Medical Insurance in the event of an aviation accident

Discussion in 'Hangar Talk' started by SixPapaCharlie, Oct 14, 2020.

  1. NoHeat

    NoHeat En-Route

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    Mine does, but it's very limited, with a $5k maximum.

    From page 2 of the "declarations", which precede the policy:

    MEDICAL EXPENSE: Including Crew, Limited to $5,000 Each Person Each Occurrence.

    Details from Page 1 of my policy:

    II. MEDICAL EXPENSES
    A. Subject to the limits shown on the declarations page,
    or in any endorsement to this policy, to pay all
    reasonable expenses incurred within one year from
    the date of occurrence for necessary medical,
    surgical, dental, ambulance, hospital, professional
    nursing services and funeral services to or for each
    person, and each member of the crew (if “Included”
    in the Policy), who sustains bodily injury or disease,
    caused by an occurrence, while in or upon, entering
    or alighting from the aircraft, if the aircraft is being
    used by the Insured or with his permission.


    And "Crew" is defined on page 4 as including the PIC, flight instructor, safety pilot, etc.
     
  2. midlifeflyer

    midlifeflyer Touchdown! Greaser!

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    That explains it. Makes sense now.
     
  3. ColoPilot

    ColoPilot Pre-takeoff checklist

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    So what is an indemnity health plan?
     
  4. SixPapaCharlie

    SixPapaCharlie May the force be with you

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    For half a second
    I break my arm. They write me a check.
    It feels kind of dirty though because sometimes the check they write is more than the cost of the bill.

    So say you hurt yourself and it costs $1000. You pay it and they write you a check. Could be for $800 could be for $1500.

    I guess it shouldn't feel dirty. On my employer plan, I was paying 20k per year in premiums / deductibles which went in the trash.
    Insurance is a total ponzi scheme. I hate it.
     
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  5. PeterNSteinmetz

    PeterNSteinmetz Pattern Altitude PoA Supporter

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    I believe a 30’ fall onto a hard surface is about a 50% chance of death (learned this while lead climbing).
     
  6. PeterNSteinmetz

    PeterNSteinmetz Pattern Altitude PoA Supporter

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    Bit of an overload on that term. “Free climbing” can mean either climbing with protection in place but not relying on it for ascent (which would be “aid climbing”) or what people sometimes call “free soloing” or “soloing”, which is without any protective gear placed.
     
  7. FormerHangie

    FormerHangie En-Route

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    I never understood that. I bought life insurance once, they asked about aviation, skydiving, scuba diving, rock climbing, etc. but the fact that I rode a motorcycle to work in city traffic didn't bother them. Scuba diving? Really?
     
  8. brcase

    brcase Pattern Altitude

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    I didn’t think a true medical insurance can have very much in the way of exclusions. That is one of the reasons it is so expensive. Almost all other insurances have so small of limits for medical expenses that they are almost useless for anything serious that will require more than a few weeks in the hospital.

    My wife was hit while riding her motorcycle in which her leg was amputated. No other injuries. The Medical bill as I recall was something like $200,000+. Our Health insurance company negotiated it down to about $80,000.
    The liability insurance of the person that hit her paid their maximum limit. Our attorney explained it to us that the insurance company is entitled take the entire amount up to their expenses of any liability recovered. But in reality about 80% of the time they will only take 30% of the money recovered. Often Attorney’s take another 30-40%. And the injured party gets to keep what little is left.

    Without health insurance we would have had to try to negotiate a lower amount rather than the insurance company doing it, and could have easily owed more than was recovered.

    After this experience I almost won’t fly with someone who does not have a health insurance policy. Just because I don’t know of any other insurance that would adequately cover them if we did have a accident with serious injury’s. I suspect that the medical portions of you aircraft insurance is really just designed to cover the deductible of the you health insurance policy. I carry enough insurance to protect my assets so their insurance will opt to take my insurance money rather than sue me for my assets. But that easily might not be enough to protect them.

