Insurance must cover B.C. man’s bypass surgery in U.S.

An insurance company has been ordered to pay more than US$180,000 in medical costs for a Victoria man 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.

On 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 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 B.C. Supreme Court Justice Jacqueline Dorgan found that before departure, Fletcher “prudently” consulted his doctors about his health and how his travels might impact his condition.

One doctor determined a medical procedure known as an angiogram could be postponed until he returned from the trip, the judge noted.

“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.”