Nov 17, 2016 in News Accident Benefits Claims

Accident Benefits Claims: Insurer faces backlash after refusing accident benefits payment to injured girl

Last week, the CBC reported that Industrial Alliance, Canada’s fourth largest insurance provider, had refused to pay out benefits for 12-year-old Emily Laprise of British Columbia, who suffered a traumatic eye injury during a soccer game. Laprise suffered a detached retina, which a surgeon was able to repair, and tear in the retinal lining of her left eye, which remains. Emily has lost most of her lower field of vision, and sees double.

If you or a member of your family has been injured in an accident, contact an insurance disputes lawyer today. Accident insurance is notoriously difficult to access, even for loyal clients, as Emily’s story illustrates.

According to Emily’s mother Nancy Desrosiers, a former emergency room nurse who has seen serious injuries impact numerous peoples’ lives, Industrial Alliance refused to pay accident benefits because Emily “does have some sight” in her left eye. A clause in Desrosiers’ policy states that in order for her to qualify for benefits, Emily would have to have “a corrected visual acuity of less than 20/200,” meaning she would not be able to see at 20 feet what someone with 20/20 vision would be able to see at 200 feet. Without glasses, Emily fits this description, but because strong prescription glasses can eliminate blurriness, Industrial denied coverage.

“I was blown away,” Desrosiers told the CBC. “After 12 years of paying for insurance? I was going, ‘I can’t believe this.’”

“Nowhere in the policy does it say, ‘by applying glasses’ the policy is no longer applicable,” Desrosiers continued. “To me, ‘corrected vision’ means if you can correct it with surgery, and get it back. She never needed glasses before, but now if she doesn’t wear them, she sees double and there’s still parts that are black.”

“In any living benefit insurance policy – and accident insurance is one – the policies are limited by the definitions they use. There’s a lot of grey area,” independent insurance broker Lorne Marr told MoneySense.com. “You may have breast cancer, for instance, but you may need to specifically have Stage 4 breast cancer for the policy to pay out.”

This variety of ‘grey area’ is a common theme in accident insurance policies, as any insurance disputes lawyer can tell you. In their report, the CBC talked to several critics who believe accident insurance ‘isn’t worth buying.’ Vancouver personal injury lawyer Scott Stanley compared accident insurance to “playing a slot machine that … never pays out.”

“A really good example is with minor hockey policies,” Stanley continued. “They pay out if you lose your hand. I’ve never heard of that. You might lose a finger or tip of a finger, but not a hand. So in a way, they are engineered to never pay out.”

Alex Saltykow of Insureye, an insurance industry watchdog, said accident insurance leaves “room for interpretation of policy definition and claim qualification. Insurance policies are worded in very deliberate, clever ways. Insurance companies need to explain to people more clearly what their definitions are.”

While an experienced insurance disputes lawyer may have the necessary expertise to navigate insurers’ complicated policies, the average citizen does not.

More than half a million people read the CBC’s report, and public outrage has led Industrial Alliance to reconsider its position. The insurance provider and Desrosiers came to “a mutually agreeable solution,” that Desrosiers said she is “very comfortable with.” Emily will also have access to $15,000 from the BC Soccer Association’s sport accident policy.

If you or a member of your family has suffered an injury and is engaged in a dispute over insurance coverage, contact an insurance disputes lawyer at Neinstein Personal Injury Lawyers today for a free, no-obligation consultation.