    Brian
     
  9. denverpilot

    denverpilot Tied Down PoA Supporter

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    Gets tricky. Your airplane medical will pay out a puddly sum immediately. Their medical will get them patched up. Then their medical will come after you for any perceived liability in the accident.

    And of course then there’s the whole “CFI” problem... and who is ultimately responsible... even if you’re asleep in the back seat... where the various CFI coverage policies may or may not be useful but will certainly make most CFI work unprofitable or so low in profit it might as well be unprofitable. :)
     
  10. Kritchlow

    Kritchlow Final Approach

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    I’m vaguely familiar with indemnity plans (very vague), so please tell me this...
    If you had a heart attack, what would they pay?
    It could be mild with one day observation, they send you home and tell you to eat right and exercise. Cost about $3k..??
    It could also be a month in ICU with several surgeries or procedures costing north of a $million.
    I truly don’t understand how that works.
     
  11. midlifeflyer

    midlifeflyer Touchdown! Greaser!

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    Think Aflac.

    Heath insurance pays medical and hospital bills subject to limitations and copayments. It doesn't help with other costs of injury or illness, like loss of income, paying the rent, buying food, etc...

    The plans take different forms, but basically, medical indemnity us a supplemental plan which provides cash to help with living costs in the case of accident or illness. More akin to a disability policy than health insurance.

    So yeah, they might pay more that it cost to set your broken arm, but the costs they are trying to cover are different.
     
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  12. RyanB

    RyanB Administrator Management Council Member PoA Supporter

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    That’s why you have some folks who choose to take the money they’d pay for an insurance premium and put it under their mattress each month (kind of like an engine reserve fund but in this case a healthcare fund). Sometimes they come out ahead, other times they don’t. It’s all a gamble.
     
  13. Chip Sylverne

    Chip Sylverne Final Approach

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    Fear is the poison of our lives.
    The Med Pay portion of your aviation policy is designed to cover injuries like a passenger falling off a wing and breaking an arm, or walking into a trailing edge and getting a gash on the forehead. It's designed to avoid litigation in such cases. Present the bill to the insurance company and there will be reimbursement.

    It's not designed to provide coverage in place of medical in case of a major accident.
     
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  14. Lindberg

    Lindberg En-Route

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    Some smart people will tell you that anyone who can afford to self insure, should. My problem with that advice for anyone who isn't f-you wealthy is that most people have no conception of what that truly means. Yeah, if I'd taken all the health-insurance premiums I've ever paid and banked them, I might have come out ahead so far. But a cancer diagnosis, a transplant, or a bad car accident would wipe all that out. At least at the group rates that I've been fortunate to have.
     
  15. Bill

    Bill Touchdown! Greaser! PoA Supporter

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    My AVR was well over $100k, and that was the negotiated price. List price was nearly double. As luck would have it, I went into the hospital last week of December, so I hit max out of pocket ($8k/yr at that time) for both years. It hurt writing $16k worth of checks, but it beats dying.
     
  16. jsstevens

    jsstevens Final Approach PoA Supporter

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    And that is the point of insurance. It is (minus all the profits-which I'm not against, in moderation) risk sharing. I pay in for things I hope I never need and if you (or I) need them, everybody else money paid in comes to me to handle the loss.

    The best medical group coverage I've ever had was a company of ~300 employees who set up a self insurance program. Up to a certain threshold (I think it was $100k, but this was nearly 30 years ago) the fund paid claims. Above that a really inexpensive catastrophic insurance policy took over. An insurance company provided management of the process for a modest fee. We got to pick what kind of coverage we wanted (more or less) and the reinsurance backstop was transparent to the insured. Good coverage at a modest cost.
     
