A traveller who tripped on a cobblestone street and hurt his back after drinking alcohol has lost his bid to have a business class flight home covered by his insurer.

But Tokio Marine & Nichido Fire Insurance has been told to cover cancellation costs after the man’s holiday ended early.

On July 4 last year, the traveller went to a hospital in Italy and was diagnosed with a fractured C2 vertebrae and head trauma. His discharge summary stated he suffered temporary loss of consciousness after a fall while under the influence of alcohol.

He was advised to wear a cervical collar and prescribed medication for moderate to severe pain.

A claim dispute before the Australian Financial Complaints Authority heard his prepaid travel itinerary included a flight from Rome to Santorini on July 8, a ferry from Santorini to Ios and European stopovers before returning home to Perth on July 19.

But after the fall, the man spoke to his mother who quickly booked a business class ticket home so he could lie flat during the flight.

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“While the … discharge summary did not specifically state the complainant was unfit to continue with his trip, it did request the complainant to return to his residence (accommodation) and come back to the spinal surgery clinic for a CT scan in 30 days,” AFCA said.

“While the scans after his return home did not identify any fractures, the complainant was diagnosed with a C2 vertebrae fracture, while overseas.”

Tokio Marine denied the claim on the basis the traveller had not shown an early return was medically necessary. And it said the man was intoxicated when he fell and its policy excluded such accidents.

AFCA is satisfied the hospital notes and the trip itinerary show the claimant could not have reasonably continued his holiday, so he is entitled to a cancellation costs payout.

But it says he “has not shown he was required to return home early on an upgraded business class ticket, based on medical advice”.

AFCA says Tokio Marine “considers the blood ethanol value of 1.89g/L to be significantly elevated and well above the legal driving limit of 0.05%, which is equivalent to 0.5g/dL. This result indicated the complainant was likely intoxicated at the relevant time and the exclusion should apply.

“There needs to be information, such as an analysis from a forensic toxicologist or another expert confirming the [blood alcohol content] recorded in the complainant’s body met the above test. Further, to show that it was this factor that led to the claim.”

AFCA says Tokio Marine failed to provide expert reports analysing the circumstances of the accident, drinks consumed, tests conducted or witness evidence to show the complainant was under the influence of alcohol and this caused the incident.

See the ruling here.