Insurance company must pay for U.S. surgery

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 experienced chest pain. He made arrangements for a return to B.C. During his return flight, his symptoms worsened and when the aircraft landed in Seattle, he was taken to a city hospital.

He was diagnosed with severe coronary artery disease. At the Swedish Medical Centre in Seattle he received emergency bypass surgery.

The bill for his medical treatment came to US$181,140, which he sought to have paid by the travel insurance section of a group insurance plan provided by Royal & Sun Alliance Insurance Company.

The insurance company’s agent denied his medical claim. At trial, the insurance company argued that Fletcher’s claim should be denied under a clause that 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.