An Australian man who nearly died after drinking alcohol and taking prescription medication over 13 hours while getting a tattoo during a holiday in Bali has won a claim dispute for medical costs after hotel staff found him collapsed on the floor and he was evacuated back home.

The man, who held a travel insurance policy with Suncorp, spent the day of August 4 last year getting the tattoo, with intermittent breaks.

The tattoo artist finished at around midnight and the man returned to his accommodation. At lunchtime on August 5 he was found in his room by hotel staff and was taken to a local hospital for medical treatment, including intensive care and Suncorp-approved emergency repatriation to Australia for preservation of life.

The man lodged a claim for the medical costs incurred in Bali which was declined.

Suncorp relied on an exclusion stating “we will not pay claims arising from the use or effects of alcohol or drugs” yet the Australian Financial Complaints Authority (AFCA) ruled the insurer failed to provide sufficient evidence to prove its exclusion applied, or sufficient medical evidence to show that the volume of alcohol and medicine taken would result in the man’s condition.

A toxicology report appeared to show traces of methamphetamine and AFCA said that suggested potential for spiking.

“The insurer did not make any further enquiries about this. This is, despite the complainant saying contamination may be a possible explanation for his condition,” AFCA said.

“The insurer has argued the proximate cause of the man’s condition is drugs and/or alcohol. It may well be. However, the insurer has not shown it has sufficient evidence to discharge its onus to establish a valid exclusion.”

AFCA said the man’s “competing theory” that he suffered poisoning or contamination “cannot be dismissed as a possibility”.

The methamphetamine in the man’s pathology results meant a drink may have been spiked, it said.

No evidence was available for the 12 hours after midnight, however Suncorp obtained CCTV footage from the tattoo parlour. All parties agreed it showed the man consuming beer and prescription medication throughout the course of the sitting.

Hospital medical observations included ‘alcohol smell in vomit’ upon admission and the preliminary diagnosis included ‘Ethanol Intoxication’. Records revealed he underwent alcohol tests around 39 hours after leaving the tattoo parlour which found his urine and his blood showed counts were still a little under 0.04%.

“It is evident that at the time of the incident and the insured becoming unconscious, his intoxication level would have been significantly higher,” Suncorp’s Chief Medical Officer said, adding the alcohol count was “very dangerously high.”

“This combined with taking a higher dose than prescribed of his medication was the cause of his medical event and all subsequent costs incurred,” Suncorp’s officer said.

The Chief Medical Officer said it was visible in the CCTV footage that the man was drinking constantly from at least 11am on August 4 last year until midnight when he left the tattoo parlour.

“Upon returning to his accommodation, it is presumed he passed out and remained unconscious until he was discovered by hotel staff that afternoon,” the officer said. “He was then taken to the hospital via ambulance.”

The man said he had not consumed enough alcohol to impair his faculties and he collapsed due to a sudden and unexpected illness that may be caused by poisoning or contamination. He had consumed alcohol and prescription drugs in the past and not had a reaction, he said, and the 12-hour period unaccounted for meant the cause and nature could not be accurately established.

AFCA mentioned a file note at Suncorp from October 2019 discussing “the high value and ongoing nature of this claim,” yet Suncorp’s Chief Medical Officer did not provide a report until May this year.

“It is concerning that the insurer has not provided copies of correspondence or contemporaneous notes of conversations,” AFCA said. “The CMO (Chief Medical Officer) and insurer repeatedly noted the importance of correct and detailed information for such a high quantum claim. In circumstances where there is 12 hours unaccounted for and the man had hypoxia it would have been useful to review an expert’s opinion on whether this could affect metabolising alcohol or influence what the peak of alcohol or drugs was in his system.”

Suncorp “could have had an independent toxicologist provide a report to address issues such as … the effects of mixing alcohol and medication and methamphetamine result. As such, the insurer cannot rely on the exclusion and is required to accept and pay the claim in full,” AFCA said.

See the full ruling here.