{"id":2428,"date":"2025-09-23T15:07:41","date_gmt":"2025-09-23T19:07:41","guid":{"rendered":"https:\/\/www.olhi-oap.ca\/en\/news\/preserver-lequite-dans-les-differends-lies-aux-soins-medicaux-durgence\/"},"modified":"2026-05-27T14:35:45","modified_gmt":"2026-05-27T18:35:45","slug":"upholding-fairness-in-emergency-medical-disputes","status":"publish","type":"post","link":"https:\/\/olhi-oap.ca\/en\/news\/upholding-fairness-in-emergency-medical-disputes\/","title":{"rendered":"Upholding Fairness in Emergency Medical Disputes"},"content":{"rendered":"\n
\n

This case illustrates how OLHI\u2019s process can lead to meaningful outcomes.<\/p>\n<\/blockquote>\n\n\n\n

A consumer contacted OLHI after they were denied reimbursement for nearly $10,000 in medical expenses under their mother\u2019s visitor travel insurance policy.<\/p>\n\n\n\n

She had travelled to Canada under a Super Visa (a visa that allows parents and grandparents to stay in Canada for an extended period of time) and experienced a medical emergency during her stay. She was taken to the emergency room and hospitalized. She underwent several procedures, including an Endoscopic retrograde cholangiopancreatography (ERCP)\u2014a treatment used to diagnose and relieve blockages in the bile or pancreatic ducts.<\/p>\n\n\n\n

The insurer denied a significant portion of the claim. They argued that the ERCP was investigative, not urgent, and could have been postponed until the insured returned to her home country. The consumer strongly disagreed, believing the treatment was part of a continuum of emergency care. OLHI\u2019s Complaints Analyst reviewed the case and identified several issues. The ERCP had led to the removal of sludge and stones, suggesting it was not merely investigative but medically necessary.<\/p>\n\n\n\n

The Analyst also noted that the insurer had failed to consult a specialist and had not properly applied the policy\u2019s definitions of \u201cemergency\u201d, \u201cmedical emergency,\u201d and \u201cmedically necessary.\u201d There was also no evidence that the emergency had ended at the time of the transfer for the procedure.<\/p>\n\n\n\n

Following informal negotiations and further clarifications, the insurer agreed to make a partial payment (approximately half of what had not been covered initially) on an extra-contractual basis in exchange for a release. The consumer agreed with the proposed settlement, and the complaint was resolved.<\/p>\n\n\n\n

This case illustrates how OLHI\u2019s process can lead to meaningful outcomes-not just by challenging decisions, but by ensuring that the evolving understanding of some medical conditions is considered when it matters.<\/p>\n\n\n\n

\"\"<\/figure>\n","protected":false},"excerpt":{"rendered":"

This case illustrates how OLHI\u2019s process can lead to meaningful outcomes. A consumer contacted OLHI after they were denied reimbursement…<\/p>\n","protected":false},"author":2,"featured_media":2429,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[33],"tags":[37,38,36,41,40],"class_list":{"0":"post-2428","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","6":"hentry","7":"category-case-studies","8":"tag-assurance-voyage","9":"tag-reglement","11":"tag-settlement","12":"tag-travel-insurance"},"acf":[],"_links":{"self":[{"href":"https:\/\/olhi-oap.ca\/en\/wp-json\/wp\/v2\/posts\/2428","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/olhi-oap.ca\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/olhi-oap.ca\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/olhi-oap.ca\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/olhi-oap.ca\/en\/wp-json\/wp\/v2\/comments?post=2428"}],"version-history":[{"count":2,"href":"https:\/\/olhi-oap.ca\/en\/wp-json\/wp\/v2\/posts\/2428\/revisions"}],"predecessor-version":[{"id":2703,"href":"https:\/\/olhi-oap.ca\/en\/wp-json\/wp\/v2\/posts\/2428\/revisions\/2703"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/olhi-oap.ca\/en\/wp-json\/wp\/v2\/media\/2429"}],"wp:attachment":[{"href":"https:\/\/olhi-oap.ca\/en\/wp-json\/wp\/v2\/media?parent=2428"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/olhi-oap.ca\/en\/wp-json\/wp\/v2\/categories?post=2428"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/olhi-oap.ca\/en\/wp-json\/wp\/v2\/tags?post=2428"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}