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Insurance Case Study: Australian Couple Owes 60k

In this article we will go over a real life case study of a recent accident that happened to an Australian tourist in BC who faced an insurance claim denial and a medical bill of $70,000 after a snowboarding accident in January 2016. We will also show you how to prevent something like this from happening to you. But let’s reconstruct the complete sequence of events.

An Australian couple, Ross Pointer, 39, and his partner Kalindra McColl,33, arrived in Canada in spring of 2015 to spend the whole year travelling and snowboarding in northern BC, Yukon, and West Kootenay. The couple went snowboarding on the extreme rated route through trees in Whitewater Ski Resort when Ross’ snowboard caught on a stump that was covered by snow. He slid onto it, using his gluts as a brake. The stump sliced his gluteus maximus muscle in half, scattering his sacrum bone, and leaving a deep 20 cm penetrating wound across his buttock. Ski patrol arrived within 15 minutes to get Ross to the ambulance waiting at the bottom of the ambulance. In a very critical condition, Ross was then rushed to the nearest hospital for an emergency surgery to remove large pieces of wood, splinters, and shatters of his sacrum that had lodged throughout his rear. According to the surgeon, the stump missed ripping his colon out by 3 mm, and his sciatic nerve was very nearly severed. Ross was lucky enough to recover from the injuries relatively quickly and to be able to walk again without assistance.

The couple had purchased a travel insurance plan from an Australian online insurance brokerage prior to their arrival in Canada. Post-surgery, they were devastated to find out that their plan did not cover for snow sports although they specifically picked that company because it offered optional coverage for snow sports. When Kalindra purchased the policy online last year, she opted for sports coverage over certain dates planned for snowboarding, including the date of the accident which was January 22. What the couple was reluctant to do was to look for specific information about snow sports coverage within the policy certificate at the time of issue to double-check for possible mistakes or misrepresentations. The insurance company was then able to deny the claim because additional snow sports coverage hadn’t been purchased. An online summary of the policy also clearly gave a two week grace period during which the coverage could have been changed.

Now the couple is kicking themselves for not checking their purchase on time while trying to raise money through a public funding campaign. Here are a few simple tips on how to avoid unnecessary hurdles:

1. Always proof read your policy: you need to be checking for spelling mistakes as well as coverage for all sports/extreme activities you are planning on your trip.

2. Familiarize yourself with policy wordings – especially the definitions section.

3. Purchase insurance from the local providers at your destination – it simplifies and speeds up the claims process.

4. If you don’t understand coverage or exclusion information- get an answer from an insurance agent in writing- this way you can rely on it if you have to claim in the future.

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