Corresponding Insurer Obligations: 2nd Payors Must Inquire & 1st Payors Must Promptly Respond
Arcelormittal Dofasco Inc v Industrial Alliance Insurance and Financial Services, 2016 ONCA 224
In this case, D.C., a woman with a rare blood disease, was prescribed the drug Soliris to manage her condition by her hematologist. The drug costs $25,000 per month. She applied to her group benefits insurer, Industrial Alliance (“IA”), for pre-approval as the policy included reimbursement of ninety percent of certain prescriptions. Despite a letter from her hematologist that explained the drug would be administered in a private clinic, IA erroneously thought the Soliris would be administered in a hospital setting and excluded the drug under the terms of its policy.
