A traveller who sought a payout for her partner’s scuba diving-related decompression sickness will not be covered after her insurer’s application of a policy exclusion was deemed fair by a complaints authority.

The complainant’s partner, referred to as JC, undertook two dives on October 17 last year, reaching depths of 39 metres and 29 metres. After the second dive, JC reported feeling unwell and fainted and was later diagnosed with decompression sickness.

JC says he sustained significant medical expenses and had to pay for additional travel costs due to the sickness.  

Mitsui Sumitomo Insurance declined the claim on the basis that JC participated in an activity that was excluded from the policy. It said the policy considered scuba dives deeper than 30 metres as an excluded risk.

JC disputed that the 39-metre dive caused his illness, because he became unwell after the second dive.

But the insurer relied on a doctor’s report to confirm that the depth of a dive, repetition of dives, and correct usage of decompression stops would all serve as risk factors for the illness. JC had done two dives in the days before October 17.

The complainant’s doctor, referred to as Dr MN, agreed that repetitive exposures to decompression stress from dives would correlate with the risk of sustaining the illness.  

Dr MN acknowledged that JC’s dives had been a “moderately provocative” exposure to the risk of illness and said it was “difficult to attribute the onset of symptoms solely to the last dive”.  

“To draw an analogy, just as consuming several shots of tequila incrementally affects one’s state, we cannot pinpoint the last shot as the sole cause of sickness,” Dr MN said.  

“The cumulative effect of repetitive dives underscores the importance of considering the entirety of diving activity when assessing risk factors for [decompression sickness].”  

The claimant said the depth of the dive had only been a risk factor for the illness, but there had been “no conclusive evidence establishing that the dive over 30 metres was the sole cause of JC’s decompression illness”.   

The Australian Financial Complaints Authority ombudsman accepted the insured’s submission but said that the policy did not require the excluded activity to be the cause of the illness, only to have a relationship to the causation.  

They note that both experts agreed that the decompression sickness “likely occurred because of a cumulative effect of dives undertaken that day, and possibly the days before”.  

“In this case, I consider the insurer has met that requirement given that JC had participated in a dive that was over 30 metres, the same day he felt unwell and required medical treatment,” the ombudsman said.

“The complainant has not been able to provide any evidence to suggest that the dive over 30 metres did not cause or contribute to JC’s decompression sickness. The insurer is therefore entitled to decline the claim.”  

Click here for the ruling.