As healthcare costs continue to rise, more and more insurance companies are including exclusion clauses to policies that can deny coverage for risky behavior such as motorcycling.
The American Motorcyclist Association (AMA) is encouraging its members to check the language in healthcare policies and to also check any subsequent riders or other communications from the insurer.
A check for examples of situations where motorcyclists may not be covered resulted in the information shared below.
When explaining HIPAA (Health Insurance Portability and Accountability Act of 1996), the Centers for Medicare and Medicaid Services (CMS) gave an example of a fictional employee, Jane Smith, who worked for the fictional company ABC. The discussion centered on Jane’s motorcycle riding. Since the company has an exclusion clause that says participation in high risk recreational activities are excluded from coverage, injuries resulting from these activities will not be covered.
In Nebraska, the Star-Herald newspaper published an article regarding the Scottsbluff Police officers and the city’s healthcare coverage and specifically the exclusion of coverage for police officers and family members engaged in activities such as motocross, horse riding, snowmobiling, and other hobbies.
City officials argued that the exclusions minimized the risk and cost to the city. The Scottsbluff Police Officers Association countered with the argument that said considering the rural area of western Nebraska where Scottsbluff is located, these types of exclusions would affect many on the force. Dick Douglas, attorney for the officers, said the city’s exclusion policy is "truly out of the ordinary."
Other activities deemed ‘hazardous’ by the city’s insurance and therefore not covered include hang gliding, skydiving, bungee jumping, parasailing, use of all all-terrain vehicles, rock climbing, ultimate fighting, use of explosives, racing (automobile, motorcycle, aircraft, or speed boat), reckless operation of a vehicle or other machinery, or travel to countries with advisory warnings.
A story published by a Tampa area newspaper tells of a Sebring city firefighter who received abdominal injuries in an off-duty motorcycle accident and was denied health insurance coverage because the city’s health insurance required him to wear a helmet while riding and he was helmetless on the day of the accident.
The firefighter fought the denial of benefits because when he was hired the clause was not in the insurance wording and the clause was added seven years later. He didn’t remember receiving notice of the change in his policy and the city clerk wasn’t sure the city employees were ever notified of the change. The firefighter said that had he known of exclusion, he would have worn a helmet.
The city’s insurance company did eventually pay the claims.
Even companies, like Geico, that underwrite motorcycle insurance are including clauses that exclude certain type of motorcycle riding that "might result in bodily injury losses sustained while your insured motorcycle is used in, or in preparation or practice for: any marathon-type contest, use in competition, and/or sporting event, or while on any race course or facility designed for racing; or any contest which sanctions continuous riding for 24 or more house and/or mileage accumulation in excess of 500 miles per 24 hour period."
Wow. The mileage restriction would include most all Iron Butt Association rides and even long vacation trips.
Steven M. Gursten, an attorney representing drivers and riders in Michigan, suggests thoroughly checking insurance policies and to also consider adding Personal Injury Protection (PIP) benefits to automobile and motorcycle policies, especially if one’s healthcare insurance is a self-funded ERISA plan or an HMO.
Source Examiner
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