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  17. SoonerAviator

    SoonerAviator Final Approach

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    I think that's the problem with modern "health insurance" anyway, because it isn't really insurance, it's a pre-paid health plan. The premiums are outrageous and the hospitals charge absurd fees for simple items because they know insurance companies will pay for it. Ideally, everyone would just pay out of pocket for things like a simple broken arm or stitches. If everyone kept a catastrophic policy to cover the really expensive stuff, it would force hospitals to quit having a 5 different prices for the same procedure depending on which insurance company was paying or if the patient was paying cash. I'm not against insurance companies making a profit, free-market and all, but honestly I think a co-op is better from a healthcare cost standpoint.
     
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  18. RyanB

    RyanB Administrator Management Council Member PoA Supporter

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    Exactly right and I agree. It’s definitely not a strategy I would recommend to anyone. Some people are fortunate and never have to undergo any hospitalization, while others do. I’d rather hedge on the side of caution and just have the insurance siphoned out of my salary. Murphy’s law would spank me if I chose otherwise.
     
  19. Lindberg

    Lindberg En-Route

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    My understanding is this is how many large company employee plans are handled now.
     
  20. denverpilot

    denverpilot Tied Down PoA Supporter

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    Two infusions of the WRONG drug for my condition by a misdiagnosis was $150,000 just for the drug. The same company makes a 5% less effective drug, but when you’re slowly losing the ability to walk, you aren’t going to choose to add a 5% risk if you have the option.

    Definitely came out ahead or at least even from all medical premiums paid in nearly 30 years in just one year. Nowadays the kids have nice tax-advantaged options to save up their own medical costs in the newer self-insured major medical plus investment plans, but they must start early when they’re healthy and young. For most of us, playing catch up with one of those doesn’t make fiscal sense.

    But definitely I have no complaints about the true premiums amortized over three decades vs what paid out this last year.

    The only silly thing insurance continues to fight is the orders of magnitude cheaper physical therapy services rendered vs the rest of the medical procedures and Docs. Every underwriter seems to have one pet peeve they don’t like paying for. Mine is PT. Still appealing a relatively cheap series of claims stretching back to over a year ago now, this month. They’ve paid more in bureaucracy fighting it than the bills themselves.

    Isn’t a co-op on the planet that’ll accept me now. They don’t have regulations requiring them to accept members of work or other groups, so they’re technically far worse than any of the silliness surrounding pre-existing conditions found in traditional insurance right now. Like... they’ll accept virtually zero people who are already afflicted with pretty much anything.

    If they got regulated to do so, they’d be as expensive as anything else.

    Also most folks don’t realize that what hospitals and Docs bill is simply a calculated ratio of what they know the insurance will pay. They never get the billed amount. Not even close. Most folks don’t make enough claims in a year to see a pile of EOBs to see what’s actually paid vs what was billed. I’ve got about 100 EOBs here showing that info in real dollars and it’s about 20-25% across the board for multiple services, Docs, you name it. Billing $1000 gets them $250 on average, super consistently.

    Billing vs paid is just a massive shell game to be able to claim “losses” and other fictional stuff. The only real numbers one will ever see you compare premiums to payments is the EOB after claims complete settlement. The rest of the fictional numbers just fuel political and other fake fodder.

    I watch a lot of YouTube and some nurses union started heavy attack ads against my wife’s employer recently. Big claims the company makes exorbitant profits, puts nurses at risk, rips everyone off, making money off of Covid... you name it. They don’t identify themselves anywhere in the ad or on the website they want people to go to.

    Pretty hilarious really. The reality is they pay her really well, their leadership has taken massive pay cuts for Covid, not a single nurse took a pay cut, not a single layoff, far better bennies than industry standard, and the only effect was a warning that annual increases might be cancelled this year... which has already been rescinded. They even halted construction on her new clinic she’ll be moving to perhaps next year, to make sure to take care of staff first and buildings later.

    Pretty much it’s like any industry. Ask the people actually doing it before trusting information given by ANYONE else. If you didn’t, what you’re hearing is likely pure fiction.

