Insurance Mess: You’ll Want To Check On This

First, let me jump to the ending:  Marty is fine.  Healing…walking…  He is fine.

Now, the backstory:

Marty is an awesome adult volunteer in our senior high ministry.  He’s been doing this for years and is fantastic.  He ‘gets’ good, relational ministry, and is a ton of fun to have around. He is a blessing to our congregation.  Marty is also a black-diamond skier.  And he’s gone with us on our annual senior high ski retreat to Bozeman, Montana for years.   This past February,  he was cruising down a hill…not even that steep a hill when control was lost, his body spun one way, and his skis remained stationary.  Basically, his body moved in ways not designed by the architect.

Marty suffered a badly broken leg.

Other folks were in the vicinity, the ski patrol was called, Marty was taken by ambulance to the Bozeman hospital and his road to recovery began.

Marty had to stay in Bozeman an extra couple of days, following surgery.  So our congregation flew his wife out to be with him, and then paid for them to fly home together.

I told Marty and his wife that normally, the individual’s insurance was primary, and if there was stuff that wasn’t covered, the church’s insurance kicked in and would cover the balance.  That’s always been my understanding of how it works.

So a few weeks later, there were outstanding bills.  They gave them to me and I began the process of running them through the church’s insurance.

They were denied.

What?  Why?

It turns out that our congregation’s insurance policy has a “sports exclusion” written into it.  If an injury happens while doing a sports-related activity, it is NOT covered by the church’s insurance.

You’re kidding me?  50% of what we do could be interpreted as sports-related.

Skiing.  Ice skating.  A fun-run.  Volleyball.  Dodgeball.  Rock climbing.  Sledding.  Bowling.  Rollerskating/blading.  Field games.

It turns out, that if Marty had tripped down the stairs of the ski chalet while wearing his ski boots, he would be covered.  But skiing does not fit the criteria because of a sports exclusion.

So we asked  “Is that exclusion just for our adult leaders?  What about young people themselves.  They’re covered, aren’t they?  Nope.  The same exclusion exists for everyone.

How is that possible?  How can we have an exclusion like that?

No one knows.  I think we just always assumed that we were covered.

So as a congregation, while we’re paying that overage ourselves (it’s the least we can do considering that he was there working “for us”)  we’re also investigating:

1. What would it cost for us to get that exclusion taken out of our policy?  No doubt, it would cause our premiums to go up, but it still might be cheaper than having to cover these costs ourselves in the future.
2. We’re also asking “what other exclusions do we have that we’re not aware of?  Any other surprises out there?

I figured, if our congregation, a pretty large one with people who pay attention to this stuff on our staff, and who do a really good job, didn’t know about this exclusion, other congregations probably also don’t know.

So I’m tossing this out there as a ‘learn from us.’  It might be worth double-checking your own coverage.  I don’t have any ‘answers’ yet. We’re still in process.  But if I learn more, I’ll let you know.

Ultimately, we are grateful that the broken leg, though serious, wasn’t life-threatening, and that there were good people all along the way to help Marty and our group.  Thanks be to God!

Blessings!
Todd