Insurance Company Faces Flak After Denying Benefits To Injured Girl

The mother of a young North Vancouver girl who was hit in the eye with the ball while playing soccer is locked in a battle with her insurance company. The insurance company has refused to make a pay-out citing certain technical points.

12-year-old Emily Laprise suffered a detached retina as a result of the accident. A surgeon was able to repair this, but was unable to fix the tear in the retinal lining of her left eye which has left the youngster with lack of vision in the lower field and also the problem of double vision.

Emily's mother, Nancy Desrosiers, a former ER nurse, has dealt with many cases of children in trauma. She says, “You can see how injuries can truly change people's lives. So I made sure that when I had children, I got insurance for them.”

Ironically, this doesn't seem to have been of benefit to Emily and her mom. Desrosiers had purchased insurance from Industrial Alliance, the fourth largest firm in Canada and had every hope of a settlement when she submitted her claim for $50,000 for loss of vision in one eye, which was the amount payable under her policy. However, Industrial Alliance chose to dispute the claim, citing a clause that says that the insured person must have corrected visual acuity of less than 20/200. According to them, though Emily does have this condition, it can be corrected by wearing the appropriate prescription glasses. Coverage was denied by the insurers and Desrosiers was devastated. “I was blown away,” she says. “After 12 years of paying for insurance.....”

Bizarrely, the insurance giant has sent Desrosiers a cheque for $8.40 to cover the costs of driving from the soccer field to the hospital following the accident!

Dealing With Disputes

Accident benefits are intended to compensate the injured victim for the injuries they've suffered. However, as our personalinjury lawyers know from handling such cases, insurance companies may not always act in good faith.

They are for-profit corporations, with a mandate to protect their own business interests first. Hence, they may use a number of tactics to avoid making large payouts.

Delays in processing the claims could cause the injured person to miss the window of opportunity to file a legal suit against the insurer. There are strict statute of limitations time-frames within which to file a personal injury suit.

“There's a lot of grey area,” opines independent insurance broker Lorne Marr. “In any living benefit insurance policy... the policies are limited by the definitions they use. You may have breast cancer but you need to specifically have Stage 4 breast cancer for the policy to pay out.”

Such “grey area” considerations can seriously affect the life of an injured victim who had reposed faith and trust in the insurance policy. In fact, many now feel that insurance policies aren't worth buying.

If you or a dear one has been injured in an accident and have issues with settlement from your insurers, our experienced 24x7 injury lawyers can help safeguard your interests, advise and advocate for you till you get the compensation you rightly deserve.