James Lothian had started a life in Thailand with a new wife and child when a car accident put him in an intensive care unit.

The fly-in, fly-out mining construction worker from Gippsland, in Victoria's east, had been living between Perth and Thailand for several years with wife Sky and their three-year-old son.

He thought he had done the right thing when he secured travel insurance. 

But when the accident happened in March this year, he and his family realised it had expired. 

They were then faced with thousands of dollars in medical bills.

Mr Lothian's mother, Theresa Matthews, said the experience had been a nightmare.

"He was in ICU … in a coma when I got the call," she said.

"It was really traumatic."

The accident in Chonburi province, south-east of Bangkok, left James with severe internal injuries when the airbag failed in his car. 

He has undergone multiple operations since, including on his stomach and liver. 

The emergency was compounded because Mr Lothian's blood type, O-negative, is rare in Thailand.

The family put a call out to travellers or expats for donations of O-negative blood, with Mr Lothian's father also travelling to be at his son's side. 

It prompted a huge informal blood drive, with Mr Lothian receiving 3.5 litres of blood in August.

"I was so proud of the Australians that lined up at that hospital to give my son blood," Ms Matthews said.

But, unable to eat or drink,  Mr Lothian's condition was still failing. He lost more than 40 kilograms and contracted sepsis. 

His family were desperate to get him home.

High cost of repatriation

Ms Matthews, a volunteer wildlife carer in Gippsland, was unable to leave the animals in her charge and struggling to find the huge cost to repatriate him.

"The embassy will organise to fly people out, but it's $150,000, which I don't have as a wildlife carer," Ms Matthews said.

The family started a Go Fund Me to help with the Mr Lothian's burgeoning medical bills and bring him home. 

But with his condition worsening and the Thai government refusing to extend Mr Lothian's visa, the family made the decision to fly James home commercially on Wednesday in business class so he could at least lay down. 

The experience has cost the family tens of thousands of dollars.

Mr Lothian is expected to undergo surgery at Royal Perth.

Throughout this experience, Ms Matthews says her son has been trying to stay upbeat to prevent her from worrying. 

"He sends me online a text every day saying 'I love you, mum'," she said.

Sombre travel insurance reminder

Experts in medical repatriation services say cases like Mr Lothian's are not uncommon and a reminder to travellers to have valid insurance when they are overseas.

The Department of Foreign Affairs and Trade (DFAT) runs a crisis service for Australian citizens in crises abroad, but it warns it cannot pay for medical costs.

It advises travellers to ensure they have adequate travel and medical insurance.

Margaret O'Donnell is a critical care nurse and director of Australian Medical Escort Service, which specialises in medical repatriation of Australians who find themselves sick of injured overseas.

She said many people underestimated the challenges of bringing home a loved one needing urgent medical care, even with valid travel insurance. 

"Luckily, the majority of people do take out travel insurance, but they injure themselves and they do require assistance because the airlines will not let people who are unable to care for themselves board the aircraft," Ms O'Donnell said. 

"So this is where they will need a companion to help them or a medical assistant.

"DFAT and the federal government are certainly there to give advice and assist wherever they can," she said. 

"However, I don't believe it's an expectation that they should be responsible for repatriating travellers who find themselves in awkward situations without the appropriate level of travel insurance."