British holidaymaker who fell from a roof and incurred £1.2million medical bills and repatriation prices has insurance coverage declare rejected as a result of he was excessive on cocaine and opioids

A British holidaymaker who fell from a roof and racked up medical expenses and repatriation costs of £1.2million has had an insurance claim rejected because he was high on cocaine and opioids at the time.

The man, referred to Mr W, suffered serious injuries in a foreign country shortly after he left hospital, a report by the Financial Ombudsman Service has revealed.

He was said to have been showing ‘paranoid’ and ‘bizarre’ behaviour on the evening of September 11 2022, before his plunge the following morning.

The man had been discharged from hospital before appearing to enter a building nearby then clambering on to its roof and  falling ‘from the sky on to the sidewalk’.

He was admitted to a separate hospital in a critical condition then later put in a claim to German-based insurance firm Great Lakes Insurance, seeking to recoup £1.2million for medical expenses and repatriation costs.

The Financial Ombudsman Service has rejected a £1.2million insurance claim by a British holidaymaker who was injured after falling from a roof in a foreign country

The man, referred to in a report as Mr W, was found to have taken LSD at the time

The tourist was treated at two different hospitals, incurring expenses valued at £1.2million

The company rejected the application on multiple grounds, including that it was self-injury – and that decision has now been upheld by the FOS after a complaint by Mr W.

Ombudsman Anna Wilshaw found that he had tested positive for cocaine and fentanyl while receiving emergency treatment for his injuries.

Employees at the first hospital in which he was treated provided a diagnosis of LSD intoxication while also noted that he had drunk alcohol, though he later tested negative for both at the second hospital.

Mr W is said to have suggested he was ‘spiked’ and had taken the drugs involuntarily, but the FOS ruled there was insufficient evidence for this.

The ombudsman said: ‘I’ve considered whether there’s evidence that Mr W took drugs involuntarily or was spiked.

‘I accept that it is possible that there was a third party involved but there’s no evidence to confirm this.

‘Based on the available evidence it’s most likely that he’d taken drugs voluntarily as it’s noted that Mr W had taken acid.’

His family had travelled to the overseas country to help Mr W after he was found in the street with ‘very serious injuries’ caused by the plunge. 

CCTV footage had showed ‘a male fall from the sky on to the sidewalk’ after he ‘pushed open the roof access door’ of a building and was ‘captured on the roof camera until he walked out of camera range’, according to the FOS report.

That happened after he had entered a police station the previous evening, telling officers he thought he was ‘being followed’ as well as hearing ‘weird noises’ and experiencing ‘paranoid thoughts’.

A hospital report stated: ‘Patient is clearly paranoid and displaying bizarre behaviour but is otherwise cooperative and redirectable.’

The FOS decision on the claim recorded: ‘I don’t think it is unreasonable, in the circumstances of this case, to conclude that the self-injury exclusion applies as the evidence is that whilst under the influence of drugs Mr W went on to a rooftop and within a few minutes was seen on the CCTV falling on to the pavement below.’

The ombudsman concluded: ‘In response to our investigator’s findings Mr W indicated that he didn’t think that his claim had been handled promptly.

‘I have reviewed the available evidence and I haven’t identified any unreasonable delays in the progression of the claim. The verbal decision to decline the claim was given approximately six weeks after the accident.

‘However, I can see that the decision was given once Great Lakes had received and reviewed the relevant evidence, including medical reports and the police report.

‘And, in any event, Mr W was being treated at the hospital and receiving the care he needed. So, I’m not persuaded that any delay in declining the claim had any significant impact on Mr W, such as preventing him from accessing treatment. I’m not upholding this complaint.’