First published in ITIJ 86, March 2008
The changing nature of winter sports has led to a fluctuation in the type of injury claims following winter holidays. Russell Dadson explores treatment possibilities, the cost to insurers and how the industry can better meet customers’ needs
When it is reported that as many as one in five skiers head for the slopes without travel insurance, we have to ask the question ‘Why is winter sports cover such a hard sell’? Yes, it costs more than regular travel insurance but the statistics are compelling if any assurance is necessary on why it is prudent to take to the piste with proper insurance protection.
Although injuries occur less frequently today, they are a concern for insurers just as much as they should be for participants. And even though skiers and snowboarders experience different types of injury, the cost of treatment can be extremely high, particularly in the privately run medical centres located in most popular ski resort villages. So, what are the most common injuries, and how can travel insurers better adapt to this evolving market?
Accident and injury
There are many factors that influence the type of injury and its severity, including speed, whether a fixed object (eg. a tree) is involved, age, experience, fitness, weather, terrain and so on but in general terms, the nature of the equipment being used affects the injury above all else. That is, was the injured party on skis or a snowboard?
Typical upper limb injuries include dislocated shoulders and fractured wrists. These are common injuries experienced by snowboarders, although not exclusively. Lower limb injuries tend to be sprains or ruptures to knee ligaments, although ankle injuries are less common these days as improvements in equipment design continue to reduce the chance of lower leg injury. Meanwhile, winter sports injury rates have declined significantly over the past 20 years, the recent popularity of ‘carving skis’, which transmit a tremendous amount of power through the leg as they carve into the snow, have increased the incidence of serious knee injury. And whilst snowboarders tend to injure themselves landing heavily on their arms or back, skiers are more likely to suffer from leg injuries.
Typical upper limb injuries include dislocated shoulders and fractured wrists
Current trends in ‘freestyle’ and ‘all mountain’ skiing, encouraged by innovative ski resort design mean that, particularly with younger participants, there are more opportunities for injury in snow parks, half pipes, and ski jumps. Snowboarders experience a higher frequency of accident than skiers – in fact, they are about 50 per cent more accident prone. This is almost certainly linked to the fact that snowboarders like jumping off things rather than sticking to the piste like the majority of skiers, who tend to be dominated by older, more cautious age groups.
The average cost of a medical expenses insurance claim is around £500 in Europe, but a serious knee repair can cost as much as £5,000, and a more complex shoulder or wrist injury can cost £3,000. Add to this the cost of repatriation, which can be £500 for an extra seat for leg support, or up to £2,000 to include a nurse escort, and a relatively straight forward injury can end up costing several hundred pounds. In North America, average claim costs tend to be between £1,000 and £2,000 and repatriation expenses at significantly higher levels.
For serious injuries requiring air ambulance assistance, the bills will run into tens of thousands depending on where the patient is being flown back from and the extent of their injuries. Claims of between £30,000 and £50,000 are not uncommon. With figures like this it is hard to believe anyone would not want to pay, on average, between £30 and £40 for a week’s winter sports insurance.
For serious injuries in Europe, where the patient cannot be treated in the local medical centre, the cost to insurers of repatriating injured skiers will often far exceed the amount they are likely to have to pay in medical costs because of the EHIC (European Health Insurance Card). The EHIC may be a reason why so many people ignore the need for insurance and perhaps for this reason alone, travel insurers should highlight the repatriation element of their policies. After all, travel insurance is not so much a ‘medical’ insurance but rather an ‘emergency expenses’ policy.
How an injury is managed will depend on many things, to list a few: location, life style, insurance availability, medical opinion, and timing. Mark Bracey from Oxfordshire was on a family holiday in Courcheval, France, where he suffered a severe ligament rupture in February 2007. He already had general annual travel insurance free with his bank account but as an experienced skier he didn’t trust it to cover him properly so he bought a specialist winter sports policy from his tour operator.
the recent popularity of 'carving skis' ... has increased the incidence of serious knee injury
He was skiing back to his chalet at the end of a day out with his wife and children when he lost control and twisted his knee heavily. His wife flagged down a passing ski instructor who called for a ‘blood wagon’ (a stretcher on a sledge) and he was quickly taken to an awaiting ambulance at the bottom of the piste where he was then transferred to a private clinic in Courcheval village.
Mark’s main recollection is the vast amount of paperwork he had to complete before he was treated. The rescue team wanted their services signing for, as did the ambulance crew, and then the clinic needed several signatures before they allowed him to see a doctor. The doctor felt his knee was too swollen to be operated on and so sent Mark’s wife off to the local pharmacy to buy a knee brace and crutches. The cost of the rescue was €457, the pharmacy bill €217 and the doctors consultation a mere €166.
Mark returned home to the UK on his scheduled return date with extra seat space to allow him to keep his leg straight. His travel insurers arranged for ambulance transfer at both ends. However, on return to the UK his travel insurance ceased to be of use to him and covered no further expenses. His claim was very typical of an injury in Europe and the cost to the travel insurer was under £1,500. However, before further treatment could be considered the knee swelling had to be reduced. An intensive course of physiotherapy was prescribed, which cost £750 and was paid by his private medical insurance. Had he not had this cover, he would have had to have waited for NHS treatment, which could have taken months.
Once the swelling had gone, Mark was sent for an MRI scan which cost £682, followed by consultant’s fees of £900, the operation at £3168, plus additional fees for things like the anaesthetist who charged £250. Overall, his claim exceeded £5,000 after return home to the UK.
Medical opinion on how best to treat injuries differs from country to country and indeed regionally depending on the availability of expertise to carry out certain procedures. It is well know that in Austria, there are many specialist centres close to ski resorts that provide state of the art private facilities for ski related injuries, particularly to knees. If Mark had had the same injury in Austria, there is a strong possibility that he would have been operated on there and then, the costs of which his travel insurers would have met, assuming they agreed at the time that the procedure was necessary. If, however, you are heli-skiing in the Himalayas or visiting a ‘new’ ski resort in a developing region, the chances of such high levels of immediate expertise being available are low.
There is an expectation that winter sports travel insurance will cover the costs of surgery, wherever and whenever it is available. If the opportunity for surgery or specialist treatment does not arise until after return home, then the policyholder is often left feeling let down by their travel insurer. This represents a big challenge for assistance companies who need to juggle the need for cost containment with the expectations of the injured skier.
Mark was lucky – he had private health insurance and, being self employed and working from home, he was able to get back to normal relatively quickly although he will not be able to ski again until next season. Others are not so lucky. If the injured skier can not return to work or, as in some extreme cases, return to work at all, there is no cover for loss of income under a standard winter sports travel policy. For example, a client who was a skilled carpenter, specialising in custom-made furniture, had a minor collision with his skiing companion whose ski edge sliced a tendon in his hand. He is now unable to hold his wood working tools and has lost his livelihood. He has never come to terms with the lack of compensation available to him. He could have tried to sue his friend but there was never really any question of negligence, it was just an accident. His winter sports policy covered his medical expenses but he was unable to accept that that was all he was entitled to.
Every winter, skiing or snowboarding holidays are eagerly awaited to ease the gloom of the dull winter months. It is hardly surprising that the last thing on most people’s minds when they pack their salopettes is the likely outcome of a serious injury. This is where travel insurance marketing for winter sports comes in, but we’ll come back to that is another issue of ITIJ. For now, insurers and underwriters need to make sure they keep up to date on winter sports injury trends, treatments and costs, and consider broadening their policies to better meet the needs and expectations of today’s mountain adventurer.