An American who spends summers on Vancouver Island is suing a travel insurance provider for $175,000 after it denied his claim to fly his wife, who had COVID and pneumonia, home from Germany in 2022 for emergency medical treatment.
Stephen McNally has filed a notice of civil claim against the ÎÚÑ»´«Ã½-based MSH International (ÎÚÑ»´«Ã½) Ltd. on behalf of his wife, Fiona McNally, who died in 2023.
She had Canadian and American citizenship and qualified for the policy that provided for emergency medical treatment, if needed, for a three-week trip they took to Europe in the summer of 2022, said the lawsuit.
Fiona, then 65, had ALS but didn’t require assistance with the activities of daily living, a policy requirement.
McNally said the couple, who lived in Florida in winter and Nanoose Bay in summer, specifically requested coverage for major issues and to be returned to Florida for treatment as soon as possible.
He said the policy covered emergency transportation by air ambulance to a hospital in Fiona’s country of origin for immediate emergency medical treatment.
The lawsuit was filed in ÎÚÑ»´«Ã½ because the policy is governed by the laws of the province where the policy was issued.
“MSH has wrongfully denied coverage of this claim,” McNally said.
The couple flew to London from Washington state on July 12, 2022, and 10 days later, Fiona was admitted to an ICU in Frankfurt, the lawsuit said. She had been diagnosed with COVID, pulmonary pneumonia and aspiration pneumonia.
On Aug. 1, McNally called MSH to open a claim and three days later began plans to have Fiona flown by air ambulance to the Mayo Clinic in Jacksonville, Florida.
Her doctors confirmed she was unable to fly on a regular passenger plane and needed the ICU capability provided by the air ambulance.
From Aug. 1 to Aug. 15, McNally “worked diligently to provide documentation” to MSH so she could fly home, and an MSH official advised him on Aug. 15 that MSH doesn’t withhold treatment and “Stephen should proceed as needed” and file the claim later, the lawsuit said
He was also told by a second MSH employee that day that going ahead with plans to fly his wife home during its investigation of the claim would not affect his coverage, based on a review of medical documents MSH had already received.
On Aug. 15, “the very same day MSH encouraged Stephen to proceed with the air ambulance, MSH ‘informally’ denied the claim and recommended McNally file a formal claim” and he did, the lawsuit states.
On Aug. 22, McNally flew his wife home on an air ambulance.
On Dec. 30 MSH denied coverage, ruling the care Fiona needed could have been provided in Germany and the air ambulance was “not required for immediate emergency treatment,” nor was it approved or arranged in advance, as required by the policy.
The wording of the policy includes that emergency air transportation when approved and arranged in advance covers such service to the “nearest appropriate facility or to a Canadian hospital or to a hospital” in the policyholder’s country.
That section “does not require that treatment be unavailable where the injury occurred,” in this case, Germany, McNally said in the lawsuit.
He also said MSH told him that “proceeding with the emergency air transportation without MSH’s final approval would not affect” coverage.
McNally is seeking the $175,000 and $100,000 for bad faith and punitive damages.
The legal grounds cited in the lawsuit is a misrepresentation of the contract and the duty of good faith and honest performance, the lawsuit said.
Neither MSH nor McNally responded to a request for comment.
None of the allegations has been proved in court.
