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Medical clinic wins insurance legal battle

Jay Jay Soares, the executive director of the HMC-Burnaby Urgent Care & Medical Imaging clinic (Photo by Chris Burville)

A medical clinic will now have its imaging services covered by standard insurance after a judge ruled in its favour.

The Bermuda Health Council (BHeC) had refused to include procedures such as MRIs and CAT scans at HMC-Burnaby Urgent Care and Medical Imaging Clinic under the Standard Health Benefit.

However, Puisne Judge Larry Mussenden overturned the BHeC decision, ruling that the Clinic had been treated with unfair bias.

Jay Jay Soares, the director of HMC, said that the ruling would allow HIP and FutureCare patients to have the cost of medical scans at his clinic reimbursed by their insurers.

He added that the decision could “put an end to certain private sector monopolies”.

Dr Soares said: “We are extremely grateful to the court for granting our judicial review applications in respect of what we have always maintained were the Bermuda Health Council’s unfair decisions and are pleased to be able to offer the standard healthcare benefit.”

He added: “Logic, fairness and commitment to justice has been restored to this process solely thanks to the judicial review – the only recourse available to us on this matter.

“The ruling is indisputably a win for the Hamilton Medical Centre, but most importantly, this is a judgment in favour of HIP and FutureCare patients, who stand to benefit the most by having coverage at our state-of-the-art facility.”

When asked if the BHeC would appeal the decision, its CEO Ricky Brathwaite, said: “The council is carefully reviewing the judgment and considering all its options.”

Dr Brathwaite added: “We anticipate that many of the flaws of a broken Standard Health Benefit system, that were highlighted well before and during this legal process, will be addressed as part of health reform in the very near future.”

He said: “We have to make SHB a more patient-centred programme and that will require a full rebuild and re-imagination of this programme.

“We look forward to working towards those significant changes that we know will result in much better value for all of residents and the insurance premium dollars that they pay.”

Dr Soares applied to have medical imaging services provided by HMC covered by SHB in March 2019, but the application was rejected by the BHeC in January last year and again in September.

Dr Soares said his clinic should be able to provide medical imaging services through the Standard Health Benefit system and accused the BHeC of using unreasonably high standards and unfair panels.

Mr Justice Mussenden ruled that the BHeC did not give adequate reasons for denying the coverage and should have done so.

He added that, although a second panel dealing with the issue did act with impartiality, Michael Richmond, the chief executive officer of the Bermuda Hospitals Board, did act with “a real possibility of bias” when he served on the panel.

Mr Justice Mussenden also ruled that Mr Brathwaite acted with “procedural unfairness” because he served as a “secretariat“ for both application processes.

Mr Justice Mussenden ruled that the BHeC took irrelevant considerations into account and fettered its discretion “on several grounds”.

In particular, he said that the HMC’s application was treated as a “mid-year application,” which was subject to harsher standards, when it should have been treated as a “full-year application”.

Mr Justice Mussenden added that it was unfair for the BHeC not to give the application the same leniency that it afforded others.

It is The Royal Gazette’s policy not to allow comments on stories regarding court cases. As we are legally liable for any libellous or defamatory comments made on our website, this move is for our protection as well as that of our readers.