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MONCTON, NB – A New Brunswick woman injured in a car accident goes to court this week to argue that 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 his lawyers said the case could have an impact on health care in Canada.
Mike Murphy, a senior partner with Forte Law in Moncton, NB, said the woman in her twenties was injured in a collision three years ago, but her hip injury had not occurred. not been diagnosed until six months ago.
Murphy says his insurance company will not cover the $ 28,000 cost of surgery at a private clinic in Nova Scotia because the specialized operation – repairing a tear in the head – should be covered by Medicare.
"We're saying that Medicare does not cover that because availability is in four years," Murphy said in an interview. "This is just not the cover … we say that availability is not there."
According to the lawyer, a surgeon has told the woman that her hip should deteriorate over the next four years, causing undue suffering and increasing the chances that she needs a replacement of the hip.
The insurance company's lawyers should also say that the woman's collision was not caused by the collision in Moncton.
Murphy refused to divulge the name of the woman or the name of the insurance company.
"Depending on the outcome of the decision, its consequences could be very important," he said, adding that insurance companies should be informed of waiting times during the badessment. accessibility to treatment.
It is true that most insurance policies do not cover the treatments offered by Medicare, but insurance companies systematically 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 (physiotherapy) because it wants you … get back to work quickly," Murphy said. "The difference here is that physiotherapy costs $ 50 a session and that the surgery costs $ 28,000 – but it's the same principle."
New Brunswick had the longest wait times for medically necessary treatment in Canada last year, according to a Fraser Institute annual survey, right-oriented.
While the median wait time in Canada was 19.8 weeks, among New Brunswickers it was 45.1 weeks, according to the institute, which describes itself as an independent think-tank and non-partisan on public policies.
The study examined the waiting time of patients in 12 medical specialties – from orientation 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 a motion in the Court of Queen's Bench in Moncton on Wednesday.
– By Michael MacDonald in Halifax
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