Insurer ordered to pay for emergency surgery while travelling.

On July 28, 2017, the Supreme Court of BC ordered an insurance company to pay for a British Columbia man’s emergency heart surgery while travelling. The court held, in Fletcher v. Royal & Sun Alliance Insurance Company of Canada, 2017 BCSC 1330, that the medical expenses Paul Fletcher incurred while outside of Canada were not excluded by the policy. The court made this finding after noting that Mr. Fletcher was advised by his treating physicians that:

a) his condition was stable;

b) he was safe to travel; and

c) further testing could wait until after his travels.

The disputed claim was for medical expenses incurred while travelling outside of Canada. Three days into a vacation to Mexico, Mr. Fletcher experienced chest pain which did not subside with use of nitroglycerin tablets. He left Mexico early to return to Canada for treatment but required an emergency coronary artery bypass surgery in Seattle on his way back to Canada.  The issue was whether the medical expenses for the surgery fell within the policy’s exclusion for “any medical condition for which prior to departure, medical evidence suggests a reasonable expectation that treatment or hospitalization could be required while travelling.”

Mr. Fletcher had previously been diagnosed with stable angina by his family doctor and cardiologist. The family doctor and cardiologist both felt that his condition was stable, that he was fine to travel to Mexico, and that an angiogram could be postponed until he returned.

Mr. Fletcher took the Royal & Sun Alliance Insurance Company to court when it refused to pay, claiming an exclusion clause applied because there was medical evidence that he might be hospitalized while travelling.

Mr. Fletcher testified that his doctors told him his angina was stable and he was safe to take a trip to Mexico. The insurance company’s expert physician criticized both Mr. Fletcher and his doctors at trial, saying there was a reasonable expectation that treatment or hospitalization could be required while travelling.

But Madam Justice Dorgan did not agree. She found that Mr. Fletcher and his treating physicians had reasonably concluded that the trip to Mexico posed no reasonable expectations of risk to Mr. Fletcher’s health and there was no “reasonable expectation that treatment or hospitalization could be required while travelling.”

The insurance company was ordered to indemnify Mr. Fletcher for $180,000 US.