US Figure Skating sports accident insurance and "ah, the dreaded mohawk"

[dlbritton]

Does anyone have experience with filing a claim under the Basic Skills/ US Figure Skating sports accident insurance program?

Does anyone know if this would cover an accident while practicing in a public session but not in a class/private lesson?
If it makes any difference I was using an LTS practice session punch card the rink provides.

I didn't really think much about an insurance claim because I knew the rink had no liability, but then I was reading over my basic skills
information and saw mention of the sports accident coverage.

I spoke to someone at US Figure Skating and she was not sure if this would be covered, that it would be up to the insurance company.
When I was telling her what happened her comment was "ah, the dreaded mohawk".

[AgnesNitt]

You know, back in 2009 I broke my ankle skating (I was in ISI and it had basic skills insurance at the time). I know you have to have an incident report (The rink asked "Did you hit your head?" over and over and gave me a report--it was a really well run rink). However, I never went to the trouble to apply. I think it only covers costs not covered by your own insurance.
I encourage you to apply.
If it turns out to be impossible to get anything out of the company,  you'll be doing all of us a favor by providing a report.

This is called 'excess accident insurance'. I have a friend in the insurance business, I'll ask her what she knows about it.

[dlbritton]

The policy has a $2500 deductible and is secondary if you have other insurance, but every bit will help.
$500 deductible for Elite skaters.

[tstop4me]

When I was telling her what happened her comment was "ah, the dreaded mohawk".

Does this mean that it's common for skaters to suffer serious injury when doing a mohawk? Or am I parsing the code wrong?

[dlbritton]

That is how I took it. I have seen somewhat similar comments elsewhere.

I know my skating director cringed when I would do them, apparently I step down too close for her comfort, possibly leading to a 'click of death". I don't think that is what happened when I fell as I was actually standing still and just going through the motions.

[lutefisk]

Four years ago I busted my right radius attempting a 7-step Mohawk combo (an ISI thing) in my weak direction.  Last year I busted my right humerus and smacked my head hard enough to require a crainitomy.  Can't remember what the hell I was attempting.  Nothing heroic.  Probably tripped over my picks, but that small part of my memory was erased and hasn't come back so I'll never know.  Since no lawyers chased my ambulance, it didn't occur to me to sue anybody.  Just a simple minded country hick.  Anyway, our son is getting married this weekend.  Wife told me to stay the hell off the ice 'til after the wedding.  She doesn't want to see any photos of me sporting another cast.

[dlbritton]

Changed the title because I want to focus on the sports accident aspect. The mohawk comment was secondary.

[FigureSpins]

I know three adults who were injured while skating.  They all said the sports accident policy was useless because it has a high deductible that only applies to the costs not covered by personal medical insurance.  I was surprised to hear that; I assumed it would at least cover the co-payments.

I wonder if skaters could buy a personal accident insurance policy that would provide better coverage?

[rd350]

Wow @lutefisk!  I guess a cast, or other medical dressing could really mess up the wedding photos.  Smart wife I think though.

@figurespins I think personal accident insurance would either carry a high deductible as well, or it would cost more than it may be worth.

I also thought the ISI insurance would cover co-pays, etc.  That's a big deductible, but then it's like $50 for 5 years so that kind of makes sense.

[dlbritton]

US Figure Skating probably throws in the accident policy because the potential payouts are probably pretty low. My primary insurance has a $4000 out of pocket max so at most the USFS policy would pay $1500. They probably count on other policies having some type of max as well.

[dlbritton]

Just submitted my Accident Report and 42 pages of EOBs (lots of boiler plate included) to USFSA for processing. 13 doctor visits so far.

I will keep the group posted on how the claim is resolved. I look at this as mana from heaven if I recover anything.

[icedancer]

So something really happened to you?  I must have missed it in one of the other threads - were you seriously injured in the mohawk incident?

[dlbritton]

So something really happened to you?  I must have missed it in one of the other threads - were you seriously injured in the mohawk incident?

Yes, (in injured reserve thread): broken left fibula and torn ligaments/cartilage in left ankle resulting in ORIF surgery to stitch it all back together. Was in cast for 8 weeks, been on crutches/ air cast for 3 weeks, hope to transition from crutches next week. Expect to be in air cast til mid July.  Full recovery expected by November/December.

