An insured brought a claim against her travel insurer for medical expenses incurred while on vacation. Her claim was allowed.

[2011] B.C.J. No. 1633

2011 BCSC 1162

British Columbia Supreme Court

R.D. Wilson J.

August 26, 2011

The plaintiff, Ms. Turpin, incurred $27,170.81 in medical expenses related to treatment for abdominal pain which resulted in an appendectomy while on a trip to California in October of 2008. In September of 2008, one month prior to the trip, the plaintiff had experienced abdominal pain. She sought treatment from her family doctor who prescribed her antibiotics. By the time that she had purchased a policy of travel insurance from the defendant, Manufacturers Life Insurance Co., in late September of 2008, she was pain free. The defendant refused to pay for the medical expenses claimed by the plaintiff on the basis that they were not covered by the policy because the policy did not cover pre-existing conditions that were not stabilized and controlled in the 90-day period prior to the effective date of the policy.

The plaintiff asserted that there was no medical evidence to establish that there was a connection between the complaints of abdominal pain prior to her trip and the problems she suffered from on her trip or evidence that treatment was going to be required. It was also argued that the definitions of whether a medical condition is “stable and controlled” in the policy was ambiguous.

The Court found that the abdominal pain experienced prior to the trip was related to the abdominal pain experienced in California. The plaintiff suffered an irregularity in her health three days before the policy was issued, so medical coverage was nullified. However, the Court also found that the defendant had presented a policy “off the shelf” without inquiry and the plaintiff had expected coverage. If the plaintiff had read the policy it would have been difficult to understand as it had a myriad of excluding conditions, variously applicable, or not applicable, to an infinite array of possible risks. The Court found that this was a proper case to apply the reasonable expectation principle and allowed the plaintiff’s claim.