Claiming against a travel insurance policy that covers scuba diving down to 30m in the event of decompression illness (DCI) is one thing – but what happens if you had already completed a deeper dive safely earlier on the day an incident occurs? The scenario was tested out recently in Australia.
A couple had taken out joint travel insurance cover for a 10-day trip to an unspecified overseas destination last year (2023). The policy was in the female partner’s name, with the male diver who sustained DCI, named only as JC, as a beneficiary. Scuba diving to a maximum depth of 30m was permitted under the terms of the policy.
On 17 October, JC carried out a 39m dive, left a one-hour surface interval and then undertook a second dive to 29m, after which he became unwell and passed out.
A doctor (Dr EG) was called in, diagnosed DCI and prescribed treatment, leading JC’s partner to later put in a claim for the significant overseas medical and additional travel expenses that resulted.
Mitsui Sumitomo Insurance declined to pay out, arguing that if JC had not done the earlier dive outside the terms of the policy the DCI would not have occurred, and the dispute between the parties went before the Australian Financial Complaints Authority (AFCA) ombudsman.
The policy-holder argued that because the DCI occurred only after the shallower permissible dive, that was the only one that should be taken into consideration in respect of the payout – but AFCA backed Mitsui Sumitomo in taking issue with that interpretation.
“JC participated in an activity that was precluded by the terms of the policy and became unwell as a result,” the ombudsman ruled. “It would be unfair to require the insurer to pay a claim in circumstances where it has not agreed to cover the risk associated with that activity.”
3 key risk-factors
Dr EG’s report to the insurer after conducting a medical review identified three key risk-factors that contributed to the diver’s DCI: depth, repetition of dives and application of decompression stops.
As pressure increases, so does the risk of accidents, said Dr EG, concluding that the DCI occurred not only because of the 29m dive but through the combination of the two dives.
Another medical expert, Dr MN, stated that the risk of DCI correlated strongly with how effectively the body managed decompression stress after a series of dive exposures, with ‘exposure’ meaning a day’s diving activities.
JC had engaged in single-dive days on 15 and 16 October but his twin-tank exposure on the 17th could be considered as “moderately provocative” – making it 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,” said Dr MN.
The partner’s argument that there was no conclusive evidence that the 39m dive was the sole cause of JC’s DCI was over-ruled by the judgment that it had likely occurred because of a cumulative effect of dives undertaken on the day – and possibly also the days before.
The 39m dive had invalidated the claim, and the AFCA upheld the insurer’s decision.
Also on Divernet: SUSPECTED DCI? HERE’S HOW TO CONDUCT NEURO CHECKS, DIVERS TOO READY TO DISMISS DCI SYMPTOMS, FEWER FAST ASCENTS AND DCI CASES IN UK