    We got a laugh out of the attack ad claiming her employer didn’t provide adequate PPE to staff. Hell, the company lawyers want the staff to wear provided face shields and the staff told them to shove the face shields for anyone NOT in a Covid ward, where the sun doesn’t shine.

    Sounds like some nice people to pay forced union dues to, though. Can’t even identify themselves, they’re that confident of their position and ad content. Haha.

    I believe one calls that sort of people, cowards.
     
  21. SoonerAviator

    SoonerAviator Final Approach

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    Right, but I would call your situation something that the "catastrophic" insurance would be better suited for. Having insurance to pay for a minor laceration or a broken arm is silly. Same with doctors visits "co-pays", etc. Pay with cash just like you would anything else. I don't try and bill the auto insurance if I have to have a car repair done. It's just an accepted expense and you move on. When you get in a car wreck, it becomes catastrophic and then I get insurance involved. Unfortunately, modern health plans have become something that people want to cover every potential medical expense, rather than an insurance plan to cover the big hits (like in your situation).
     
  22. jsstevens

    jsstevens Final Approach PoA Supporter

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    Self insurance plans are still available. We looked at one where I now work. The main reason we didn't pull the trigger was we were bought and we knew our insurance plan would only last out this year anyway.

    The main problem with current medical system is for the vast, overwhelming majority of people it's a service paid for with other people's money. The various and variable pricing structure (each insurance plan including Medicare and Medicaid have their own negotiated prices based on "Fair and Acceptable") and the medical companies (or nonprofits) start the pricing with room to negotiate waaaaay down. As an individual, sometimes I can get the "self paying" discount. Sometimes not. But I have essentially no way to shop, as in many cases they can't (or won't) tell me what something will cost unless they submit to the insurance. And as @denverpilot said above, when it's your health-perhaps in an emergency situation, you're not likely to shop anyway. So free market economics won't play either. And hey, it's just my insurance paying so why bother?
     
  23. wsuffa

    wsuffa Touchdown! Greaser!

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    In addition to that, one of the big benefits for "everyday stuff" is the pre-negotiated rates the insurance companies have, often with most-favored-nation clauses. Don't have insurance or provider doesn't have a negotiated rate? Then full list price for you.

    @SoonerAviator is right: part of the reason for increased prices is that there's someone willing to pay (insurance companies). If we get "single payer", there will be enough added demand on the system that prices will go up (the laws of economics still work) and if prices are capped a number of providers will leave the industry which will either cause rationing or price increases. Much as some politicians think the laws of economics can be regulated into submission, they are more powerful than any laws written by man.

    It depends, Nate. When I most recently worked for a big company, they put a high-limit plan into place that was far better for most employees (financially) than taking traditional plans. Even beat the HMOs. Basically the firm subsidized the plan by depositing $2000/year into the HSA account (on top of your contributions, to the IRS limit) and lowered the premiums pretty substantially. Net result was in addition to that $2000, there was a savings approaching $100 a month for going on the plan. Aside from the deductible, the plan coverage was pretty close to the same as the PPO plan. One doesn't have to "start early" to accumulate savings.

    Others are a wash. I helped a friend compare the high-limit plan to the PPO plan that she was offered. For typical and expected needs during the year it was within $50 of being even. Note that the payer wouldn't (or couldn't) disclose their prescription pricing differences between the two plans, making the decision harder.
     
  24. Chip Sylverne

    Chip Sylverne Final Approach

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    Fear is the poison of our lives.
    We had one too. What they don't tell you is that the claims manager keeps costs down by denying the secretary's claims, and the suits happy by paying the executives' without delay.

    Never let the fox run the henhouse.
     
  25. wsuffa

    wsuffa Touchdown! Greaser!

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    And yet if you hand around here long enough, you'll run across a pilot that wants their aviation insurance to pay for repairs that should be routine.

