The mother of a 12-year-old girl who suffered a traumatic eye injury playing soccer is angry that her insurance company won’t pay out because it says the injury isn’t sufficiently severe.
Emily Laprise took a ball in the eye during a game in North Vancouver last fall.
She remembers falling to the ground, screaming in pain.
“I was telling them, ‘I can’t see anything! I can’t see anything!'” Laprise said.
The ball detached the retina in her left eye and tore a hole in the retinal lining.
A surgeon was able to reattach the retina, but the hole remains.
Laprise now sees double in the eye and doesn’t have most of her lower field of vision.
“The insurance company says it’s OK because ‘She does have some sight,'” said mom Nancy Desrosiers.
“It’s very frustrating, as a parent.”
Nitty-gritty of accident insurance policy
As an emergency room nurse two decades ago, Desrosiers had seen many children in trauma.
“You see how injuries can truly change people’s lives,” she said. “So I made sure when I had children, I got insurance for them.”
Desrosiers bought accident insurance from Industrial Alliance, the fourth largest insurance company in Canada.
For loss of sight in one eye, the policy pays out $50,000.
But when Desrosiers submitted her claim, it was denied.
“I was blown away,” she said. “After 12 years of paying for insurance? I was going, ‘I can’t believe this.'”
- Been Wronged? Contact Erica and the Go Public Team
Industrial Alliance pointed to a clause that says the insured person “must have a corrected visual acuity of less than 20/200” — and that is where the disagreement lies.
Laprise’s vision without glasses is less than 20/200, which means what she sees — still blurry — at 20 feet, someone with 20/20 vision would be able to see 200 feet away.
The insurance giant says even though Laprise only sees black in the bottom half of her vision, she can wear strong prescription glasses to eliminate blurry, double vision in the upper field, so she doesn’t qualify for coverage.
‘I was telling them, ‘I can’t see anything! I can’t see anything!”
– Emily Laprise, 13
“Nowhere in the policy does it say, ‘by applying glasses’ the policy is no longer applicable,” Desrosiers said.
“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.”
Laprise’s optometrist, Dr Jason Louie, says there’s also reason to be concerned about her vision in years to come.
“Eye injuries are injuries that don’t all manifest right away,” he said. “They take time to develop.”
“If the retina were to re-detach, that could cause complete loss of vision in that eye. She could also develop what we call a traumatic cataract. If that cataract requires surgery to remove and there’s complications from that, that could also damage her vision.”
Industrial Alliance declined a request to be interviewed.
In a statement, the company said it applies “… the highest rigour so that clients can get the most out of the benefits to which they are entitled under the contract.”
Accident insurance ‘almost never pays out’
Vancouver personal injury lawyer Scott Stanley says accident insurance isn’t worth buying.
“It’s like playing with a slot machine that … never pays out,” he said.
Stanley says most accident insurance is designed to only pay for things that rarely happen.
‘It’s like playing with a slot machine that … never pays out.’
– Lawyer Scott Stanley
“A really good example is with minor hockey policies,” he said.
“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 Saltykov, who runs a company that tracks the insurance industry, blames insurance companies for writing policies that are difficult to understand.
“Unlike life insurance, where a claim is black and white — there is a deceased person — accident insurance … leaves more room for interpretation of policy definition and claim qualification,” he said.
“Insurance policies are worded in very deliberate, clever ways. Insurance companies need to explain to people more clearly what their definitions are.”
Soccer association pays claim
All players with the BC Soccer Association are covered under a sport accident policy, administered by Crawford Company.
Last week, Desrosiers learned her daughter will receive $15,000 for “irrecoverable loss of sight in one eye.”
The payout, says Desrosiers, is “bittersweet,” but she’s grateful the claim was handled without dispute.
As for Industrial Alliance, it sent a cheque, too — for $8.40 — to cover mileage costs for Desrosiers to drive her daughter from the soccer field to the hospital after the accident.
“They didn’t even pay for parking,” Desrosiers said.
She’s now considering a legal battle to try to get compensation.
Emily Laprise says “it’s stupid” the insurance company won’t pay, given that her quality of life has dramatically changed.
“It’s sad that I can’t see people the way I did before.”
She no longer plays soccer, afraid another injury could damage what vision she has left.
Submit your story ideas
Go Public is an investigative news segment on CBC-TV, radio and the web.
We tell your stories and hold the powers that be accountable.
We want to hear from people across the country with stories they want to make public.
Submit your story ideas at Go Public.
Follow @CBCGoPublic on Twitter.
Article source: http://www.cbc.ca/news/canada/british-columbia/insurance-company-refuses-claim-for-severe-eye-injury-1.3834953?cmp=rss