Do you know, dear fellow citizens, that alcohol is indeed an excess and in a certain sense a blow to the astral body. But when that alcohol meets an insurance policy, the result is not just a household accident, but a genuine legal ballet with leaps into the unknown.
I once had a case with a respected citizen. Let us call him, for the sake of confidentiality, Citizen K. This K. decided to celebrate the New Year at a hotel in City N. And he celebrated in full measure, bringing his body to a state of 2.98 per mille. In such a state, dear friends, a person no longer merely gazes into infinity, he holds that infinity by the button.
And then, at the moment of unity with the universe, Citizen K. steps out onto the balcony and... good heavens! Performs an unauthorised flight from there. The result is sad: two ambulances, with musical accompaniment, a cast, total incapacity for work, and sombre thoughts on the transience of life.
Citizen K., being a cautious man, held accident insurance with company XXX. He goes there, limping on every possible limb, and there sit people with stern Buddhist faces who say:
«No, dear sir, there will be no payout for you. You have more alcohol in your blood than in a pharmacy. This is, excuse me, gross negligence. Our expert believes that in this condition you could not have remained standing even on a flat floor, let alone a balcony.»
The client weeps. And the insurance apparatus rejoices: budget savings achieved. Then I enter, all in white. I look at their ideology and draw upon my experience. I think, I must strike, likely with VÕS § 552.
I tell them:
«Listen, you giants of insurance thought. Our law states in black and white: in health insurance, there is a presumption that the damage was caused by an external factor. It is you, dear sirs, who must prove that the sole and exclusive cause of the fall was alcohol, and not, say, a slippery tile or a wobbly railing.»
The insurance clerk's eye twitches. But I continue:
«You wrote in your decision that he was 'alone in the room'. Who saw that? A camera? Witnesses? Perhaps there was ice on the balcony or a cat tripped him? To deny a person a 100% payout, you must prove that this balcony was absolutely safe for a sober person. And until you provide evidence that the balcony was perfect, your refusal is pure voluntarism and a violation of the principle of good faith!»
Indeed, citizens, one cannot place all the blame solely on alcohol when you have not examined the balcony yourself.
The insurance company, realising that it would now have to commission an expert assessment of ice on balconies in City N. from six months ago, decided not to take the matter to court and paid Citizen K. his lawful thousands of euros.
For alcohol may be poison, but the law, citizens, is the antidote to bureaucratic greed. And Citizen K. now celebrates holidays exclusively on the ground floor. Just to be safe.