[icedancer]

OH MY GOD!!!

That is horrible - I don't actually look at that thread because I just don't want to know I guess - I have a number of ongoing things at my age (62) but try not to dwell - maybe I will be in touch with that forum... have always learned a lot from this particular group.

Anyway, I hope you are better quickly and will return to the ice when you are ready!

[Query]

http://www.usfsa.org/content/Insurance%20Program.pdf says

"Bodily Injury or Property Damage: The policy DOES NOT respond to any event or
activity, workout or organized practice except when scheduled under the direct physical
supervision of a coach or staff member approved by the Named Insured."

I don't know if that is up to date, or if it applies to your case.

http://www.usfsa.org/content/ClubMattersSummer2015.pdf says

"There should never be unsupervised activities on the ice. A coach/instructor or
responsible adult must supervise all skating activities."

I bet the USFSA says they are not responsible for injuries occurring without direct instructor supervision...

I'm not a lawyer. You may need one.

It would cost A LOT to cover the costs of injury treatment, lost income, and lost time. There is no way they can cover the costs of most injuries, for the prices USFSA charges. In some ways, it isn't good for sports and those who participate in them to have other people be held responsible for your injuries unless they caused them - most sports facilities and clubs would have to close down. OTOH, it may reasonably be asked why USFSA insists skaters in BS classes get sports accident insurance. There should be some benefit, to someone other than the USFSA.

[AgnesNitt]

http://www.usfsa.org/content/Insurance%20Program.pdf says

"Bodily Injury or Property Damage: The policy DOES NOT respond to any event or
activity, workout or organized practice except when scheduled under the direct physical
supervision of a coach or staff member approved by the Named Insured."

Well, I think that's interesting. I read through it, and I think it's so well written that the company never has to pay out anything.

[dlbritton]

http://www.usfsa.org/content/Insurance%20Program.pdf says

"Bodily Injury or Property Damage: The policy DOES NOT respond to any event or
activity, workout or organized practice except when scheduled under the direct physical
supervision of a coach or staff member approved by the Named Insured."

I don't know if that is up to date, or if it applies to your case.

That is under the Commercial General Liability Coverage section and (I believe) would apply to the rinks liability for an injury.

Under the Sports Accident Coverage section it states:

Class II – While participating in figure skating lessons, practices and competition sponsored, sanctioned and supervised by the policyholder including travel to, during or after such activities as a member of a group in transportation furnished or arranged by the policyholder.

It could center around "supervised". The rink always has someone in charge, but not necessarily on the ice or outside the rink but observing skaters. The practice session is obviously sponsored and sanctioned by the rink.

http://www.usfsa.org/content/ClubMattersSummer2015.pdf says

"There should never be unsupervised activities on the ice. A coach/instructor or
responsible adult must supervise all skating activities."

I bet the USFSA says they are not responsible for injuries occurring without direct instructor supervision...

I'm not a lawyer. You may need one.

That is under a Risk Management article and is appears to be addressing rink liability.

It would cost A LOT to cover the costs of injury treatment, lost income, and lost time. There is no way they can cover the costs of most injuries, for the prices USFSA charges. In some ways, it isn't good for sports and those who participate in them to have other people be held responsible for your injuries unless they caused them - most sports facilities and clubs would have to close down. OTOH, it may reasonably be asked why USFSA insists skaters in BS classes get sports accident insurance. There should be some benefit, to someone other than the USFSA.

With a $2500 deductible and being secondary they probably don't expect to pay out very often, and probably don't in reality either. I believe the Sports Accident insurance is included as a PR move. USFSA is not insisting BS skaters get insurance but rather provides it as a benefit.

If my claim is denied I probably won't pursue it beyond one appeal, certainly not worth getting a lawyer. I expect to recover $1500 maximum, which while not a trivial amount , is also not something I originally expected or counted on so any amount will be gratefully welcomed.

I didn't pursue anything earlier because I certainly knew the rink wasn't responsible for my fall and injury but once I saw they have the Accident insurance I decided it is worth pursuing.

[TreSk8sAZ]

Under the Sports Accident Coverage section it states:

Class II – While participating in figure skating lessons, practices and competition sponsored, sanctioned and supervised by the policyholder including travel to, during or after such activities as a member of a group in transportation furnished or arranged by the policyholder.

