Who picks up the tab if you crash in a bike race?

Today's Coffee Talk Tuesday discussion comes to us from Hottman Law Office, Megan Hottman, who was recently in a serious crash herself. Hear how painful and time consuming it is to get coverage from a event bike crash. I'm not sure which is more painful, the crash or the insurance part!

Who picks up the tab if you crash in a bike race? Does event insurance really cover all of your bills?
I had occasion to answer this question based on my own personal experience and thought I would share what I’ve learned with 303Cycling readers. I crashed at Cascade Cycling classic on July 20, 2011, when a “race moto” unexpectedly swerved in front of our 109-rider peleton causing everyone to move right, which prompted a woman riding to my left to swerve into me. Unfortunately for me, we were descending at the time, so when I hit the ground, I hit hard. Right away I was told I’d broken my collarbone so I could not continue in the race.

I was transported by ambulance (over an hour’s drive, and yes, they billed me by the mile) to the nearby hospital in Bend, admitted to the ER and diagnosed with a broken clavicle, 2 broken ribs, and a pneumothorax, which led to my admission for an overnight stay to monitor my lung. I was given numerous CTs and xrays on my head neck, shoulder, pelvis and back, as well as a handful of chest xrays for my lung issue. Once I got back in Golden, on July 28, I had surgery on my clavicle – a plate and 7 screws were used to put it back together.

Megan moments after the crash

Take my word for it: an ambulance ride, overnight hospital admission, CTs and xrays, and orthopedic surgery (and pre/post-op office visits) are EXPENSIVE. The total amount billed by my providers so far is $17,026 and that doesn’t include all the bandaids, chiropractor visits and replacement parts on my bike, or my new helmet.

I am lucky that I have good health insurance. It has a $1,000 deductible (annual) and an 80/20 split after that, with my 20% capped. I was not hit with any penalties for being treated out-of-state, since my policy does not make “out-of-network” distinctions. Also, since I was admitted into the ER, my ambulance deductible was waived. So that was the good news.
Cascade is a USAC-governed stage race. Once I recovered from surgery I began to look into the insurance coverage provided to racers competing in USAC events. I learned that (1) a rider MUST file a claim within 30 days of the occurrence, and (2) a “First Occurrence Report” must have been filed by a USAC official on the day of the occurrence. USAC has two separate insurers: K&K insurance, for injuries occurring during competition (such as mine), and Philadelphia Insurance, which covers general liability at the race (i.e. someone trips and falls on an item).

I also learned that USAC’s insurance has an additional $1,000 deductible which must be met, before it will kick in. Translation: I’m on the hook for no less than $2,000 at this point. (If a rider does not have insurance, they must cover the first $5,000 of the bills first before USAC’s coverage kicks in).

What you learn after you file your notice of claim (again –you must do this within 30 days) is that the insurer will mandate that First Occurrence Report before it will open a claim officially for you. Interestingly enough, this “first occurrence report” that race officials must complete when an accident occurs, is a Philadelphia Insurance form with its business address and phone number at the top. However the rider is supposed to fill out a K&K claim form.

In my particular case, after emailing the race promoter, the chief official, and numerous other folks at USAC, it took me 6 weeks to finally confirm that the insurer had a copy of my report –and to receive a copy of the report myself. This was after I had filed a claim with both K&K and Philadelphia Insurance, because it was not made clear to me which company covered my claim. And as you might expect –each was pointing the finger at the other. This was frustrating to say the least, when bills are piling up and I began fearing my providers might send me to collections. Crash: July 20. Final confirmation that K & K opened a claim for me: August 30. Just so you know –the people at USAC who normally handle stuff like this are in the membership services/coordinator positions. However I ultimately had to send a nasty email to about 5 different people before I finally got what I needed.

I received a letter from K&K telling me that once my $1,000 deductible was met (above and beyond my own $1,000 insurance deductible), that they would cover 70% of “the reasonable and customary expenses above the amount of your deductible.” The Maximum benefit amount is $25,000. (Furthermore, certain limitations were spelled out: PT, dental, orthopedic devices, and ambulance transport coverages are all limited to $500 each). No mention was made of massage, chiropractor, medical supplies like bandaids and Neosporin, or bike equipment expenses. I have asked for clarification on these items but have not received an answer.

So if you’re keeping track – I’m out of pocket $2,000 on the deductibles, plus I’ll have to cover the 30% that USAC/K&K does not cover. Plus all of my other treatments and repair bills.

Although I have faxed in all of my insurance EOBs, bills and receipts to K&K– I have yet to see a statement from them about payments made to my providers or reimbursements it intends to make to me. I anticipate this will be a lengthy process. I do this for a living in my law practice for clients, so I am accustomed to the minutia it requires and the amount of time it takes – but for a cyclist who is unfamiliar with the insurance industry here’s my advice: be patient, but be proactive. You must document carefully, keep track of everything and stay on top of it – persisting with emails and calls – until it gets resolved. Calendar weekly follow-ups so you do not forget.

