On the piste

The stereotypE of skiers hobbling on crutches, covered head to toe in plaster, has emerged for a very good reason ' the probability of being injured through winter sports is high. According to ski-injury.com, the latest Scottish ski and snowboard injury database study for the 2000-2001 season, a total of 845 injuries were recorded for just 775 individuals.

With such high statistics, winter sports enthusiasts need to make sure they are covered for medical treatment should they get injured on the slopes. However, it is no surprise that both private medical insurance (PMI) and critical illness (CI) policies are littered with numerous exclusions to cushion the costs of this high risk area.

Cover is complicated as insurers tend to weight premiums on particular activities. The fact most winter sports enthusiasts will need cover outside the UK adds another layer of cost. As the most common injuries from winter sports tend to be condition such as sprains, fractures and joint injuries, ongoing treatment is often needed so insurers also have to take these potential costs into consideration when establishing exclusions and premium weightings. It is for this reason many PMI providers choose to cover winter sports injuries as an optional add-on.

The small print

Andrew Green, specialist PMI consultant at Green Denman, says it is crucial to check the small print before clients take to the slopes, as almost every provider has different criteria when it comes to winter sports.

'Many providers offer cover, but usually as a bolt-on plan. This kind of cover generally forms a sub-set of insurance from the private medical insurance policy itself. Treatment when back in the UK is usually provided and some policies do include emergency cover when abroad, up to certain limits. It is very important to check the small print as skiing and other winter sports activities may be classed as hazardous sports and excluded,' he says.

With off-piste sports such as heli-skiing and snow mobilling becoming increasingly popular, providers are having to regularly review their winter sports exclusions. Until recently, Clinicare did not have any exclusions for winter sports on its PMI policies, but due to an increase in claims, the provider has had to tighten its claims criteria.

'The number of claims have been increasing so much we have had to introduce exclusions,' says Rachel Jenkins, marketing supervisor at Clinicare. 'Anyone planning to do professional, competitive winter sports will now find that cover is automatically excluded.

'More hazardous sports such as off-piste skiing, ski jumping, heli-skiing and ice hockey are also excluded. With winter sports injuries it is not just the immediate effects of the accident, but also long-term treatment related to the accident and this is also now excluded by PMI policies once a client returns home. All PMI policies include worldwide travel cover, but an extension is now needed on top of this to cover winter sports.'

The effect of high claims has also hit Norwich Union Healthcare. The provider does not cover winter sports injuries through any of its PMI options. Treatment in the UK for rehabilitation is sometimes permitted, but a travel policy needs to be purchased if clients want immediate cover for injuries incurred on the slopes.

Western Provident Association (WPA) also declines to cover any winter sports injuries ' at home or abroad ' due to the high claims ratio.

When it comes to more hazardous sports, clients are therefore often better off disregarding their PMI policy altogether and taking out specialist travel cover instead. Specialist providers such as Citybond Travel Consultants can provide more cost-effective cover for sports injuries that PMI providers are less able to insure.

'Every year people are dreaming up new sports and it is our responsibility to keep up with emerging activities. When it comes to medical claims, difficult snow conditions can mean a huge rise in injuries, but because we specialise in this area, we can still offer comprehensive cover,' says Iain Chalmers, sales director of Citybond.

Specialist help

Citybond, like many other specialist travel consultants, covers injuries related to any winter sports including not only medical costs, but also emergency rescue and even treatment such as physiotherapy when clients return to the UK. Its worldwide policy, Spectrum Winter Sports, covers activities such as heli-skiing, ski-diving, snow mobilling and tobogganing at no extra cost. The most hazardous sports, such as scuba diving under ice, are also covered, with a medical excess of £150.

But not all PMI providers are completely adverse to covering winter sports injuries. Standard Life Healthcare (SLH) has worldwide travel cover attached to both its Primecare Plus and Primecare Gold policies and policyholders can claim medical treatment for any injuries that happen on piste. Ongoing treatment when back in the UK is also provided, unless injuries occur off piste.

Karen Kinder, spokesperson for SLH, says: 'Policyholders are covered for skiing and snowboarding injuries that are incurred on piste, including evacuation to medical facilities when abroad and repatriation to the UK. Once back home, clients will also be able to claim for treatment related to on-piste injuries. Those who want to take part in off piste activities will have to purchase add-on travel insurance to cover injuries when abroad and will not be able to claim for treatment relating to those activities through their PMI policy when they return to the UK.'

PPP healthcare is also undeterred by on piste activities, but normal PMI polices are only valid in the UK. The insurer does, however, give clients the option to upgrade their PMI policies to cover off piste activities and provides add-on travel insurance for clients wishing to go abroad.

Ben Faulkner, spokesperson for PPP healthcare, says: 'If a member has a UK PMI policy they will be covered for skiing and snowboarding accidents on piste and treatment afterwards as long as they were not skiing for competitive purposes. We also provide travel insurance for on-piste cover abroad with an upgrade option for off-piste activities, but this all means extra cost.'

It's what you do....

For winter sports in the UK, BUPA's normal PMI policies will also provide cover for all injuries. For cover abroad, BUPA provides an annual travel policy for winter sports, but clients do need to state which activities they will be participating in as the premium will be affected. When it comes to ongoing treatment for injuries back in the UK, full cover is provided regardless of whether the accident happened abroad, or how hazardous the sport was that caused it.

'We would always cover treatment when in the UK. We do not see the point of interrogating clients about how they broke their leg and what they were doing. We do not usually ask them in other circumstances ' clients should still be entitled to cover,' says Simone Miller, spokesperson for BUPA.

PMI is not the only kind of protection that winter sports injuries can have an impact on ' CI policyholders may also want to claim, should they lose a limb, for example.

The Association of British Insurers' (ABI) industry standard exclusion does not include skiing, unless it is off piste. So most providers will provide cover as long as policyholders have not gone out of their way to attempt more dangerous activities off piste.

Nick Kirwan, chairman of the ABI Critical Illness Working Party and head of product development at Scottish Provident, says that if winter sports were excluded from all CI policies, it may put people off purchasing cover. 'One of the issues we discussed in the working party, when coming up with the industry standard, was that we were worried about excluding winter sports when the socio-economic groups that are most likely to buy critical illness products are the same groups that would be more likely to participate in winter sports,' he says.

CI policies provided by Scottish Provident do not exclude any winter sports, regardless of any injuries sustained from more hazardous activities. There is also no exclusion if policyholders are injured while on holiday abroad, as according to Kirwan, this is not regarded as anti-selective behaviour.

Matt Rann, head of underwriting and claims at Scottish Equitable, says most providers will provide cover as long as medical conditions occur through purely recreational activities.

'Some companies historically have claims turned down on hazardous pursuits, but now most providers tend to provide cover. If there are exclusions, they tend to be specific activities, rather than winter sports as a whole. If clients need to claim for conditions that were incurred through recreational, rather than competitive or professional activities, most providers will pay out,' he says.

Injury from winter sports activities is a high risk area to insure. Unfortunately, apart from staying on piste, there is little that sports enthusiasts can do to make PMI add-ons cheaper. For the real adrenaline junkies, specialist travel insurance will provide the most comprehensive cover. But, whatever the policy, clients need to ensure that they are aware of exclusions and that some activities undertaken on impulse may not be covered. Although CI providers tend to take a more liberal attitude, again it is important exclusions are highlighted to avoid disappointment if it comes to claim. Unless care and attention is paid to the small print, policyholders taking to the slopes could find that medical costs soon begin to snowball out of control.