BC man battling cancer denied insurance coverage for last-hope trials

BC man battling cancer denied insurance coverage for last-hope trials

Maple Ridge’s Toby Cleary was denied insurance for ‘last hope’ clinical trial because he forgot to disclose an ER visit nearly two years before his diagnosis.

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A Maple Ridge man battling Stage 4 cancer is losing hope after being denied health coverage by Canada’s largest insurer, Manulife — all because he forgot to disclose a visit to the emergency room nearly two years before his diagnosis.

“It is absolutely devastating,” said Toby Cleary, a 54-year-old contractor. “They cancelled not only the benefit I was hoping to be able to use to pay for clinical trials in the U.S. but my entire health plan.”

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Manulife rescinded the plan last month following Cleary’s application for a $25,000 critical illness benefit. The company said its refusal was because Cleary failed to disclose a visit to Maple Ridge Hospital on Oct. 11, 2019.

“I had gone to the bathroom, saw blood in the toilet and panicked, thinking I was going to die,” recalled Cleary. “Once the ER doctor examined me there, he chuckled and told me: ‘You’re totally fine, you’ve just got a hemorrhoid’ and sent me home. So it completely slipped my mind.”

But in Manulife’s rejection letter, the company said Cleary signed an agreement that he had to disclose “any illness, disorder, injury, operation or treatment,” and that failing to include a record of the ER visit meant the insurer was “not given medical information necessary to properly underwrite your policy.”

Manulife said it wouldn’t have issued Cleary the plan “without understanding the cause of the bleed,” which was not documented by the ER doctor in his record of the visit.

The company’s six-month-long review process has left the husband and father, who is now housebound due to his colorectal cancer, struggling to find another way to cover the cost of treatment.

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“Chemotherapy hasn’t been working as well as my doctors had hoped,” he said. “The type of cancer I have is so aggressive that it returned within three months after being removed in full by surgeons last December.”

The family has started a GoFundMe page in hopes of coming up with a means to explore other treatment options, most of which exist outside Canada.

Cleary is on the waitlist for two clinical trials in Seattle. One trial targets a specific genetic tumour mutation using surgery. The other trial involves immunotherapy, which costs $97,000 US. Both options require full payment upfront.

While Manulife said it could not discuss details of specific cases due to customer privacy, spokesperson Emily Vear told Postmedia, “When someone is applying for life insurance, critical illness insurance, or disability insurance, we do require that any medical treatment received — prior to and during the application process — be disclosed.”

“Failing to do so is in violation of the terms set out in the policy,” Vear said in an email.

Dr. Pardeep Dhillon, Cleary’s primary care physician, contested Manulife’s decision in a letter addressed to the company in late August.

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The Pitt Meadows doctor attributed the 2019 hospital visit to an isolated health event, and that a colonoscopy referral the ER doctor made never reached her desk.

“There were no other symptoms present at the time and that rectal bleeding most likely was not related to his colorectal cancer diagnosis as it is quite unusual for a person to have just one episode of bleeding in a period of nearly two years if there is underlying colorectal cancer,” said Dhillon.

The physician confirmed that Cleary showed no symptoms relating to his current diagnosis until close to two years later, in October 2021.

“Prior to that, (the) patient never presented to my office with any rectal bleeding, abdominal pain, weight loss, or change in bowel habit.”

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Toby Cleary is currently battling Stage 4 colon cancer. Photo by Ashleigh Wells

Cleary’s wife, Danielle Raymond, said she feels betrayed by Manulife and is worried for other families who purchase health insurance and become unexpectedly ill.

“Toby had been completely healthy for years before cancer. When we took out insurance we did so in good faith, hoping that we would never need to use it, but trusting that if we did our insurance provider would cover us,” said the 39-year-old, who is now her husband’s primary caregiver.

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“Insurance companies should be able to protect themselves from people acting in bad faith — who are hiding health conditions and taking out insurance — but what they should not be able to do is to use their access to someone’s medical records to scour them endlessly to spin a narrative that bears no resemblance to what has happened.”

Cleary said after filing an appeal to Manulife after its initial decision to review the policy in mid-June, he received multiple phone calls from company underwriters.

“They were accusing me of all of these things, like going to Pentiction for a doctor’s appointment in 2017, but I have never been there in my life,” Cleary said.

“We found out it was because a doctor who sent Toby for an X-ray after he hurt his neck kayaking had moved to Pentiction, taking those medical records with him,” his wife added.

“It feels like Manulife was looking for something to indicate that Toby had been sick all this time.”

The company’s decision came as a surprise to Cleary’s insurance broker, Christine Binder of Burnaby.

Binder said she expected Cleary to be approved for the critical illness benefit like hundreds of other clients of hers who initially forgot to disclose a health visit or appointment.

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“This is one of two times in my 30 years on the job that I’ve seen an insurance company decide to review a claim as extensively as this. The decision was unfortunate,” the broker said.

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