Out of sheer curiosity, I decided to explore how the ACA handles its insurance for riders who are injured during a race, given the recent discussion about joining the USAC in Colorado. The ACA coverage is quite a bit better -- it pays 100% of reasonable expenses above the deductible, not to exceed $25,000 –compared to USAC’s 70%. BUT – if a rider has their own insurance like I do, there is NO deductible for ACA coverage to kick in. In my case –that would have saved me $1,000. If a rider does not have insurance, the ACA’s insurer requires only a $1,000 deductible – compared to the whopping $5,000 required by USAC. And, the ACA insurance representative lives in Boulder and is an ACA member –aka fairly accessible. Versus my contact person at K&K, who lives in goodness-knows-where and is just a voice on the phone.

But back to USAC -- Regarding racers who don’t have health insurance –I hope they have $5,000 saved up. Because as I understand it, a USAC racer who does not have insurance, and who cannot meet the K&K $5,000 deductible, will be on the hook for the full amounts billed if they crash. And in my case, with a fairly straightforward injury, that would be a $17,026 hit.

The other take-away lessons: have someone check with race officials the DAY OF YOUR CRASH to be sure a report was completed and obtain a copy for you. And be sure you file your claim within 30 days of your crash or you will likely be out of luck. Insurers look for any possible reason to deny a claim.

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Nice write-up

Thanks for the clear and concise explanation of your experience. Makes you wonder whether the risk of racing is worth the potential hit in the pocketbook if you go down.

As a past race promoter, I recall having to pay exorbitant fees to insure the moto officials. If the moto in your situation ultimately caused the whole peloton to take evasive action to avoid a collision, have you considered a claim against him/her? It's a stretch, but might rattle some cages and shake loose some additional funds to reimburse your expenses.

Risk Management

FYI...I was the first US Cycling Federation Technical Director from 1984-1990.

A big part of my job was insurance, lawsuits and risk management.

In fact, the first race permit application "safety checklist" was witten by me on the plane to the US National Road Championships in Park City, Utah in the late '80's. If I did not have the draft when I got off got the plane, the insurance company was going to cancel the race. True story! That check list, in different form, is still used today by both the USAC and ACA!

Also, to this day, I am one of only several expert witness's who give expert opinions in bicycle racing lawsuits. My last deposition was given in May, 2010 in Denver.

In April of this year I was the USAC Race Official at the Mountain Staes Cup race here in Colorado Springs at Cheyenne Mountain State Park. This is the same venue I used for my 2009 and 2010 UCU Pro XCT race.

A female rider went down, went on her own to a hospital, I filed the Occurence Report (It does not have to be filed the same day unless really bad) and I learned this past Sunday from her at my Pro Cycling Palmer Park 50 that the USAC insurance policy would not help with her $7,000 bill. She has no insurance of her own.

So, keep this in mind.

Andy Bohlmann
Sand Creek Sports, Inc.
www.sandcreeksports.com and www.tourofcolorado.com

The ACA is coverage may look

The ACA is coverage may look good on paper, but when my wife crashed in a crit last year the ACA's insurance paid exactly $0. We reported our claim the day after the event and they sent us old paperwork with incorrect addresses. Then we had to start from square one and resubmit all of our paperwork. The crash was in June, and in December we received a letter from the hospital saying we would be sent to collections. Meanwhile, the ACA had never re-submitted our paperwork at all. In the end, the ACA's insurance never paid a cent.

New ACA Insurance Provider in 2011

There is a reason the ACA changed insurance providers this year.

Anyways, I would never rely on ACA or USAC insurance. Hopefully everybody racing is buying good insurance before buying $2K carbon fiber wheels.
Aflac has good secondary insurance but it won't cover injuries if you are competing for $$$$.

This just underscores why

This just underscores why our medical insurance system needs to be scrapped in favor of a simgle payer, everyone in system. For profit medical insurance companies could care less about you or your health, their main concern is profit for shareholders and many times it's at our expense.

The current system is crappy

The current system is crappy healthcare for most, good if you have a job that provides good care or if you are rich. The very poor get covered under various programs, but unfortunately many hospitals/Dr's simply won't provide care to these people because they don't get reimbursed at an equitable rate, or they get stuck with a bill by non-paying patients. Healthcare is commodity in this country and if Dr's don't get paid, as they should, the cost gets shifted somewhere/someone.

I saw a study recently that on average Palestinians get better care than your average American. It was shocking to hear, but when you think about how many people don't have insurance in the US or are under-insured it makes sense. I'd think twice about the statement referring to the US as "best health care in the world" because it just isn't true for the majority of people.

This is all besides the point. It's a good idea to get insurance if you plan to race.