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Travel Insurance claim after an injury and Ski Hire shop responsibility

 Poster: A snowHead
Poster: A snowHead
So had a bit of a tumble yesterday and the result is a broken Anterior Cruciate Ligament on my left knee.
Had to call the local rescue, who helped me sit at the back of a snowmobile and drove me to the nearest medical centre, where I got an examination, an X-ray and strapping with some bandages and sent me to the nearest pharmacy to buy crutches and a knee brace. This happened in Les Arc 1800 and had to pay 160EUR for a taxi to get back to out chalet in La Plagne 1800.

I have never had to claim on a travel insurance before, so not sure of a few things:
Here is the policy wording: https://docdro.id/BPjuM9a Mine is a Premier policy with Wintersports cover.

1 - The claims company told me I can only get a refund on the ski pass if lost/stolen and NOT if I cannot use it due to my injury. Is this standard practice?
2 - My bindings should have opened, but they didn't. I used one of these machines in the rental place that measure your weight and you answer a few questions and it told me 6.5, which is what I have always used and have taken many falls with these settings. I am yet to return the skis (use my own boots) and wonder if there is any possibility for the bindings to be faulty or not setup correctly. The insurance company is not really interested in doing anything about this and just advised me to take it directly with the rental shop, who will most probably not going to accept any responsibility. Do I bother to get an independent inspection on the skis or it is just a waste of time and just return them?
3 - The french doctor here told me to get some physio as soon as I can. Not sure if this will be covered by the insurance, but can you recommend a place here in La Plagne 1800 or this side of Paradiski.

Any other advice is much appreciated. Currently being stuck in the chalet limping around.

Thank you.
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Obviously A snowHead isn't a real person
As far as the ski pass is concerned I have always successfully claimed for unused full days following injury. Can't help with the rest.
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Well, the person's real but it's just a made up name, see?
Very bad luck, @CYPER. Sad Yes, that is my understanding about the cost of unused lift pass - which you could, I think, get back on Carte/Carré Neige, but not most travel insurance policies. I'm no expert on bindings but falls vary in the strain they put on bindings - they're not exactly foolproof. You have plenty of stress already - I'd personally not start an argy-bargy with the ski hire shop.

You have obviously already spoken to the insurance company - keep in close touch with them and get their prior authorisation for any expenditure. Keep all receipts.

Rest your leg as much as possible - Rest, Ice, Compression, Elevation. Ibuprofen. Somebody knowledgeable might come along and suggest some easy physio you could do for yourself.
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@CYPER, Sorry to hear about the injury. When I was injured I got a refund from the lift pass office; just had to ask them to take pity on me. To be honest the excess on the travel insurance would hardly make a claim worthwhile for a couple of days.

Binding fault? probably a waste of time. What would you expect them to do -you have travel insurance to cover your costs

Don't know about physio in La Plagne, your policy will say if you have physio cover - mine had £500

other advice? Check into the ACL club thread
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Sorry to hear of your accident Cyper.
I've sucessfully managed to claim unused lift pass from my insurer (LV) previously - subject to excess of course. But I guess it depends on the terms of the policy. Even if you could the excess may may it not worthwhile to bother (depending how many days left on it)

Sorry to say I don't think you've got much come back on the hire shop, normal bindings are designed to reduce the likelihood of broken legs but can't effectively protect against ligament damage. There are other bindings like 'knee-bindings' which are designed to provide better protection against those kinds of injuries but they are not common on rental kit. (This is just my layman opinion though, I'm not a ski tech).

Regarding your Physio, talk to your insurance co. first. If it is covered they will probably only reimburse if pre-approved. If not covered then at least you know.
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re the ski shop... I suspect you signed something in the shop that covers them for such eventualities and/or somewhere in the shop is a dis-claimer notice.
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Bindings aren't designed to protecy ACLs so you are on a loser I think. Really no blame no claim I think
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After all it is free Go on u know u want to!
We had our ski passes refunded when hubby was injured and we had to leave early and return home, but I guess it depends on your insurer.
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Won't the local lift pass office refund the unused days...?
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@schnitzel_skier, only if the skier took out the insurance with the ski pass.
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@Hells Bells, I got a refund in Flachau; no insurance. Sue was very persuasive...
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When my son was injured a couple of years ago he got a letter from the medical centre and was refunded at the lift pass office for the days he couldn't use.
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@larry1950, in France?

