Canadian travellers have a lesson to learn from Sandra Turpin. She expected more from a travel medical insurance policy than the contract would provide. Now, after two court hearings, the conditions of the contract have been upheld. She and her husband John have both medical and legal bills to pay.
Abdominal Pain Occurred Days Before Flying
The British Columbia resident saw three doctors in Victoria and took medication for abdominal pain. A day after seeing her family doctor, Sandra and her family bought insurance for a trip to California. Sandra’s pain had subsided, but nine days later after a trip to Disneyland with her young son, she saw another doctor in California about new pain to her abdomen, and spent five days in hospital for treatment and tests. Weeks later, in Victoria, she had her appendix removed. Manufacturers Life Insurance Co. (Manulife Financial) refused to pay the $27,170.81 medical bill she had incurred in California. Turpin’s policy excluded coverage for medical conditions investigated and treated within 90 days of departure.
She Hadn’t Read the Policy She Bought
She had never read the policy, which warned on the front page that there were limitations and exclusions. Yet a sympathetic judge later ruled it was reasonable of Turpin to expect coverage. He decided that, even though the policy exclusions were not ambiguous, Turpin would not have understood the policy even if she had read it. Now three judges of the Court of Appeal for British Columbia have overturned that 2011 decision and disagreed with decisions on insurance made by the Court of Appeal for Ontario. The ruling was issued June 17, 2013.
Exclusion “Reasonable And Predictable” Judges Rule
“The Supreme Court of Canada has repeatedly and consistently affirmed that the reasonable expectations of the parties (to an insurance contract) only become relevant if the provisions…are ambiguous,” Madam Justice Kathryn E. Neilson wrote on behalf of the panel of judges. “I cannot agree that, because a travel insurance policy clearly excludes coverage for pre-existing medical conditions, (that all) coverage is nullified,” she added. “This is a reasonable and predictable exclusion. Insurance remains in place under the policy for many other medical risks and emergencies (than pre-existing conditions) as well as for other exigencies (pressing and urgent situations) encountered during travel.”
Contract Wordings and Legal Decisions
Many consumers may have never read a medical emergency policy. But, as Sandra Turpin learned, it can be dangerous to ignore the fine print and make assumptions. All commercial insurance policies exclude coverage for certain losses, and certain applicants from coverage. All insurers set rules for making a valid claim, as well as for qualifying for benefits. You may not understand the full implication of a policy exclusion or rule without reading the definitions contained within. Here are key sections in the policy the British Columbia judges have ruled Turpin should have read and understood.
This insurance does not cover and no benefits will be payable for:
“…pre-existing conditions or related medical conditions which were not stable and controlled during the 90-day period immediately preceding your effective date.”
Medical Condition: an irregularity in your health which required or requires medical advice, consultation, investigation, treatment, care, service or diagnosis by a physician.
Pre-Existing Condition: a medical condition for which treatment has been received or taken, or which exhibited symptoms, prior to the insured trip in question and within the period specified in this policy . . .
Stable and Controlled: the medical condition is not worsening and there has been no alteration in any medication for the condition or its usage or dosage, nor any treatment prescribed or recommended by a physician or received within the period specified in this policy for the plan you chose and for which you are eligible prior to the trip in question.
Treated or Treatment: any medical, therapeutic or diagnostic procedure prescribed, performed or recommended by a physician, including but not limited to prescribed medication, investigative testing and surgery.
Read the Fine Print
If you take the time to read both the initial ruling and the ruling of the Court of Appeal, you will see that even learned judges sometimes disagree. So seek expert advice before putting your financial well-being at risk.