A woman injured in a car crash is headed to court this week to argue her insurance company should cover the cost of her hip surgery in a private clinic because she faces a four-year wait in the public system.
One of her lawyers says it’s a case that could have implications for health care across Canada.
Mike Murphy, a senior partner with Forte Law in Moncton, says the woman in her 20s was injured in a collision three years ago, but her hip injury wasn’t diagnosed until six months ago.
Murphy says her insurance company won’t cover the $28,000 it would cost to have surgery in a private clinic in Nova Scotia because the specialized operation—to repair a labral tear— should be covered by medicare.
“We’re saying that medicare doesn’t cover this because availability is four years away,” Murphy said in an interview. “That’s just not coverage … We’re saying the availability is not there.”
The lawyer says a surgeon has told the woman her hip is expected to deteriorate over the next four years, causing undue suffering and increasing the likelihood she will need a hip replacement.
Lawyers for the insurance company are also expected to argue the woman’s injury was not caused by the collision in Moncton.
Murphy declined to release the woman’s name or that of the insurance company.
“Depending upon the results of the decision, the implications of the decision could be quite substantial,” he said, adding that insurance companies should be instructed take wait times into account when assessing accessibility to treatment.
While it’s true that most insurance policies don’t cover treatment offered through medicare, insurance companies routinely offer to cover less-expensive treatments in private clinics, including many forms of physiotherapy.
“Most of the time, the insurance company pays a private clinic (for physiotherapy) because they want you to get … back to work quickly,” Murphy said. “The difference here is that physiotherapy is $50 a session and this is a $28,000 surgery _ but it’s the same principle.”
New Brunswick recorded the longest wait times for medically necessary treatment in Canada last year, according to an annual survey by the right-leaning Fraser Institute.
While the median wait time across Canada was 19.8 weeks, in New Brunswickers it was 45.1 weeks, according to the institute, which describes itself as an independent, non-partisan public policy think-tank.
The study examined wait time patients faced across 12 medical specialties—from referral to treatment. Saskatchewan had the shortest median wait time at 15.4 weeks.
At the national level, the longest wait times were for orthopedic surgery at 39 weeks.
Murphy is expected to file an application before the Court of Queen’s Bench in Moncton on Wednesday.