@holidayloverxx, I bet she was.
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 You know it makes sense.
You know it makes sense.
LV paid the unused part of our season passes for my wife's accident when she had to be flown home by air ambulance.
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Otherwise you'll just go on seeing the one name:
Is it a partial tear or a full separation.

If it is separated then you should consider reconstructive surgery.

Yes you can get by without it but you need it if you are active eg a skier.
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 Poster: A snowHead
Poster: A snowHead
Quote:

got a letter from the medical centre and was refunded at the lift pass office for the days he couldn't use.

I've done this in Austria but they did insist on the medical note.
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Its standard in Ski Amade to refund unused days for injury with medical papers, very easy transaction at the Kassa/ticket booth. I hope you have success - and you make a full speedy recovery. Hurty knees are not at all nice. Ange
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
Ski pass - they seem to be quoting what is written in your policy, so not unreasonable. (But you could try the lift pass office)
Bindings - you should be able to read the settings. If 6.5 I wouldn't bother. If they are set higher then you may have a case, but it could end up in an argument over whether or not they have been adjusted since leaving the shop.
Physio - check with insurer if you are covered; ask around in resort - most company reps or accommodation providers will probably know of someone.
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TQA wrote:
Is it a partial tear or a full separation.

If it is separated then you should consider reconstructive surgery.

Yes you can get by without it but you need it if you are active eg a skier.


This is the medical report from the doctor, translated with Google translate as he told me:

Dear colleague,

I am addressing you to Mr xxxxxxxxxxx, whom I am consulting today to
Left knee trauma
Falling skiing this day, on a jump reception.
Brought by trackers.

EXAMINATION
the movement during the fall is: in valgus flexion external rotation
Accompanied by: crunching sensation
"The instability in support is: felt while frying to leave

PHYSICAL EXAMINATION
The effusion is: moderate 1 hour after the accident
Functional impotence: important, by the instability, but without limitation of the articular amplitudes initially
Palpation reveals pain: poorly located
Valgus in extension: negative
Varus in extension: negative
Anterior flexion drawer (Lachman): soft stop feeling, positive ++ compared to the opposite side

CLINICAL DIAGNOSIS
Severe sprain: anterior cruciate ligament

TREATMENT
Treatment: immobilisation by strapping + relay by articulated splint according to the sensation of instability
Rehabilitation: starting at the return
Necessary for further treatment an opinion: specialised with MRI

RADIO REPORT
Knee: left
Realised impacts: face and profile
Radiological diagnosis: absence of radio-visible bone lesion

I thank you for taking charge of further treatment and keeping me informed of developments.
Please, receive the expression of my confraternal feelings.
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Bad luck Sad See you on the rehab threads, then... (Best place to post for advice & sympathy.)

When I did my ACLs the insurance repaid the unused lift pass from the date I handed it back. The lift pass office gave me a letter saying refunded due to injury. I thought it was standard.
(Just read your policy quickly, per your link - curtailment winter sports says you can claim unused lift pass, as I read it. Couldn't see physio, but try reading it fully yourself, it's quite usual for there to be a few £100s physio benefit.)

Bindings? No point. 1 of mine came off, 1 didn't. Still buggered both knees...

Right. This knee... I advise from personal experience, not training or qualifications. Start clenching the VMO muscle. Start doing gentle leg extensions and slides if they don't hurt too much; even gentle squats if there's nothing else wrong and not advised not to. Get your quads exercised and stimulated, stop things stiffening and scarring up. Otherwise, rest, elevate and ice if swollen, Voltarol (diclofenac) or ibuprofen creams (I prefer to tablets) if you can take them.
Physio imho isn't urgent, unless you won't be home for a while - but ultimately will be very useful. If you have a choice, get a knee specialist one, or get referred yo one via hospital or your GP. It won't really do much on an immediate basis, bar assess things again and advise you on how to start rehabbing and strengthening quad (and hamstring) muscles, which will have switched off and will rapidly lose strength and size. Strong quads and hams are now your BFFs! Get used to exercising them every day (OK, maybe not too much too soon, but...).
You'll have the time to Google all this, I'm sure.

