A dispute between the mother of a 12-year old girl whose eyesight was significantly impaired by an accident during a soccer game, and the family’s insurance company, has raised questions over the wording of the terms and conditions of insurance policies.
Emily Laprise was hit in the eye by a ball during a game in Vancouver last fall, leaving the retina in her left eye detached and a hole torn in the retinal lining, CBC
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A surgeon was able to reattach the retina, but Laprise now sees double in that eye as well as only seeing black in the bottom half of her vision.
Now, her mother is locked in a battle with her insurance company, which says that the girl’s injuries do not meet the terms required under the policy to pay out.
Nancy Desrosiers, Laprise’s mother, has an accident insurance policy from Industrial Alliance, the fourth largest insurance company in Canada, which pays out $50,000 for loss of sight in one eye.
However, Industrial Alliance says that a clause within the policy states that the insured person “must have a corrected visual acuity of less than 20/200,” and determined that Laprise’s injuries do not meet this.
Laprise’s vision without glasses is less than 20/200, which means what she sees at 20 feet, someone with 20/20 vision would be able to see 200 feet away, according to the report.
But Industrial Alliance says Laprise can wear strong prescription glasses to eliminate blurry, double vision in the upper field, and so she doesn’t qualify for coverage.
Desrosiers hit back: “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.”
The dispute raises an important issue over the interpretation of policy terms and conditions, but one Vancouver personal injury lawyer says accident insurance is like taking a gamble.
“It’s like playing with a slot machine that ... never pays out,” Scott Stanley told CBC.
Stanley said most accident insurance is designed to only pay for things that rarely happen, pointing to minor hockey policies as an example: “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.”
Meanwhile, Desrosiers has learned her daughter will receive $15,000 under a sport accident policy taken out by the BC Soccer Association.
The coverage, provided by Allsport Insurance, will pay out for “irrecoverable loss of sight in one eye.”
Desrosiers said Industrial Alliance has sent a cheque too, but only for $8.40 to cover mileage costs for the drive from the soccer field to the hospital after the accident.
Desrosiers says she is considering legal action to try and get compensation.
Laprise said “it’s stupid” the insurance company won’t pay, adding: “It’s sad that I can’t see people the way I did before.”
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