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Insurance company ordered to pay B.C. widow $400K in damages over denied claim

This photo shows someone signing an insurance claim form. (Credit: Shutterstock) This photo shows someone signing an insurance claim form. (Credit: Shutterstock)
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An insurance company that denied a B.C. widow's claim for accidental death benefits has been ordered by a judge to pay $400,000 in damages.

The decision in the case was handed down last week, but the woman's dispute with Sun Life Assurance Company of Canada over the claim dates back to 2018, according to B.C. Supreme Court Justice Lindsay M. Lyster's ruling.

"The issue for determination is whether (the man) died as a direct result of an accident, and if so, was the death independent of any other cause," she wrote.

The woman's husband died in January of 2017 in what the court describes as "very sad circumstances" – he was found alone, in a freezing-cold, blood-covered apartment by police doing a welfare check. The officer who attended observed an injury to the man's face and "opined" that the man was drunk, fell and hit his head, and that the blood likely came from that wound. Criminality was ruled out.

An autopsy was ordered but never completed, the decision says, something the judge described as "inexplicable" in the circumstances.

"A post-mortem would likely have provided important evidence that would have borne directly on the cause of (the man's) death. In its absence, the court must do the best it can on the evidence available," Lyster wrote.

A medical examiner's report dated December 2017 – based on an external examination of the man's body – said the man died of natural causes.

"In the absence of a traumatic or toxicological cause of death, and with the examination findings, cause of death is cardiovascular disease," reads a portion of the report quoted in Lyster's decision.

The medical examiner also noted the cut on the man's head, as well as bruising around his eye and his history of alcohol abuse, but ruled out the possibility that the injury in and of itself was the cause of death.

Shortly after this report was completed, Sun Life informed the widow that her claim had been denied because her husband died of "atherosclerotic cardiovascular disease," the judgment says.

Lyster, when reaching her decision, looked at the records from the police and the medical examiner. She also considered an expert report from a forensic pathologist that the widow submitted, which included a review of all of her husband's medical records.

That review, Lyster said, did reveal that the man had gone to the hospital complaining of chest pains, but follow-up tests did not reveal any cardiovascular disease.

It also noted that the lack of a full autopsy "precludes reliable determination of the cause of death," according to the decision, which also quotes the expert report as saying that the cause and manner of death were not "determined with any reasonable degree of certainty."

The expert forensic pathologist said that even though heart disease could have been the cause of death – there were also other potential causes based on the limited evidence before the court.

The judge found that the likely cause of death was hypothermia combined with blood loss from the head wound.

"The evidence does not establish that (the man) suffered a cardiac event or that his death was otherwise caused by atherosclerotic disease," Lyster wrote, rejecting the findings of the medical examiner.

Further, the judge said that even if the man did have a heart attack and suffered a fatal fall afterward, the death would still be accidental and his widow would still be entitled to the benefits.

"I have concluded that (the widow) has established that (her husband's) death was an accidental death, independent of any other cause, and therefore covered by the policy, and that the claim ought to have been allowed," Lyster wrote.

The $400,000 in damages awarded for breach of contract were the equivalent of the value of the insurance policy.

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