An insurance company refused to compensate a client injured during a mountain hike, despite a valid policy and submitted medical documents. The reason – vague contract clauses and the absence of a “reservation.”
In this article, we explain how the G&P Law team successfully defended their client’s interests and achieved a final victory with a ruling at the appellate level. The case is indicative and may be useful for all travelers and hikers who want to understand their rights in insurance disputes and fight for the compensation they are entitled to.
The client of G&P Law had taken out a travel insurance policy for Bulgaria and suffered an ankle injury during a mountain hike. The accident occurred during the validity period of the insurance policy and was documented by the Emergency Medical Center and a hospital discharge summary. Nevertheless, the insurance company refused to reimburse the medical expenses.
The insurer gave two reasons for the denial: first, that there was no document proving that the incident occurred during an organized short-term holiday or sport activity (such as a reservation or ticket); and second, that the costs for medical devices were not covered under this policy.
This highlights a well-known issue – insurance contracts written in unclear, technical, and often confusing language. In this case, there was no clarity about what exact document was needed to recognize the event as covered. Nor was it explained what exactly was meant by “medical devices,” which gave the insurer an opportunity to deny payment without an objective reason.
The court rejected the insurer’s arguments. Both judicial instances ruled that when the accident is clearly proven, the absence of a “reservation” cannot justify a denial. A mountain hike without an overnight stay also falls within the scope of the policy. The court emphasized that such requirements place the consumer at a disadvantage and cannot be used to limit the insurer’s liability.
Furthermore, it was noted that the specific conditions of the mountain insurance policy were formulated in a way that does not meet legal standards – the covered risks and exclusions were not described clearly and understandably. As a result, the insured party was left at a disadvantage, not being adequately informed about what exactly was covered. For this reason, ambiguous clauses must either be interpreted against the party who drafted them – in this case, the insurer – or be declared null and void.
This case not only ended in a victory for our client but also serves as an example of legal protection against unclear and misleading terms in insurance contracts – a practice still too common in the sector.
If you are facing a similar denial from an insurance company, contact us. The team of lawyers and legal experts at G&P Law has experience in insurance law and in defending both consumers and business clients in insurance disputes.