A sporting chance

Private medical insurance (PMI) providers are not too keen on sporting types, which can present a problem if you are a keen sports person who needs to be fit to participate in your chosen activity ' be it canoeing, horse riding, football, golf, or bowling. A simple muscle strain or back injury are probably the most common injuries sustained by sports people, but more serious problems such as a torn cruciate ligament can bring about a premature end to a sporting career.

So logic would suggest that someone who plays a lot of sport ' either on a recreational or professional level ' needs the front-end benefits of a comprehensive PMI policy, such as outpatient diagnostics and physiotherapy. And as more people turn to alternative therapies, a policy that provides easy access to an osteopath and a chiropractor would be desirable for those people who participate in an active sport.

Reading the small print

Most comprehensive PMI policies provide an alternative/complementary treatment benefit, but the majority of insurers insist on referral from a GP or a consultant. This means claims procedures need to be looked at very closely, as access on referral by a GP is generally quicker than access via a consultant and speed of access is an important consideration.

Two providers that stand out from the crowd in this respect are Norwich Union Medios and Clinicare. NU Medios Healthcare and Executive Plus policies both provide direct access to an osteopath, a chiropractor and acupuncture treatments without the need for referral from a medical professional.

The Clinicare Carte Blanche policy also provides access to alternative/ complementary treatments without referral. It is now generally accepted, particularly in sporting circles, that strains and bone displacements are often best treated by an osteopath or a chiropractor. The fact that no referral is required by an insurer means quick access to a practitioner and, hopefully, a speedy return to the sporting field.

Plans for all budgets

A practical and possibly more affordable alternative to a comprehensive PMI policy is a cash plan sold alongside a budget PMI policy.

There are a number of cash plans available that will pay a full refund on specialist consultations, physiotherapy, osteopathy, a chiropractor and acupuncture, up to an annual limit.

However, attention should be paid to the limits on individual benefits, as well as overall limits that are provided by the policy, to ensure that they provide sufficient cover for foreseeable circumstances. If inpatient or day-case hospital treatment is required, the PMI policy will generally provide speedy access and cover the cost of treatment.

As many advisers will have discovered, most PMI insurers consider sports people to be high risk and tend to give them a wide berth. Professional sports people are generally impossible to insure for any condition arising from their sporting activity, although domestic cover ' that is for any acute illness or injury not related to their profession ' can be provided.

Amateur or pro?

But what is a professional? One client was training full time and canoeing almost every day in order to make the Olympic squad and had State Lottery funding, but because he was not being paid a salary or prize money, he was not considered to be a professional.

Having trawled around the insurers and suffered many rejections, we eventually found an insurer happy to provide him with a comprehensive policy at standard rates. Although he received Lottery funding he was still, in their eyes, a student who was an amateur sportsman. Other insurers considered his sporting activity to be of a professional nature and were not interested in providing cover.

This is certainly a grey area, as there seems to be no common approach to the subject of sports people within the PMI industry.

So what makes a person a professional from an insurance perspective? Is it the remuneration an individual receives for engaging in a sporting activity, or is it the frequency they engage in that activity? It would help if insurers were able to provide a common interpretation on the subject of professionalism and who or what can and cannot be covered.

And does it matter whether someone is a professional, semi-professional, or an amateur? A professional who trains regularly, eats the right food and has a clean lifestyle may be considered a good risk against injury compared to the amateur who frequents the pub, sits in front of a TV playing computer games half the night and lives on a diet of fast food when they are not playing sport.

On the other hand, the professional who trains and plays hard because their livelihood depends on it could be a higher risk than the amateur, who just wants a bit of fun and does not over exert themself.

Covering footballers

Anyone who has played football, will tell you that you are more likely to get injured by taking a half-hearted approach to a tackle, than you are by putting everything into it. Muscles and limbs that are only called upon once a week to perform to their limits are more likely to suffer strains, aches and pains than those that are honed to perfection by regular training.

We were once approached by a mini minor football league in Kent. The league comprised boys' amateur football teams, ranging from eight to 14-year-olds who played in local parks on a Sunday afternoon.

They were pro-active in raising funds and consequently had a healthy bank balance. The league wanted to be seen to be providing the best for its boys and was interested in a group PMI policy for over 700 members. One would assume a boy playing football on a Sunday afternoon and covered on a group policy is no greater risk than a boy doing exactly the same thing, but covered by a family policy. Onbw would think boys at that age participating in such a common hobby are not a huge risk. If they do get injured they will be taken to the nearest accident and emergency unit and nine times out of 10 will have their injuries attended to on the NHS.

However, not one PMI provider was interested in taking on the business. We approached Lloyds in desperation, but even they were unable to offer cover.

The truth is that insurers tend to take a one-size-fits-all approach to sporting risk, and to be fair, common logic would suggest they are right to be cautious.

After all, an insurer has a duty to protect its portfolio from high risk and the subsequent high cost to its members. Which insurer in their right mind would provide cover for a professional boxer with the potential cost of a brain surgery claim? There is no doubt that most professional sports people will require the frequent services of a physiotherapist, if nothing else, during their career. A PMI portfolio with a high sporting content could therefore see its resources drained by numerous small claims for X-rays, scans, physiotherapy, and so on.

However, BUPA is one insurer which will provide cover for professional sports clubs. Cover is provided on scale A rates on its Company Premier policy, with a 30% loading on premiums if treatment for sporting injuries is to be included.

As a last resort and if nothing else works, it may be possible to arrange bespoke cover, possibly through Lloyds. It is said that any risk can be covered at a price and Michael Schumacher has cover against injury that stops him from racing at a reported £2.5m a race. Some time ago we managed to arrange cover for a group of bomb disposal experts travelling to Bosnia on a mine clearing contract. Not exactly a sporting activity, but certainly high risk.

Stephen Walker is the proprietor of Medical Insurance Services