    By making insurance plans into "service contracts" (which is essentially what they are now), people have become accustomed to having "someone else pay". And that situation isn't going to get any better if the politicos do some sort of "medicare for all". Changing the situation will be like trying to change attitudes on "free" government services - in other words, not gonna happen.
     
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  26. Half Fast

    Half Fast Final Approach

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    Right. It's similar to parimutuel betting, with "winners" collecting more than they pay in and the "losers" footing the bill, while the insurance companies take a cut off the top.
     
  27. charheep

    charheep Line Up and Wait

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    Not all companies are like that. My company offers phenomenal insurance. Family of 3, I think I pay less than $200 a year for visits and prescriptions(not premiums). When a co-worker's kid needed speech therapy, the insurance company pointed to vague wording to deny the claim. HR then re-wrote the policy to specifically include the therapy. I dont know the specifics of everything, but my friend in HR confirmed what my co-worker said.
    Some companies do think their employees are valuable.
     
  28. denverpilot

    denverpilot Tied Down PoA Supporter

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    Great point. If the employer is adding a big chunk the high limit thing gets better. That’s one downside of my current place, the employer isn’t putting in a large amount so it just moves the math to favoring the traditional plans.

    Wife’s place being a medical company themselves leans heavily toward having a better than average plan — their oddity that makes sense is you going to one of her company facilities is nearly nothing out of pocket to employees and families. But even out of network on hers, the contracted rates are incredibly low. I guess the medical companies don’t get into pricing cold wars with each other’s employees health care bills. “You don’t mess with my people, I won’t mess with yours.”

    I’m almost convinced they’re really self-insuring behind the scenes and just using a rival as their “insurance” entity because they don’t want to operate an actual insurance company. The rules are too close to cash based for it to be a complete coincidence. We submit to a rival massive medical company who “manages” her company’s “insurance” with completely different rules than any of the rival company’s actual insurance plans. Enough so that it confuses every single provider.

    “Oh it’s Company B. Your coverage will be roughly X. All their plans are similar.”

    “No. It won’t. See Company A’s logo on the card? Better look that group policy up. It won’t even be close. There’s also a different 800 number on the back of the card, it’s that different.”

    About half the time the provider’s computer system doesn’t even have a way to look it up. Only some have learned the hard way. That plan will flat deny the Doc claim AND tell us we legally owe $0 on the EOB because the Doc broke their contract, and it’s all because their software was too dumb to handle a different group ID number for Company B plans.

    I’ve talked out of network Doc’s staff more than once through how to properly re-submit a claim when they got ticked off at getting flatly denied because they don’t know their own contracts. Not really my problem but I’ll explain it ONCE. Ha.

    Once their admin staff “get it” there’s magically a note in your account as to how they were supposed to do it. LOL. Imagine that.
     
  29. denverpilot

    denverpilot Tied Down PoA Supporter

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    You’d think. My situation isn’t categorized as catastrophic at all.

    It’s in the grey no-man’s land of “chronic conditions”, which after meeting a bunch of fellow sufferers I could probably write a Doctoral thesis on how badly ALL plans handle those.

    They don’t like knowing they’ll be paying for stuff the rest of your life. That’s a big ugly red flag for all of them.

    They like catastrophic stuff way better. It means you’ll much more likely be dead in five years or less.

    30 years or whatever of monitoring with imagery and continuous follow up with an entire fleet of specialists — they all try to weasel out of that circumstance really really hard. Some make the referral process onerous, and mandatory, meaning they annoy the crap out of your GP Doc unless they’re a fighter type. Others drive the specialists crazy with, “Sure we will process this as soon as you send us three inches of documentation, and we will require that for every single visit.”

    Wife’s place does the latter to physical therapists. “Please describe the multitude of tests you ran every visit on this patient in an hour session...” every single session.

    Of course I’m helping her annoy them back with an appeal listing every session and a scathing letter saying “It’s six months worth of sessions with a bad diagnosis, go find an actual Doctor who can read this.” Lol.

