ITIC APAC 2023 | Assistance challenges and solutions, part 1: Cruise assistance and repatriation options
On the first day of our ITIC APAC conference in Sydney, Michael van Niekerk, David Stone and Victoria Roy discussed the key challenges that can be encountered when cruise ship passengers require assistance and repatriation
The ITIJ team have been reporting from ITIC APAC 2023 in Sydney this week (18-20 June) sharing the discussions that took place at the conference. Read all reports
Michael van Niekerk, Health Operations Center Regional Doctor APAC, Carnival Australia
Van Neikerk began with a brief overview of cruising in APAC, noting that the region had been the last to reopen after the restrictions of Covid-19. It remained the only region with cruise-specific requirements, he said, highlighting Indonesia and South Korea as places where he was aware of recent difficulties in getting Covid-19 patients ashore.
However, last year saw ‘quite a large resumption’ in the number of Australians that embraced cruising, he said:
- 457,200 Australians sailed in the latter part of 2022
- Passenger levels increased to approximately 90 per cent of those seen in the same period of 2019
New trends were being noticed since the resumption of travel, for example cruises are becoming popular with younger travellers, particularly millennials and Generation X. Solo cruise travel seems to be on the rise, as do ‘expedition journeys’ to remote locations.
Van Neikerk described the onboard medical environment on a Carnival cruise ship, and how the shipboard medical team – comprising doctors, nurses, paramedics and administrative or healthcare assistants – provide care for patients with anything from minor illnesses to major trauma. Where possible, the preference is to treat the passenger onboard, but the team will decide if medical disembarkation will be required. “This is where collaboration with medical assistance companies comes into play,” he said.
As well as the state of the patient, the ship’s itinerary must be considered: for example, it may be at sea for several days with no access to shoreside facilities.
The teams must identify the most appropriate medical facility in the area and how to get the patient there, whether by ambulance or helicopter transfer. Certain countries, such as Papua New Guinea, may not be able to offer the required level of care.
Other considerations would be the time spent in port, which usually provides a timeframe of six to eight hours to repatriate the guest – unless the medical emergency takes place during this time. “This happens very frequently,” he said.
Working together with assistance companies is crucial, he added: “I think we’ve learned some great shared practices and good points on how we can collaborate as an industry to get the best outcomes.”
Victoria Roy, Principal Solicitor/Director, Victory Travel & Cruise Lawyers
Describing herself as “a personal injury lawyer with a twist”, Roy helps people who’ve had accidents on cruise ships, overseas and on aircraft to pursue compensation claims when the accident was (at least partially) someone else’s fault. When the passenger gets home and insurer assistance ends, she said, ‘for the moderately to seriously injured, that’s just the start of their journey – and that’s where I get involved’.
She explained why this might be of interest to an audience of travel insurance and repatriation experts.
First, they would be in a strong position to help the customer gather necessary evidence while onboard the aircraft or cruise ship, which would become inaccessible after they’d left. This included taking photographs but also gathering names and contact details of fellow passengers and witnesses.
Second, if the claim was successful, the insurer may be able to claw back their outlay. In Australia, the private health insurer will routinely have their outlay included in a personal injury claim, so personal injury lawyers are very used to dealing with private health insurers and getting that reimbursed.
Roy listed some of the most common causes of accidents in these environments:
- Slips and trips, especially on stairs
- Wet floors
- Getting on and off tender boats
- Jet ski accidents
- Shore excursions/activities, including road traffic accidents
Claims are not only pursued for severe injuries requiring repatriation, she said; it is often orthopaedic injuries that may not incur a huge medical expensive onboard but can involve ongoing medical needs when the passenger gets back home.
“Time is really of the essence with these cases,” she said. “Passengers should be getting expert advice as soon as possible after they’ve had an accident.” This was because time limitations can apply to claims – usually three years in Australia.
Roy said that most lawyers in Australia who work in this area take the same, no win-, no-fee approach. “So it doesn’t cost the client anything if they don’t win, and it wouldn’t be costing the insurer anything.”
David Stone, Global Provider Network Manager, World Travel Protection
In his session, Stone provided a detailed account of assistance support for cruise passengers.
Cruising’s resurgence since Covid was reflected in cruise offload case figures from World Travel Protection Australia, which saw average cases per month double between 2022 and 2023.
As well as more people travelling, they were seeing more variety in cruise destinations, he said, and ‘some of those locations are much more challenging than others’.
Looking at the reasons for medical offloads in 2022 and 2023, Stone listed a variety of factors including the following:
- 21% Covid
- 13% Neurological
- 11% Cardiovascular
- 11% Gastrointestinal
- 11% Limb injury/fracture
Stone pointed out the importance of strong communication when the assistance company is notified of a case. “The earlier notification that we have, the quicker that we can start to put a response in place,” he said.
Satellite can be a challenge, as well as incomplete information. “Typically we need a medical report to start with, so we can start the medical assessment process,” he said. “Travel insurance isn’t automatic; it needs to be assessed from a claims perspective.”
Once a case is opened, the medical team makes plans for offload, working closely with the cruise ship doctors, and again factoring in the local available facilities as well as the condition of the patient. They need to make sure they have all the necessary documents and paperwork, such as passports and insurance policies, and find out whether the patient has somebody travelling with them. Even if the passenger hadn’t purchased cruise cover, the assistance company can still offer non-financial support, for example by making recommendations and bookings.
Countries that present more challenges in terms of medical facilities and travel infrastructure include Papua New Guinea, Vanuatu, Tonga, Samoa, Fiji and New Caledonia. The teams must decide whether offload is the best option, he said: “If the better medical care is actually on the ship than it is in the location, and the ship is heading towards another port that’s not that far away, then it might be the right decision to keep them onboard a little bit longer.”