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.

Other Articles by Megan

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24 Comments

Be Prepared To Pick Up Your Own Tab

I am not puzzled or surprised by this article, but I am concerned about the underlying premise that it promotes. The premise as I understand it is that if I engage in an activity that has a risk of physical harm, that I am not responsible for planning - in advance - for the consequences to myself and my life should I suffer physical harm.

I am a new bicycle racer (specifically, first-year cyclocross), but I have engaged in many recreational interests that have significant potential for injury or death. Many of those other interests have become much more expensive, and had many venues/locations closed to access due to the increasing liability costs to owners or other people not actually participating in the sport/interest.

If you can afford all the gear, and the travel to play games (yes, these are GAMES for the vast majority of us who participate), then I think you should accept the responsibility for putting yourself in harm's way (i.e. choose health insurance and deductibles that you can live with). If you want someone else to take that responsibility, then the costs for playing games goes up substantially, and we end up with prohibitive costs, rules, access or some other restrictions that frequently remove the FUN which attracted us to the activity in the first place.

Life is dangerous. It WILL kill you. Choose what you love to do, and plan on taking responsibility for the consequences of your choices. If you don't want to do that, stay off the course, off the rock, out of the water, off the field, and sit on the couch and watch those who accept the risk as simply another part of the game.

The most rewarding path in life is usually not the one of least effort. If you race, you understand this. The most rewarding path is also not the safest or least expensive. If you race, I suggest you reflect on this.

Yep, you missed it.

The premise is: be prepared to get all your ducks in a row and go to battle with the insurance carrier if you expect to get reimbursed. What you say about risk v. reward is obvious, but beyond the scope of Ms. Hottman's article. "You're NOT in good hands" when dealing with these carriers nor are they "on your side." The cards are stacked against you and that is where prior planning is vital.

I agree with this comment.

Yes, racing is risky, and yes a racer should be prepared for the financial consequences of crashing. That wasn't the point of this writeup.

The point was to (a) remind riders that every USAC and ACA race is mandated to provide coverage to riders if they are injured -you pay for this insurance as part of your license fees and also part of your entry fee. It's already been purchased on your behalf -but most racers don't know/remember that when they crash at a race. So if the coverage is there, a racer should not feel badly for accessing it.
(b) remind racers that the insurance process is tedious and often, not what it appears to be on its face. I wanted to explain HOW and WHEN to file a claim so a rider doesn't accidentally remove themself from coverage by failing to do so w/in 30 days or failing to use the wrong form or in my case -I was given the wrong insurance company to pursue.
(c) explain to racers that they will need to set aside time and patience to pursue the insurance coverage. And to stay on top of the paperwork and keep it organized so they can get the coverage intended for them when usac/aca purchased it.
(d)urge racers to have some money saved up in case a disaster happens so they don't end up in bankruptcy proceedings.
And (e) to outline some of the difference between usac and aca insurance given the recent discussions about merging aca with usac.

Thanks Hottman

I agree with both the comment and your reply. It is very helpful to racers to have any information on this topic since most don't realize there is insurance. I have crashed many times racing mtb, road, cross, etc. for over a decade and I have never utilized the insurance, although I have had 3 trips to the ER and 5 broken bones. Mostly because of the hastle and time it took to chase this whole deal down.

Who picks up the tab?

I don't feel it is a race promoter/organization's responsibility to insure for a racer's medical needs but to insure that the racer is provided with a safely run race and safe course. In the end, the racer's insurance company will look to the promoter/organization to prove who was at fault when injury is caused by an accident.
Maybe a racer's proof of insurance should be required to enter - I agree that if you can afford the gear and entry fees but not health insurance, it's time to review your priorities.

Insurance

Glad you feel that way, but it doesn't matter. The promoter does not insure the rider for medical, it is the licensing organization, ie ACA or USAC. The insurance comes out of your license and entry fee.

Tab?

If the USAC were to require individuals to provide proof of insurance to race, our sport participation numbers would probably drop. Remember that about 25% of Americans do not have insurance, and many of us that have experienced career hiccups are not about to give up risk sports in which we have invested time and money. Although you bring a valid point, we as racers pay for an insurance benefit through USAC, and as a student I take advantage of that benefit, fully aware of the risk.

Why hassle with USAC insurance

So given that your insurance was better all the way around (lower deductible, better share ratio, out-of-pocket cap, probably much greater limit than 25K, etc), what was gained by also filing for coverage from the race insurance?

Very good points and perspective put wondering about the case where one's primary insurance is much better.

Great question.

Since I wrote this article on September 13 (date of submission to 303) I have received some statements from K&K insurance outlining how they will handle my bills. I am going to use a specific bill of mine to explain WHY I am pursuing USAC insurance in addition to my own insurance.

As I said, my insurance is 80/20, meaning it covers 80% of a bill, I'm responsible for 20%.
Using as an example my anesthesia bill from my clavicle surgery:
amount billed: 4800
my insurance paid: 2688 (plus it negotiated an adjustment with the provider for an additional 1440 reduction, so they actually handled 86% of the bill) ...
That leaves 672 - which I am personally responsible for.

This EOB (explanation of benefits) was sent to USAC/K&K insurance -and according to their statement:
They will pay 70% of the 672, or 470.40.
The remaining 30%, 201.60, is the new amount I owe.

So instead of my bill being 672, I only owe 30% of the 20% my insurance didn't cover -or 201.60. I saved 470.40 by sending this bill to the usac insurer. In my opinion that is worth the hassle. Basically for every 1000 charge, instead of owing 200 I will only owe 60 by using both primary and secondary insurance.

About "HASSLE" - I firmly believe insurers count on people thinking something is too much of a hassle and therefore won't bother with it. I would encourage people to get rid of the "too much of a hassle" mentality in these scenarios and apply themselves to the analysis so they can save money under a policy that was purchased for them in their entry fee and race license.

Another update since the article ran: K&K reimbursed 70% of my "reasonable and necessary" medical supplies from treating my road rash -bandaids, neosporin - etc. I sent my walgreens receipts in and they sent me a check for 70% of the totals. So be sure to keep your receipts for all medical expenses after a crash!

and -K&K will not cover bike repair costs -they only handle medical expenses.

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