It could center around "supervised". The rink always has someone in charge, but not necessarily on the ice or outside the rink but observing skaters. The practice session is obviously sponsored and sanctioned by the rink.

Sanction is a term of art in the US Figure Skating rules. I believe this is actually referring to practice ice and competitions that have applied for and received a US Figure Skating sanction. Sanctions are required for such activities as exhibitions, competitions (which includes practice ice), and any time any non-club members are invited to ice time. The sanction is obtained by the Skating Club so it would likely not be referring to something that is just held by the rink, rather something that is sponsored and supervised by the entity that requested the sanction for the activity.

For example, no sanction is needed for a freestyle or public session at my rink because they are run by the rink and there is no performance aspect. But the exhibitions held by the rink as part of the summer training camp require a performance sanction because the public is invited to watch the skaters do their programs by themselves on the ice.

It's worth a try, but I wouldn't be surprised if the claim is denied.

[Query]

USFSA might pay because fighting the case might cost more than paying. But the very fact that you have made it public here might mean they can't afford to pay, because too many people would follow your example and apply. Injuries in all sports are too common - they would have to charge a lot more for insurance than they do.

It's true that the USFSA doesn't explicitly require BS skaters to get insurance directly. But they require BS membership for lessons and competitions - and perhaps soon for tests - and BS membership includes insurance. They also require BS instructors and BS programs to have insurance. But many rinks, like mine, use general liability insurers, rather than the USFSA, or get insurance through PSA (I think).

Regardless of insurance claims, I hope you recover well, and that you aren't scared away from skating and other sports. Good luck on healing!

[dlbritton]

Just sent off my EOBs to the insurance underwriter along with a form describing accident and other insurance coverage.
The form has pretty generic sports injury related questions. Nothing about being in a lesson or competition.

Pertinent questions on the form were:
     Activity participating in at time of injury:
     Name/location of accident (include city and state):
     Describe injury (including part of body injured):
     Describe how accident occurred:

Keeping my fingers crossed that I get something. Rereading the Description of Coverage it does cover Physical Therapy (up to $1000), which I start tomorrow.

As an aside, at chair yoga today, the question following my reply that I fell figure skating was: Oh, were out with your grandchildren?  followed by an incredulous look when I explained that I have been taking lessons for 3 years. The grandchildren question seems to come up fairly often.

[dlbritton]

Interesting information about ISI accident insurance:

Who is protected : All currently registered ISI Skater Members.

Covered activities: While participating in ice skating activities. Coverage excludes all commutation/travel to and from.

Coverage: Accident Insurance

Maximum Amounts: $25,000 Accident Medical Expense Benefit, (Excess basis)
$ 1,000 Deductible amount per accident

[AgnesNitt]

dlbritton

Did you ever hear from the insurance company?

[dlbritton]

dlbritton

Did you ever hear from the insurance company?

I have submitted all of my EOBs and itemized statements to the insurance company and am waiting now. At first I sent EOBs and the hospital/surgeon bills but they needed the claim format (with "procedure" codes and descriptions) sent by providers so I have sent those. No overly detailed questions so far about the accident from insurance company. USFS claim form was more detailed. USFS probably filters some claims and forward rest to insurance company. Hopefully insurer does cover all skating related accidents at a USFS rink for USFS members. Again, since the policy has a $2500 deductible I doubt they get very many claims.

[dlbritton]

Just got a call from the insurance adjuster. Most of the charges (in excess of the deductible) I submitted will be covered and I will be getting a check for around $1000 soon. 
Once the physical therapist provides more documentation my co-pays for PT should be covered as well. Mind you, I am still $2500 out of pocket but at least it is something.

I'll update this once I really have a check in hand, but it looks like the insurance does actually pay off.

[AgnesNitt]

Just got a call from the insurance adjuster. Most of the charges (in excess of the deductible) I submitted will be covered and I will be getting a check for around $1000 soon. 
Once the physical therapist provides more documentation my co-pays for PT should be covered as well. Mind you, I am still $2500 out of pocket but at least it is something.

I'll update this once I really have a check in hand, but it looks like the insurance does actually pay off.

1/3 of something is better than nothing of somethng