Are you UK based? Get yourself in to the nearest A&E if so, as soon as you're back home and able - bypass GP and hopefully get a referral into an emergency knee injury clinic and Ortho consult.

Good luck. It's all a bit daunting the first time, but many here will be happy to share their experiences.
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Oh, p.s. keep receipts for everything you need to spend, buy etc because of injury and claim back off insurance (but you will need receipts) - including taxi, extra phone calls, the brace, etc.

Take your skis and lift pass back asap - unlikely to get insurance refund until proved not used. And get a receipt of early return and any money actually repaid to you (if the ski hire or lift pass place refunds you anyway - which some will do if you're injured - then that's job done, no insurance involvement needed).
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Did the piste patrol keep your skis till their bill was paid? Happens sometimes and easy to lose track if you don't have someone with you to help.
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After all it is free Go on u know u want to!
p.p.s. reading your hospital letter, and retranslating Google Translate, it sounds as if it's a tear, not full rupture, and no other MCL or LCL damage is suspected, nor any meniscus damage,cand no bone damage seen. The Lachman ++ is a standard result on manually tugging and rotating the leg, noting play or looseness due to suspected acl damage.
MRIs, as advised, are I believe helpful, though again they don't always point to your ultimate prognosis or need for treatment. Time now is also your friend, along with patience. NHS provision of MRIs vary, in willingness and delay in getting them. Private ones can be got if you can afford it and want them quicker. However, if your symptoms are consistent with your stated injury, and nothing else, many physios and doctors seem to be happy to continue without them (but be guided by whom you see).

Have you got a fit to fly letter, if you need to fly back?
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Quote:

Private ones can be got if you can afford i

Not ruinous - IIRC mine was about £110.
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Standard bindings don’t protect against an ACL injury, they are design to protect against breaking your leg.

Having done my ACL skiing and then damaged the recon a good number of years later playing hockey, I now have Kneebindings fitted on my ski in an attempt to preserve what is left of my knee.

Best of luck with the rehab, you will find lots of good advice here and on kneeguru forum.
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@Hells Bells, No Italy but would they not do the same in France or any other country.
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And love to help out and answer questions and of course, read each other's snow reports.
Quote:

Get yourself in to the nearest A&E if so, as soon as you're back home and able - bypass GP


I don't think that this is particularly responsible advice at this time of year when the service is under extreme winter pressure. Better advice on how to access services can be found at: https://www.nhs.uk/using-the-nhs/nhs-services/urgent-and-emergency-care/when-to-go-to-ae/


Last edited by And love to help out and answer questions and of course, read each other's snow reports. on Thu 14-02-19 22:01; edited 1 time in total
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@CYPER, no idea on the insurance. Most of us don't but here's where you should read the policy before buying but who expects to have an injury? (Not me!)

The shop's Ts&Cs almost certainly include a waiver that they carry no responsibilty. Even if not, it's just not worth trying to determine if there was an issue. Most binding issues are anyway due to snow build up on the boots... which is your own responsibility.

