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Old     (bmartin)      Join Date: Jan 2007       07-28-2010, 11:17 AM Reply   
My son cracked 4 teeth while wakeboarding behind our boat about a month ago and has had oral surgery to fix them. More dental work on the way. Medical and dental insurance denied coverage for it for several reasons so no help from the health insurer. Would our boat insurance's medical payment cover this accident? We have US boat insurance and pasted what it says for their medical payment on their policy.

"In the event of on-board injury, your policy includes up to $5,000 in per person, per occurrence medical coverage, and up to $25,000 for Family Members."

We are looking at about $8K in dental oral surgery bills and not sure how "on-board injuries" are interpretted in this scenario and wanted to get a feel of what to expect before I called USBoat.
Old    ScottRobinson            07-28-2010, 11:20 AM Reply   
I would say call. I am a State Farm Agent and would advise to try it. Worst is they say no. Odds are they will, as I think "on board" simply means that. Not sure wakeboarding would be included but worth a shot.
Old     (alans)      Join Date: Aug 2005       07-28-2010, 11:20 AM Reply   
What do you mean, your medical and dental insurance denied coverage?
Old     (mendo247)      Join Date: Mar 2005       07-28-2010, 11:28 AM Reply   
Should be included. Mine specifically states that it cover skiers etc though. Let us know what they say.
Old     (bmartin)      Join Date: Jan 2007       07-28-2010, 11:37 AM Reply   
We maxed the dental benfit for him this year. He had his wisdom teeth out about 3 months ago. Medical doesn't pay for dental work, and though we had prior-authorization submitted, they denied the MD as being out of plan. Not to mention there is already some risk avoidance forms that were mailed to us. . Apparently my insurance doesn't pay for high risk activities. Long and short of it is, there seem to be too many road blocks with the medical insuran
Old     (bill_airjunky)      Join Date: Apr 2002       07-28-2010, 1:01 PM Reply   
Originally Posted by ScottRobinson View Post
I would say call. I am a State Farm Agent and would advise to try it. Worst is they say no. Odds are they will, as I think "on board" simply means that. Not sure wakeboarding would be included but worth a shot.
Considering the the Coast Guard considers skiers/boarders a part of the boat, it would be interesting if the insurance companies weaseled out of it this way. Seems like it would allow them to void pretty much every single riding injury if it was the case.
Old     (trace)      Join Date: Feb 2002       07-28-2010, 1:10 PM Reply   
Be very careful how you answer those "how did this happen" questionnaires. Every question is loaded, and their only purpose is to find a way to deny your claim.

I certainly hope my boat policy covers people riding behind it. Never really considered that it wouldn't. I can't see how it would be any different for your family vs. anyone else.
Old     (epic1)      Join Date: Oct 2006       07-28-2010, 1:44 PM Reply   
god bless this country....
Old     (BWB745)      Join Date: Jun 2010       07-28-2010, 4:05 PM Reply   
I am studying for the Alabama insurance exam now (taking next week).

From what my materials say is basically if someone is injured water skiing then they assumed the risk by doing so and that the boat insurance would not cover this.

Maybe your policy is different, or state regulations are different. Good luck.
Old     (dirwoody)      Join Date: Apr 2003       07-28-2010, 9:06 PM Reply   
I'm with Scott, as an adjuster, we get questions like this all the time. The worst they'll say is no, so it's worth the phone call to find out
Old     (chris4x4gill2)      Join Date: Sep 2009       07-29-2010, 6:15 AM Reply   
My boat insurance (skisafe) covers skiers on the medical protion, I cant remember how much the coverage is off the top of my head but I do know it covers watersports behind the boat.
Old     (psudy)      Join Date: Dec 2003       07-29-2010, 7:41 AM Reply   
You mean your son fell down in the boat and hit his teeth on the ski pylon? That sucks.
Old     (tre)      Join Date: Jul 2002 Location: WI       07-29-2010, 9:32 AM Reply   
Slightly off topic but how did your son crack 4 teeth? Did the board come off and hit him in the face? I want to know how to aviod such a thing in my family. Sorry to hear about you troubles.
Old     (mikebu)      Join Date: Aug 2008       07-29-2010, 9:37 AM Reply   
A mouth guard will prevent this or lessen the injury. Many pro snowboarders wear them...
Old     (bmartin)      Join Date: Jan 2007       07-29-2010, 9:54 AM Reply   
We have mouth guards now, but obviously that ounce of prevention is a day late and dollar short for him now. I recommend mouthguards to anyone wakeboarding, especially if you are trying new inverts where you may not spot your landing. 99cents versus $8000 in dental bills + pain + time off is a no brainer move IMO now.

