Kiwi woman's 'life saved' in Mexico resort but insurer won't pay out

The woman had been dancing at the resort in Cancun when she compained of knee pain. Photo / Grant Bradley

The woman who had to be resuscitated after a night of dancing at a Mexican resort had her travel insurance claim rejected.

Returning to her hotel, the woman reportedly ceased breathing and had to be transferred to hospital in Cancun by ambulance.

However, after receiving what was life-saving care the woman's insurer refused to pay the $12,500 when translated hospital reports which described her as "intoxicated".

But the tourists insisted the case was not as clear cut as it appeared, and it was taken to the independent disputes mediator Financial Services Complaints Ltd.

She and a friend were holidaying in Cancun and had spent the night drinking and dancing, when the woman complained of a pain in her knee.

The tourists had been holidaying in the beach resort of Cancun, Mexico. Photo / Grant Bradley

The woman had recently undergone knee surgery and been prescribed codeine for the pain.

After taking two pills before bed, her friend said the woman "let out a big sigh and stopped breathing."

According to the dispute case the woman started to "turn blue" and had to be given rescue breaths "until hotel medical staff arrived".

Fortunately the woman was resuscitated by ambulance staff and discharged by the hospital her friend's insurer refused to cover the medical costs.

Although the codeine had been prescribed, the insurer took objection to the medical reports which described the woman as "intoxicated" and as having taken codeine.

The woman's friend who took out the policy said that the medical documents were poorly translated, and it was wrong for the insurer to rely on them.

Upon review, the dispute body FSCL found that the insurer had relied on a poor translation of the Spanish-language medical documents.

"There were several mistakes in the translated copy which inaccurately described [the woman's] symptoms and presentation," FSCL said in a review of the case.

However, this was a small victory. While the codeine was a prescribed drug, the FSCL later came down on the side of the insurer who pointed out that the woman's policy did not cover her for claims "arising directly or indirectly from alcohol use."

While the tourists said she had consumed "about four drinks" there was no blood work or blood alcohol levels recorded in the hospital reports, in this case FSCL decided to agree with the insurer that the woman was not covered.

"We agreed with the insurer that [holder]'s policy did not cover [the woman's] medical costs. This was because, she had told us she had been taking codeine for approximately one year without any side-effects. However, on this occasion she had suffered severe side-effects after she had also consumed alcohol.

"In our view, it was most probable that [the woman's] symptoms had been caused by a combination of alcohol and codeine, rather than codeine alone. As we did not have any blood tests from the hospital to tell us what [the woman's] blood alcohol level was, we made our decision on the balance of probabilities, and [the policy holder's] admission."
The complaint was later withdrawn.

The FSCL said that the case should be taken as a warning to travellers to read the policy wording carefully – particularly with regards to alcohol consumption - and keep evidence of potential claims.