Sorry to hear about your injury, what a real nuisance. I'd just focus on best treatment and rehab for next year.
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 You know it makes sense.
You know it makes sense.
As @under a new name says, it's times like this when it's worthwhile to have read the small print. I'm the sad person who checks wording before buying insurance. After finding out a few years ago that my car insurance had some weasel words that meant it didn't cover something I thought it did, I'm now more careful about this.
I've just flicked through the policy wording the OP linked to and was surprised how restrictive it is. Based on the wording, you can only claim for the unused portion of a lift pass if you curtailed your holiday, i.e. came home early. There's also no mention of physiotherapy.
I checked back and can confirm that my ski insurance (MPI) would refund the unused portion of the lift pass and covers physiotherapy in the UK in some circumstances.
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@Rareperk, it's a valid point, but the exact and very valuable advice that I was given 2 years ago by experienced Snowheads - and I was very grateful for it, as it was the only way in which I could be seen by any specialist without waiting probably many, many months.
My GP had no clue at all (I had contacted them whilst abroad, straight after injury), no-one knew where I went to get assessed and into 'the system', get specialist acute advice, etc. There was no acute injury pathway except to self refer via A&E. In fact, that was exactly what my local Minor Injuries Unit told me, too. They could and would not deal with it. As I had compression (well, elasticated) bandages on, they wouldn't even touch them to treat the sweat sores which had developed after several days!
As it was, upon enquiring by phone of A&E before going, I found out that there was a knee & fracture acute clinic available at the same hospital, so I got myself straight into that, and then a specialist knee consultant's appointment the following working day.
I was not prepared simply to sit at home for the several months which the GP said an outpatients referral would take, in significant pain with both knees having suffered severe trauma and having received no physio or other rehab or acute care advice after the Austrian clinic had initially diagnosed me and patched me up.
Maybe the system is different 2 years on; maybe it is different in the OP's CCG area. For me, that was exactly and the only right thing to have done in the circumstances. There was no other option, and it's exactly what I'd do again. Where else, bar a private physio (which I also did), would you have gone?
(Edit - I will caveat the above by saying that Urgent Care and Walk in Units did not exist in my area. An MIU, as above, did, but were clearly not appropriate. The same is pretty much true where I live now, by the way; the only option will be a main hospital where specialists live. If the OP has a UCU or limp-in centre, then that/they may well be the correct port of call.)
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If an insurance company tried to argue that physiotherapy wasn't a clinical need then I think that would not stand up in court. They would more likely argue that the NHS stuff is adequate and free, hence their liability is zero. That too may be sketchy for them as selling you insurance for something which is free may also be hard to defend.

However the NHS physio is really about getting old people walking again. I was the only person there who needed to get back on the slopes within a few weeks.
I don't use insurance though, so when something gets broken, I use some of the money I saved to fix it wink

You may well be able to get through your GP quicker if you actually suggest visiting A&E should they prove unhelpful. Depending on the CCG that may be the lever you need.

--
oh yes, in North America just take your ticket back and you'd expect a full refund on the unused part of that and also any rentals.
Plus you'd have definitely signed the waiver on your binding settings.
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Hi @Grizzler, I am one of the hospital specialists to which you refer, although not an orthopaedic surgeon. I work in a very specialist tertiary centre which also is a major trauma centre. We will have to agree to disagree that attending A&E with a week old injury is fair and appropriate use of a scarce emergency resource. A brief scan of the BBC website will reveal the extent to which the service is trying to discourage this practice, some hospitals would triage the OP at the door and advise them on alternative options for accessing acute care.
A GP, rather than their reception staff, will offer the best route to an appropriate referral in my opinion. If they can't; change GP!

@CYPER, For what its worth the advice on the immediate care of this type of injury seems perfectly reasonable and is of course what the French (?) medic, who has examined you, advised.
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philwig wrote:
If an insurance company tried to argue that physiotherapy wasn't a clinical need then I think that would not stand up in court.


Think you'll find that travel policies only cover emergency medical and the ongoing care once the patient gets home is up to them. In other words if you have been patched up and can travel that's their job done. ACLs are perfect example - repairing an ACL isn't an emergency so it's up to the patient when they get home. People who ski regularly really should get private medical insurance - for most people its about the same price as say Sky TV.

I have seen some policies covering physio but for small amounts of money. ie used as a selling point.

