Industrial Alliance turned down the insurance claim because it felt the injury wasn’t severe enough
“You see how injuries can truly change people's lives, so I made sure when I had children, I got insurance for them," said Nancy Desrosiers, a former ER nurse who had bought an insurance policy for her daughter Emily Laprise, now 12, from Industrial Alliance. Desrosiers is now trying to submit a claim for an injury her daughter sustained, but the provider has countered that the injury concerned isn’t severe enough to warrant a payout.
According to a report from CBC News, Laprise was hit with a soccer ball in the left eye, which knocked her to the ground and detached her retina. “I was telling them, 'I can't see anything! I can't see anything!'” Laprise recounted.
While a surgeon was able to reattach the retina, a hole remains in her left eye’s retinal lining – damage caused by the ball’s impact. She now suffers blurred double-vision through that eye, and most of its lower field of vision is gone. “The insurance company says it's ok because 'She does have some sight,'” said Desrosiers.
The policy she purchased pays out $50,000 for loss of sight in one eye. However, Industrial Alliance cited a clause that says the insured person “must have a corrected visual acuity of less than 20/200”; they claimed that despite the loss of lower-field vision in her left eye, strong prescription glasses can still help Laprise see. The company instead covered the $8.40 mileage cost Desrosiers incurred driving Laprise from the soccer field to the hospital.
“Nowhere in the policy does it say, 'by applying glasses' the policy is no longer applicable,” said Desrosiers. “To me, 'corrected' vision means if you can correct it with surgery, and get it back [to its original condition].” Laprise’s optometrist, Dr. Jason Louie, said she could experience complications, including possible re-detachment of the retina that would lead to total blindness in that eye.
Alex Saltykov, whose company InsurEye tracks the insurance industry, noted that companies intentionally use confusing language in accident insurance policies. “Accident insurance ... leaves more room for interpretation of policy definition and claim qualification [than life insurance],” he said. “Insurance companies need to explain to people more clearly what their definitions are.”
Under a sport accident policy that covers all players with the BC Soccer Association, administered by Crawford & Company, Laprise will receive $15,000 for “irrecoverable loss of sight in one eye.” The claim under that policy was handled without dispute.
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According to a report from CBC News, Laprise was hit with a soccer ball in the left eye, which knocked her to the ground and detached her retina. “I was telling them, 'I can't see anything! I can't see anything!'” Laprise recounted.
While a surgeon was able to reattach the retina, a hole remains in her left eye’s retinal lining – damage caused by the ball’s impact. She now suffers blurred double-vision through that eye, and most of its lower field of vision is gone. “The insurance company says it's ok because 'She does have some sight,'” said Desrosiers.
The policy she purchased pays out $50,000 for loss of sight in one eye. However, Industrial Alliance cited a clause that says the insured person “must have a corrected visual acuity of less than 20/200”; they claimed that despite the loss of lower-field vision in her left eye, strong prescription glasses can still help Laprise see. The company instead covered the $8.40 mileage cost Desrosiers incurred driving Laprise from the soccer field to the hospital.
“Nowhere in the policy does it say, 'by applying glasses' the policy is no longer applicable,” said Desrosiers. “To me, 'corrected' vision means if you can correct it with surgery, and get it back [to its original condition].” Laprise’s optometrist, Dr. Jason Louie, said she could experience complications, including possible re-detachment of the retina that would lead to total blindness in that eye.
Alex Saltykov, whose company InsurEye tracks the insurance industry, noted that companies intentionally use confusing language in accident insurance policies. “Accident insurance ... leaves more room for interpretation of policy definition and claim qualification [than life insurance],” he said. “Insurance companies need to explain to people more clearly what their definitions are.”
Under a sport accident policy that covers all players with the BC Soccer Association, administered by Crawford & Company, Laprise will receive $15,000 for “irrecoverable loss of sight in one eye.” The claim under that policy was handled without dispute.
Related stories:
Government bureaucracy being challenged in class-action suit by mothers denied sickness benefits
Sun Life rejects coverage for 9-year-old because of his ‘build’
