Schu Schu Schu, BANG, Crash!!!! Oh dear, something seems to hurt. Since I seem to have become a statistic, I must be one of 35 skiers in every 100 who hurt themselves each year. I wonder if I have broken my leg? Little chance of that, as very few people break legs these days. It could be an arm, but then only one fifth of ski injuries are to the upper body, I’ll bet it’s the ligaments in my knee: they say one quarter of all ski injuries are to the knee.
The bloodwagon ride was OK, if a bit bumpy, and while I was patiently waiting for the doctor (I now know where the word ‘patient’ comes from) I began to think about the insurance policy I bought before leaving. Would it pay for this, that and the other?
Many articles on insurance talk about how wonderful the cover is and how high the sums insured are. If you are a regular skier, you will have heard it all before. It is therefore my intention to concentrate this article on how it works from the point of view of the client, the emergency service and the loss adjuster: in other words, the service behind the product.
First, a few basics to describe who’s who in the make-up of a wintersports insurance policy:
- The client, who buys insurance – usually from a broker.
- The broker, who places the business with an insurance company or at Lloyd’s.
- The loss adjuster, who represent insurers and handles claims in accordance with the policy wording. (Some insurance companies handle their own claims).
- The emergency organisation, which is retained by insurers to handle medical emergencies, confirm payment of local bills and arrange the repatriation of seriously injured or sick people.
Having established the extent of one’s injury and the doctor having recommended that you return home, it is advisable to contact the emergency service immediately. To establish which emergency service to contact refer to your policy – and remember to read the policy wording (referred to as RTPW from now on), or consult your rep. Give as much information as you can, whether it is for you or on behalf of a friend. This is the beginning of the service behind the product. Scant or poor information will hinder the emergency service. Good, concise facts will go a long way in helping them to help you. Below is a list of the information you should have ready:
- Name of patient
- Your name and telephone number if calling on behalf of a friend
- Nature of injury
- Age and sex of patient
- Name and telephone number of hospital
- Name of consultant, if known
- Name and telephone numbers of relatives in UK who may wish to be informed
- Patient’s UK address and, if possible, details of his GP.
From now on the emergency service should take on the job of looking after the patient, so relax.
Should your injury or illness be of a minor nature it is possible that the doctor will ask for payment of his whole bill, there and then. I am afraid you will have to pay it and file a claim on your return. If, however, the doctor does not ask for payment immediately and he offers to forward the bill to insurers for payment, please pay the excess to the doctor. It is most important that on your return to the UK you contact the loss adjusters to advise them of the claim as they are unable to pay the doctor until you have completes a claim form.
So much for the medial services and emergencies. How about the rest of the cover one would normally find in a wintersports insurance policy?
If you have booked the holiday and, due to an injury or unexpected illness to you, your family or even a friend with whom you had arranged to travel, you have to cancel your holiday, this would normally be covered under the policy you have purchased. The cover for this part usually starts from the date you have booked the insurance, so it is most important that you book insurance at the same time as the holiday! This section usually has a little more cover than described above, so RTPW.
The other part of this section is called curtailment. If you have to cut short your holiday, usually due to serious injury, the unused portion is refundable. To qualify, one would have to be admitted to hospital or repatriated to the UK on a doctor’s orders. Watch this section, as a minor injury that stops you from skiing but is not serious enough to have you sent home would not cover the loss of the whole holiday. Some policies do, however, cover loss of ski passes in this event, so RTPW.
Third party liability is very important – don’t leave home without it. Should you run into another skier and the injured party can prove you were negligent he might sue you for damages. Your action at the scene of an accident, whether involved or as a witness to the accident,
could help considerably – provided you do the right thing. Act as you would for a road traffic accident and do not forget: never admit liability to anyone. Of course, the best way to avoid being sued is not to hit anyone in the first place, so ski carefully and in control at all times.
Personal accident. This is often confused with medical expenses. It gives a lump sum payment for death, permanent disability or loss of earnings for temporary injuries. Most wintersports insurance polices have a lump sum for death and permanent disability, but vey few give any benefit for loss of earnings. (There is a separate scheme available from the British Ski Federation, which gives weekly benefits and higher sums insured).
Most policies these days give some degree of cover for delays. What some cover, others do not, and what some leave out, others cover. Most, however, give ‘misery money’ – a small lump sum payment.
There are a number of ‘retail’ policies on the market, most of which are available at an additional premium as part of a general travel insurance policy. To include wintersports, the premium is usually 2.5 times the summer rate and nor specifically tailored to skiing. It is therefore advisable to approach a broker who specialises in wintersports insurance. The Ski Club of Great Britain has been marketing such a policy for over 30 years.
If your holiday is organised through a tour operator, and provided you are happy with the cover they have recommended, you are well advised to take out their insurance package. It is usually cheaper than other policies on the open market , the resort rep will be familiar with the systems for that insurance company and will have been briefed on how to handle emergencies. It makes it simpler if everyone is with the in-house arrangement.
For those already covered by private medical insurance in this country, the following is a hypothetical telephone conversation between a subscriber and a medical insurer:
Subscriber: I am covered by Medi-Sure and I’m planning to go skiing this winter. Am I covered by your policy?
In this case the answer was correct, but the question was wrong. Let’s try again:
Subscriber: I am going skiing next winter and I am covered by Medi-Sure in the UK. Am I also covered abroad?
Medi-Sure: You are covered abroad, but for the same limits and limitations as you enjoy in this country.
Private medical insurance will not, of course, cover cancellation, public liability, baggage, skis and so on. Therefore, one should still obtain a wintersports policy to cover these items, as well as full protection for medical expenses.
The E111 form can be obtained from your local DHSS office. It is a good idea to obtain this before going away (allow 4-6 weeks). It costs nothing and cover a proportion of medical expenses in national hospitals as an in-patient in EEC countries only (not Switzerland or Austria). It does not cover repatriation, mountain rescue, ambulance charges or visits to a private clinic. Therefore it is not much use on its own – but it can take the sting out of large bills and helps to keep premiums down in the long terms.
Ski insurance is often available in the resort you are visiting. Do not buy it. Such policies are designed for locals who already have a certain amount of cover for medical insurance under their own national insurance scheme. These policies are consequently very limited. In addition to which, of course, claims would have to be presented in that country and possibly in the local language.
If you have a claim, do not panic. Calmly RTPW to establish who is handling the claims for the policy you have bought. Telephone, or better still, write to them asking for a claim form. Complete it, enclosing all the documentation they have asked for. It is your responsibility to formulate the claim and provide loss adjusters with all the relevant facts and evidence before they are able to consider your claim. If you are claiming for something that may or may not be covered, depending on the interpretation of the wording, this is what is known as a grey area. In these circumstances, do not expect or demand your claim to be paid. It is more appropriate to ask if underwriters could ‘give sympathetic consideration’ to it. This approach may win the sympathy of the claims handler who, after all, is only a human being.
Do not forget to insure. Our research shows there is still a small percentage of skiers who do not insure. And when you have insured, read the policy wording.
From Debrett’s Ski Resorts of Europe, Sterling Publications Limited, 1987