Rental shops and waivers - waivers are literally not worth the paper they are printed on. In court the existence of a waiver is looked upon poorly - a kind of admission that they think they might need absolving of guilt if things go wrong. If a binding is improperly adjusted or faulty, then they are liable. Period. Proving it is another matter though. If you suspect binding to be at fault then keep hold of 'the evidence' and get it tested by an expert asap. Easier said than done and for a torn ACL, which can so easily pop without the binding wanting to release, it's unlikely to be a fruitful claim.
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Rareperk wrote:
Hi @Grizzler, I am one of the hospital specialists to which you refer, although not an orthopaedic surgeon. I work in a very specialist tertiary centre which also is a major trauma centre. We will have to agree to disagree that attending A&E with a week old injury is fair and appropriate use of a scarce emergency resource. A brief scan of the BBC website will reveal the extent to which the service is trying to discourage this practice, some hospitals would triage the OP at the door and advise them on alternative options for accessing acute care.
A GP, rather than their reception staff, will offer the best route to an appropriate referral in my opinion. If they can't; change GP!

This has always been my thought. A&E is surely for people who need urgent treatment, else their condition may deteriorate. If you've been able to carry on with your holiday, albeit without skiing, it can't be that urgent. My GP operates a triage system, and can for e.g. refer people for X-rays (which is rather handily in the Minor Injuries Unit next door).
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Fall and a binding releases or it doesn't, depends on the exact magnitude and direction of the forces your boot puts on it. Part of what makes skiing a risky sport sometimes so I very much doubt OP would stand much chance with that.
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@Rareperk, interesting. In many ways I would agree with you on the principle (although I am not a medical doctor). However, having damaged my knee in early january, in Europe, I spoke with my BiL who is an A&E consultant; he recommended that I (1) arrange an immediate phone consultation with my GP, to get them to start the knee clinic referral process while I was travelling home, and (2) go immediately to A&E when I arrived back home (which I did, straight off the ferry and 5 days post injury). He was very clear that attending A&E was the speediest way for folk injured (but not treated) overseas to slot into the nhs system for treatment on their return. His advice was helpful - between the GP referral getting the ball rolling, and the A&E triage nurse/ physio specialist at speeding it up, I was sorted with an appointment for knee orthopod 8 days post injury. Which I think is fairly good.

I should say I am in Scotland - not sure whether that might have a bearing on things.

The fact I’m still waiting for an MRI scan 6 weeks later is another story, though...
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Pruman wrote:
Rental shops and waivers - waivers are literally not worth the paper they are printed on. In court the existence of a waiver is looked upon poorly - a kind of admission that they think they might need absolving of guilt if things go wrong. If a binding is improperly adjusted or faulty, then they are liable. ...
Those papers are primarily there to provide a record of the actual settings used which is hard for either party to later deny.

Perhaps I shouldn't have used the word "waiver"; that's the colloquial term in BC, although of course you can't waive your rights.
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Quote:

The fact I’m still waiting for an MRI scan 6 weeks later is another story, though...

Well, you could pay a fairly modest fee and get it done much quicker. I'm still waiting after several months in tachycardia-mediated heart failure to go on the list for the procedure to try to get my heart working right. NHS resources are finite, and demand almost infinite. We can't always be first in the queue.
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NHS resources are finite, and demand almost infinite. We can't always be first in the queue.

@pam w, very well said! In fact you have expressed what I was trying to say far more succinctly than I ever could and with greater humility. I wish both you and the OP a full and speedy recovery.
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What is true is that it can be hard to break into the NHS system if you have an injury abroad. When my mum broke her ankle at the SFaB the hassle she had trying to get the follow up appointments necessary because she didn’t break it in the UK was crazy.

She tried to get GP to reefer her - they refused saying she just needs to book an appointment with fracture clinic.

Fracture clinic refused without GP referral.

She came very close to ending up at A&E because of sheer beaurocary and due to elapsed time was becoming and emergency to be seen!

She finally broke it down by refusing to leave the local surgery without a referral and demanding loudly and constantly at the desk. She should not have to have done that!

However all being said. ACL is different. Physio is important - my area allows self referrals for this. Make a GP appointment and they will refer, they are much more used to that. One tip to help is request “Choose and Book”. This will let you select the hospital with the shorter waiting list. This isn’t widely advertised which seems crazy as it seems a sensible way of managing the load to me.
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