Peachland widow wins legal fights after ICBC refuse to pay
A Peachland widow has won a legal fight with ICBC after the insurer refused to accept that her partner's death was the result of a motorcycle accident.
The case involves former Peachland resident Gerald Prins who died of a cardiac arrest 11 days after having a motorcycle accident in July 2022.
Under the ICBC's insurance policy Prins' partner, Christina Passmore, was entitled to death, funeral and grief counselling benefits.
However, ICBC refused to pay, stating there was no connection between Prins' motorcycle accident and the cardiac arrest he had 11 days later.
The case details are laid out in an Oct. 23 BC Civil Resolution Tribunal decision, after Passmore challenged ICBC on its position.
Passmore submitted evidence to the Tribunal from Prins' family doctor, Dr. Elizabeth Allen, who knew the 77-year-old's medical history.
The doctor said Prins' was in good physical condition at the time of the accident and it was "highly likely" that the accident played a role in the major venous thromboembolism that caused Mr. Prins’ death.
The family doctor supported her position by filing medical literature to the Tribunal which showed that pulmonary embolism could be caused by both major and minor trauma.
However, without presenting any evidence to support its position ICBC argued it was unclear that Prins' family doctors medical opinion was "valid or reliable."
The Tribunal had none of it.
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"It provide(d) no evidence these studies are not reliable, such as an opinion from a medical professional or contrary studies. I find Dr. Allen is a medical professional, and their opinion is entitled to be relied upon. ICBC has provided no evidence they are not qualified to give this opinion," the Tribunal ruled.
The Tribunal also refused to accept information from an ICBC doctor who passed on a statement from an on-call coroner who said Prins' death was "unlikely" caused by the motorbike accident.
"Neither ICBC nor (its doctor) has set out (the coroners) qualifications or experience, or what specific information they were given about Mr. Prins. As (the coroners) evidence is about the central issue in this dispute, I find it would be unfair to rely on their hearsay evidence and I decline to do so," the Tribunal ruled.
The Tribunal also highlighted one aspect of ICBC's contradictory evidence.
The insurer said a doctor's report stated the cause of the cardiac arrest was not identified. However, the doctor later said the motorcycle accident was not the cause of the cardiac arrest.
Also in dispute is how serious the accident was.
ICBC said it wasn't serious, but Passmore gave detailed evidence, some from ambulance records, saying that he had a brief loss of consciousness.
ICBC argued that Prins' family doctor didn't assess him after his cardiac arrest, however, the Tribunal points out that ICBC's doctor didn't assess Prins after the accident.
"(ICBC's doctor's) report does not explain why their opinion is that Mr. Prins’ accident injuries were not 'serious,'" the Tribunal ruled.
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ICBC's final argument was that Prins had hypertension, osteoarthritis and carpal tunnel syndrome.
However, again, ICBC failed to support its statements.
"ICBC does not provide any supporting evidence of whether these conditions would have increased Mr. Prins’ risk of a pulmonary embolism, or whether they did in this specific instance," the Tribunal ruled.
Ultimately, the Tribunal ruled Prins' cardiac arrest was a result of the motorcycle accident, and therefore his widow was entitled to the insurance benefits.
But as Passmore didn't provide any amounts in her claim for death, funeral and grief counselling benefits, the Tribunal couldn't order ICBC to pay them.
However, the Tribunal did order ICBC to calculate the amounts of death benefits for a spouse under the policy and pay Passmore.
The widow will also get her $125 in fees covered.
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