I posted a mouthguard diddy where I described the wreck in the wakeboard section a month ago, but here it is again. He just learned tantrums and landed about six of them and when he tried another, he came up short and he put his knee into his chin. He was also concussed for about 8 hours but medical insurance paid for the ER trip less the copay. The knee to chin wreck is not that rare in wakeboarding. I put my knee to chin on an inside out backroll attempt last year. Thought I broke my jaw, but turned out I just needed a few stitches for the split chin. Should have learned from that but thought it was a freak thing.

Last edited by bmartin; 07-29-2010 at 9:57 AM. Reason: spelling
Old     (bill_airjunky)      Join Date: Apr 2002       07-29-2010, 11:31 AM Reply   
Didn't Randy Harris knock a couple teeth out some time ago in a similar way? Seems like he thought it was cool to be missing the two front teeth.

I emailed my insurance agent & got this response:

The skier/boarder is covered for medical under Safeco's contract, here's the definition:

L. “Occupying” means in, upon, entering or exiting a watercraft. This includes water skiing or any similar sport (except for parasailing, hang gliding, kite skiing or any similar activity using aircraft).

Note that the guy on the forum is likely getting accurate info, however. Some companies separate medical coverage and you have to pay extra for medical coverage for a skier. This also varies depending on what state they live in.

Your Umbrella would not pay medical expenses unless you were negligent. So if it's an accident or their own fault, you have medical coverage they can use. But if it's your fault and you were negligent and caused their injury, then your liability coverage will apply.

We had a claim denied from SkiSafe a number of years ago. And since then have been with Safeco, who has been a lot more cooperative. So you might check with whoever your insured by.
Old     (bmartin)      Join Date: Jan 2007       08-10-2010, 8:49 AM Reply   
Good news! Boat U.S. is stepping up and the accident is one that is fully covered under the medical payment policy Wakeboarding behind the boat IS COVERED with them. I do not have a check yet, but so far everything seems to be going pretty smoothly. I will be a Boat US customer for life if things keep going like they have! I only wish my health insurance was a little more like BoatUS.
Old     (alans)      Join Date: Aug 2005       08-10-2010, 8:51 AM Reply   
I work in the Health Insurance industry and still am confused why your health insurance isn't covering this? Never heard of anything like this.
Old     (bmartin)      Join Date: Jan 2007       08-10-2010, 9:17 AM Reply   
If you want to read a case study of the health insurance industry read on:

Alan, It is kind of complicated as this stradles 2 coverages, medical and dental. My son had some oral surgery to remove his wisdom teeth and to remove a benign cyst in his jaw in April or May. The oral surgeon is a dentist and an MD and files under our two different plans. The surgeon filed the claim with our medical after obtaining prior-authorization, and they paid a portion of the claim for his cyst removal sinc ethat was a medical condition. The wisdom teeth extractions were filed with dental and paid through dental, but that maxed or nearly maxed our dental coverage for him which is about $2-3K/year. My son then has emergency surgery scheduled after the wakeboarding accident with the SAME oral surgeon and he calls to get Prior Authorization. Next day he goes for surgery to extract that tooth and install an atificial one in his jaw. Two weeks later the medical insurance denies the claim and then denies the initial oral surgery for the cyst removal and is trying to collect the claim they already paid in April! Reason, out of plan provider. He also needs three crowns which he has not had yet from the dentist and that can only be covered under dental and since we maxed out coverage, no beuno for getting those paid.

This seems fishy to me and raises lots of questions. How can they pay the claim for the initial oral surgery in April for the cyst removal if he was out of plan back in April? When was the surgeon out of plan? After they were looking at another $3K health claim then decided to make him out of plan? It really frosted us, that our insurance is renigging on the claim filed in April. Not only do we have the bill for the emergency oral surgery, but now the oral surgeon is billing us for the April surgery they previously paid.

We are appealing the health insurance coverage decisions and would rather have the helath insurance cover it instead of the boat coverage, but am rather doubtful we will get any coverage. My wife and I are hopping mad at our insurer. We have heard from other medical providers that my insurer is notorious for slow payment and denying coverage and have begun not accepting patients with our carrier QualChoice.
Old     (alans)      Join Date: Aug 2005       08-10-2010, 9:37 AM Reply   
Sounds like someone is not telling the truth. Your doctor is either in network or out. The doctor can get prior authorization from the carrier whether or not he is in network, since your plan has in and out of network. If your doctor led you to believe he was in network, when in fact, he wasn't, you might have a case against him. Then again, it is ultimately the planholder's responsibility to check the status of their doctor's network status. Fortunately Health Insurance Companies don't and can't play games, as they are subject to their own contracts, by law, and without exception. On the other hand, I have seen many doctors do some really shady stuff over the years and every so often the insurance company will over extend itself to help out a client, such as in a situation like this.


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