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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24 Comments

Thank you Megan

Great information and sequence of expectations... Insurance is such a circus (scam business in my mind). I agree it is set up with the expectation that most people will become frustrated in the process, and then become disorganized and eventually give up... costing them in the final bill.

I remember someone telling me, "ohhh if you crash, the XXX will cover your expenses if you don't have insurance ". Reading you describe your experience in using your own personal insurance AND then the process and steps required by USAC's, was quite eye opening.

It is quite easy to see how discouraging this is to someone such as myself where this is not my background as it is someone like yourself. Even for you, this is quite a game of perseverance.

I don't want to live in a cave and not come out... but wow... it is scary when in the position of having no insurance (due to lay off from job, unable to afford it).

Thank you for the very well written article, Megan.

Very Informative!

As a fellow cyclist and lawyer, I commend you on a well-written and informative article. This is very practical advice that many people can use. (But hopefully, few will need it.) Best of luck in your cycling and legal endeavors!

Update

At veloswap last fall, I had a handful of folks stop by my booth and ask me to provide an update once this was all said and done. So -here is the final note.

Of course now that CO is governed by USAC, the ACA insurance is gone and all CO riders are covered under the USAC insurance (K&K) discussed above.

Final amounts billed by my providers: over $54,000. This is why riders MUST either have good health insurance OR have $5k saved up to cover the deductible so that USAC insurance will kick in. Otherwise you personally will be on the hook for the majority of the billed amounts.

USAC insurance (K&K) certainly helped by covering 70% of the portion of the bills I would have been responsible for. (my final out of pocket expenses were under $5k) ... All riders have this coverage available to them each time you enter a race, so there's no reason why you WOULDN'T pursue this coverage if you're hurt at a race.

However I had quite a time getting them to timely pay their portion of my bills. In fact, they sat on my ER hospital bill for over 4 months which resulted in the hospital sending me to collections. My insurance covered all but the $100 copay, so K&K owed $70 - I'd already sent in my $30 portion. And sure enough as we were refinancing our home, my credit report revealed that K&K had not yet paid their portion to the hospital so there was a collections mark on my credit until K&K finally mailed their payment in. These types of hiccups were typical of this entire process. That's why the rider must maintain good control and organization over their records and documents.

The bottom line and takeaway message I'd like racers to have is to be sure you protect yourself from massive debt and possible bankruptcy if you are injured in a bike race. The risks are high and chances of crashing are, sadly, pretty likely in this sport. Please be sure you get health insurance with a relatively low deductible, or (if you don't have insurance), that you can pay the first $5k of your bills so that USAC's insurer will kick in and help you pick up 70% of your remaining bills.

Reality of deductibles

First off, great enlightenment for me, problems with low ded's. They tend to cost so much more per month, especially if you are not getting it through the traditional employer program, I am fortunate to use the max on a HSA account, prepared to cover the loss until it kicks in. Lots of young people, or people with hiccups in coverage $ is tight, not an easy decision, cause if you can't pay the monthly higher premium, you get screwed for lapse in coverage, coming up with a bunch of dough is rough, I do know this, sticking your head in the sand only works until you need it, face health care is a bitch, consensus seems Obama care will not work, but that Bush head in the sand leadership doesn't appear to have us faired well either, sorry youngsters , we let you down

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