption must be a direct cause of the injury, simply having consumed alcohol by itself is not a disqualifier. And there is also room for debate around what constitutes deliberate recklessness. 

 

One would assume the family has appealed but either lost or the appeal is still in progress.

 

 

Sheryle....  I'm not sure which of the Insure and Go policies you are quoting from, but the specific backpacker (Bronze) policy is even more specific:

 

https://www.insureandgo.com/media/1336/iag_mf_pw_adv_0918.pdf

 

Quote from page 11, under the heading Reckless or Malicious Acts... Also repeated further in the policy under medical exclusions.

 

"We do not expect you to avoid alcohol consumption on your trips or holidays but we will not cover any claims arising because you have drunk so much alcohol that your judgement is seriously affected and you need to make a claim as a result e.g. any medical claim where in the opinion of the treating doctor, your excessive alcohol consumption has caused or actively contributed to your injury or illness, including but not exclusively having a blood alcohol reading of more than 150mg per 100ml".

 

I totally agree with your observation that their policy is not in small print.  That said, it is 34 pages long of double column script and I doubt very much that most young backpackers will take the time to read through it and fully understand their obligations as part of the contract.

 

It is possible that when the insurer discovered the circumstances of the incident (late night party with alcohol involved), and they subsequently requested her medical notes from the hospital, if her notes indicated that she a high blood alcohol reading at the time of initial admission, this would almost certainly have given them (the insurance company) the 'golden bullet' to deny her claim. 

[torturedsole]

14 hours ago, GinBoy2 said:

... but in general, the cheaper the policy, the more weaseling out clauses will be embedded in the small print, which of course none of us read!

I'm another that has read all 64 pages of my annual travel insurance policy.  

1 hour ago, Sheryl said:

But pretty much all travel insurance (and even general health insurance) policies have general exclusions for injuries suffered due to negligence or intoxication. The following is from Insure and Go's list of General Exclusoons (which are not in small print):

My not inexpensive travel insurance policy also has the standard wording:

Quote

What is not insured?

Any claim as a result of dependency, excessive consumption, or withdrawal of alcohol

Any claim as a result of you being involved in any malicious, reckless, illegal or criminal act

Edited November 30, 2019 by torturedsole

[torturedsole]

Quote

Her sister Georgina Wilson said there had been a sign warning diving was not allowed, but as it was almost midnight and dark, Sophie had not seen it.

"She'd been having the best time of her life," she said.

"Everyone else was doing the same thing at the time and nobody was telling them to stop.

"She wouldn't intentionally do anything to hurt herself."

 

https://www.bbc.com/news/uk-england-leicestershire-46567237

My father used to chastise me 'would you jump off a cliff if your brother did'.  I never had an answer for that.  

 

 

 

[Sheryl]

38 minutes ago, 007 RED said:

 

It is possible that when the insurer discovered the circumstances of the incident (late night party with alcohol involved), and they subsequently requested her medical notes from the hospital, if her notes indicated that she a high blood alcohol reading at the time of initial admission, this would almost certainly have given them (the insurance company) the 'golden bullet' to deny her claim. 

 

Or they might be denying based on the "reckless behavior" provision.

 

That said, if the insured person appeals the decision the burden of proof is on the insurance co to show reasonable grounds for believing the injury was due to recklessness or intoxication.

 

[torturedsole]

5 minutes ago, Sheryl said:

Or they might be denying based on the "reckless behavior" provision.

Quote

Travel insurance company Insure and Go said it would not cover costs as the accident happened as a result of "reckless behaviour".

 

https://www.bbc.com/news/uk-england-leicestershire-46567237

That's exactly why Insure and Go refused the claim.

 

[Grumpy John]

The fine print is to important not to read at least once....if you stick to the one company.  Change company and you read theirs!  Before sickness put an end to scuba diving for me I went through the fine print till I was satisfied I was getting decent coverage.

[natway09]

What the h,,, are you talking about, jumping head first into the shallow end of a swimming pool

is NOT,,, doing it right,,,when will people realize that they have to be a bit responsible for their own actions,,,,she is lucky to be alive we have lost 2 stupid Ozzies in Bali for doing the same thing

[Rod the Sod]

4 hours ago, Sheryl said:

 

Or they might be denying based on the "reckless behavior" provision.

 

That said, if the insured person appeals the decision the burden of proof is on the insurance co to show reasonable grounds for believing the injury was due to recklessness or intoxication.

 

If all else fails, and a UK claimant feels the Insurer has been unfair, they can appeal to the Financial Sservices Ombudsman. He or she will look at all the circumstances and make a decision based upon a "balance of probabilities". It would seem that since the claim remains refused, the Ombudsman, if involved, ruled against her.

 

I know this because in a past life I was Advisor to the Ombudsman on behalf of the industry.

Edited November 30, 2019 by Rod the Sod

[torturedsole]

5 minutes ago, Rod the Sod said:

I know this because in a past life I was Advisor to the Ombudsman on behalf of the industry.

It's been nearly a year and still no mention of successfully overturning the decision and I'm really not surprised.  

 

Saying that, the young lady's charity fundraising efforts are to be commended and wish her all the best in her recovery.  

[Just Weird]

On 11/29/2019 at 3:38 PM, GinBoy2 said:

The worst part of this, given the current level of agitation over insurance, was this girl did all the rights things, had insurance yet the snakes refused to pay up!

 

Insurance companies the world over are really really good at taking your money, yet really really good at finding ways to not pay out. 

That shows how much you really know about insurance companies and their payout record!

 

By the way, she didn't do everything right, if she had done the insurer would have accepted her claim and paid out; she obviously invalidated her policy.

Edited November 30, 2019 by Just Weird

[Just Weird]

On 11/29/2019 at 6:03 PM, Thian said:

What was the reason for them to not pay up? And which company was it? If it's mine i 'll cancel my contract.

Whichever one you're with, or whichever one you change to, will also refuse a claim if you dive drunk into the shallow end of a pool that has signs prohibiting diving! 

[justin case]

if there was a sign at the pool of no diving ... insurance should not pay

[SchopenhauersGhost]

On 11/29/2019 at 2:31 PM, webfact said:

Her family launched a go fund me page to get her home

I knew I'd find this in the story. Another fund me grub.

 

Family and herself can't afford a ticket home but she had the money to travel the world.

 

Maybe one parent should have flown out and both flown back. Genius.

 

Why are these stories always British?

 

Edited November 30, 2019 by SchopenhauersGhost

[torturedsole]

8 minutes ago, justin case said:

if there was a sign at the pool of no diving ... insurance should not pay

The signage is a moot point whether it's there or not.  That wouldn't have been a consideration for the loss adjuster.  

[jerojero]

Sorry for her suffering. But diving into any pool without checking water depth is utter stupidity.  Stupidity results in accidents. Perfect example here.