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Coverage Denied

Insurance Discrimination Threat Hangs Over Motorcycling

By Jim Witters

Street motorcyclists and off-highway riders who hoped that the Patient Protection and Affordable Care Act would require health-insurance policies to cover treatment for injuries sustained while riding are in for a big disappointment, experts say.

The president’s signature health-care reform legislation, which began rolling out in January, failed to close the gaping loophole in the 1996 Health Insurance Portability and Accountability Act that allows employers and insurance companies to exclude “risky activities” from coverage.

Instead, employers and insurers can continue to establish arbitrary standards of behavior and determine health-care coverage based on the source of the injury.

It’s not just motorcyclists and all-terrain vehicle riders who are affected.

Other activities typically excluded by health-care plans include hang gliding, skydiving, bungee jumping, parasailing and rock climbing. Also excluded: automobile, aircraft or speed-boat racing; reckless operation of a vehicle or other machinery; “ultimate fighting;” use of explosives; and travel to countries with advisory warnings.

While injuries resulting from these activities can result in costly medical bills, motorcycle and ATV riding are arguably everyday activities enjoyed by an estimated 22 million Americans.

All too often, injured motorcyclists and ATV riders don’t realize the limits of their health-care coverage until they are lying in a hospital bed.

Devastating effect

Kent Stuermer

Kent Stuermer of Roseburg, Ore., crashed his Honda CR250 in December, breaking his neck and hand and tearing ligaments in his shoulder.

The results: $173,000 in medical bills that his health-care plan won’t cover, and the prospect of those expenses rising to more than $250,000 when all the treatments and rehabilitation are complete.

“That’s more money than I’ve made in my whole life,” Stuermer says.

Stuermer’s C2 vertebra is secured with a screw. He is wearing a neck brace. His arm and hand are in a cast. He can’t work his truck-driving job. And the 56-year-old and his wife are scraping by on her $700-a-month Social Security check and drawing down their savings account.

The Stuermers bought their policy directly, because his employer does not provide health-care benefits.

“I should be the poster boy for the campaign to get people to read their insurance policies,” Stuermer says. “Most everybody trusts their insurance agent. You look the policy over a little bit, see you have $2 million in coverage, then sign it.”

The exclusion for injuries sustained in dirt bike crashes is on page 22 of Stuermer’s policy.

When he found out in mid-February that his policy would not cover his medical bills, Stuermer called his insurance agent.

The agent reminded him that he had 10 days to read the 50-page policy before signing it.

Stuermer wrote a letter to the insurer, called a lawyer and enlisted the help of a state lawmaker. But no one has been able to help.

“We are just up against a hard wall here,” Stuermer says.

Injured firefighter

Lt. James Baker, a firefighter in Sebring, Fla., crashed his motorcycle along U.S. 27 while off-duty in June 2009. He was not wearing a helmet.

The city’s insurance carrier denied his claim for about $86,000 in medical expenses, saying the employees’ policies called for riders to wear helmets, even though Florida law does not require them.

The provision had been added to the policy in 2005 to exclude “activities of a hazardous nature,” but the city failed to inform the affected workers.

The city eventually reached a settlement with Baker, who successfully argued that he sustained no head injuries in the crash, so the helmet requirement was irrelevant.

But the result could have been much more dire.

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