    Ahh why not... only took an hour to create what will probably be the most annoying appeal ever dropped on some non-medical beancounter’s desk. Saves me a little money, make her a LOT more money. Better than me sending her a thank you card. Ha.
     
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  30. Everskyward

    Everskyward Experimenter Management Council Member

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    So you're saying you have this plan as your only plan, without an underlying major medical plan?
     
  31. GMascelli

    GMascelli En-Route PoA Supporter

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    I'm really late to this thread but I thought I would add my two cents from my experience.

    Some of the things I learned after my accident without going into great detail.

    1) Do NOT name your spouse as a co-owner. This eliminated Mary from collecting on the aviation policy after our accident. lesson learned.
    2) The pay out from the aviation insurance for co-pays was a lump sum for each of us and the company waived collecting receipts. We still saved every receipt/ co-pay bill we paid. This included transportation to and from rehab and all doctor appointments when we could not drive or I couldn't get the "rebuilt leg" in the SUV. All co-pays for doctors, emergency room, and hospital admittance was covered up to the one time lump sum pay out amount.
    3) My medical insurance paid all my medical bills. Mary's disability medicare and her secondary paid all of her bills.


    The aviation insurance company was great to work with, and so was my medical insurance. The same for medicare and Mary's secondary which is provided through my medical insurance from my former employer. I hoped some of this helped.
     
  32. Chip Sylverne

    Chip Sylverne Final Approach

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    Fear is the poison of our lives.
    Glad to hear somebody was on the ball and caught the fox.
     
  33. SixPapaCharlie

    SixPapaCharlie May the force be with you

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    It is
     
  34. Everskyward

    Everskyward Experimenter Management Council Member

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    Just curious since while I was falling asleep in the, ugh, benefits meetings I used to attend while I was still employed, certain companies (I seem to remember the duck) tried to sell us these types of plans, but only in addition to the normal plan, not instead of. As someone pointed out in a previous post, I wonder how they determine the schedule, since, for example, if you break an arm, it might be trivial enough to just cast it, or you might need surgery if it's a bad break. Then there are many other complicated medical conditions where it seems the payment would be hard to determine.
     
  35. jsstevens

    jsstevens Final Approach PoA Supporter

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    All that was handled by an outside administrator organization for the one I was in. There were no shenanigans of that sort.
     
    Last edited: Oct 15, 2020
  36. Ghery

    Ghery Touchdown! Greaser!

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    I can't say that we've had a problem with an insurance company denying claims. But, I'm ready to go nuclear on them if they do. Demand that they have someone licensed to practice medicine in the state of Washington review the claim. Show me that this person is indeed licensed. And, if necessary, use the term "bad faith" or something along that line. Insurance companies hate that term.
     
  37. 3393RP

    3393RP En-Route

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    3393RP
    Which I assume is because...

     
  38. DavidWhite

    DavidWhite Final Approach PoA Supporter

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    Apr 19, 2011
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    VBP
    I am covered if it happens at work but not outside of that. I also don't think my life insurance policy will pay out for a GA accident (which is probably something I should rectify)
     
  39. SixPapaCharlie

    SixPapaCharlie May the force be with you

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    6PC
    When I was 28, I got a 30 year policy from West Coast Life for 400k that is $25 / month and they will pay if I auger my plane into the ground.
    When I turn 58 the price skyrockets and I won't renew at that time.
     
  40. jsstevens

    jsstevens Final Approach PoA Supporter

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    jsstevens
    I have a 30 year term life insurance policy that excluded GA for the first two years. Since I was past that period when I started flight training, no problem. I got it when I was 40 and by the time it expires (assuming I have not expired) I don't see the need for it any more.

    I've never heard of a medical policy that excludes injuries from specific activities (though I suppose self inflicted injuries might be excluded-think attempted suicide).