Insurance Company Refuses To Cover Cost Of Mattress Following Car Accident
There are obvious concerns someone will have when they involved in a motor vehicle accident. Immediate issues to address include the injuries of those involved in the accident, as well as any immediate financial help they may have. However, accidents can require a lot of time, and a number of different tools, equipment, and services in order to fully recover. In a recent case before Provincial Court of Alberta, a plaintiff brought an action against his insurer when it denied coverage for a special mattress following an automobile accident.
The plaintiff was involved in a car accident and began to receive Section B medical benefits from the insurer. On February 9, 2018 he was told by the insurer that the medical benefits would not cover a mattress recommended to the plaintiff by his physician. The insurer “explained and confirmed…there is no cov[erage] for a mattress under Section B benefits.” The plaintiff was informed the only type of bed the policy covered was a hospital bed. A manager with the insurer told the plaintiff’s lawyer “a mattress is not deemed to be a reasonable or necessary medical device nor does it rehabilitate or treat an accident-related injury.”
The plaintiff’s policy required both his own physician as well as a medical advisor for the insurer. The insurer arranged a medical examination with an orthopedic surgeon, who took the opinion that the mattress was not medically necessary and that the plaintiff’s neck and lower back injuries had been resolved. The plaintiff filed an action seeking
The court was asked to determine if the plaintiff’s action should be summarily dismissed on the basis that the policy requires both doctors to agree on the necessity of the mattress. The plaintiff also sought to include a claim for bad faith and to exclude the insurer’s doctor’s evidence.
The court’s analysis
The court looked at the wording of the policy as it relates to medical services and supplies. The policy states,
“all reasonable expenses incurred within 2 years from the date of the accident as a result of those injuries for necessary medical, surgical, chiropractic, dental, hospital, psychological, physical therapy, occupational therapy, massage therapy, acupuncture, professional nursing and ambulance services and, in addition, for other services and supplies that are, in the opinion of the insured person’s attending physician and in the opinion of the Insurer’s medical advisor, essential for the treatment or rehabilitation of the injured person.”
The court found that the insurer’s interpretation of the policy was correct, and that both doctors would have to agree on the need for any medical equipment, including the mattress. As a result, the court also held that the insurer could not have acted in bad faith in refusing to cover the mattress since it was not obligated to do so.
The days and weeks following an injury can be difficult to navigate. You may find yourself contacted by representatives from your insurance company, who may try to aggressively pursue statements and documentation from you. We advise everyone to speak to a qualified lawyer, such as the personal injury lawyers at Derfel Injury Law before speaking to anyone else about your insurance. We help our clients understand their insurance coverage and work with them to ensure they don’t miss important and strict limitation periods. Our exceptional team works tirelessly to achieve the best possible results for our clients. Please don’t hesitate to reach out to us at 416-847-3580 or online to talk about your case today.