This is excellent news. We have a person who checked with his doctor prior to travel if it was safe to travel, was given the okay. He had travel insurance, and thought he was covered. Insurance companies have been hiding behind the "pre-existing conditions" clause for many years.
It was great to see a judge strip that coverage away.
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Insurance company ordered to pay US$180,000 to B.C. man who had emergency heart surgery in Seattle
An insurance company has been ordered to pay more than US$180,000 in medical costs for a Victoria man who was denied insurance coverage after he had emergency heart surgery in the United States, on his return from a trip to Mexico.
In March 2011, Paul Fletcher, who was being treated for issues related to his heart, consulted with his doctors about his condition and was given approval for the Mexican trip.
Three days into his trip he began to experience chest pain which he felt was not subsiding even with the use of nitroglycerine tablets. He made arrangements for an early return to B.C.
During his return flight, his symptoms worsened and when the aircraft landed at a scheduled stop in Seattle, he left the plane and was taken by ambulance to a Seattle hospital.
A cardiologist diagnosed Fletcher with severe coronary artery disease and he was transferred to the intensive care unit at the Swedish Medical Centre in Seattle where he received emergency bypass surgery.
The bill for his medical treatment came to US$181,140, which he sought to have paid through the travel insurance section of a group insurance plan provided by Royal & Sun Alliance Insurance Company of Canada.
When the insurance company’s agent denied his medical claim, Fletcher filed his lawsuit.
At trial, the defendant insurance company argued that Fletcher’s claim should be denied under an exclusionary clause in his insurance policy.
The clause stipulated that the policy did not cover losses for any medical condition for which before departure, evidence suggested a reasonable expectation that treatment or hospitalization could be required while travelling.
But in her ruling on the case, B.C. Supreme Court Justice Jacqueline Dorgan found that before departure, Fletcher had “prudently” consulted his doctors about his health and how his travels might impact his condition.
One of the doctors determined that a medical procedure known as an angiogram could be postponed until he returned from the trip, noted the judge.
“This action alone satisfies me that the plaintiff’s condition was considered to be stable and that his proposed travel would not pose any increased risks to his health.”
While a medical opinion by the insurance company found that Fletcher’s pre-travel condition was not stable, the doctor who provided the opinion was not the plaintiff’s treating physician, said the judge.
“I accept the plaintiff’s evidence that if he thought he was at risk of having a medical emergency while he was away, he would have cancelled his trip.”
The judge ruled that Fletcher was entitled to be indemnified for the medical expenses he incurred in Seattle.
Michael Velletta, Fletcher’s lawyer, said his client was “thrilled and pleased” that he can now settle his accounts and have the doctors and the hospital who saved Fletcher’s life paid for their efforts.
In an email, the insurance company said that due to privacy concerns it was not their policy to comment on any individual client claims.
vancouversun.com/news/local-news/insurance-company-ordered-to-pay-us180000-to-b-c-man-who-had-emergency-heart-surgery-in-seattle
