Ski Insurance Claim Query

A snowHead

Hi - hoping someone can help. My daughter is boarding in Morzine - yesterday she fell and dislocated/fracture her wrist. She got treated - plaster cast I think + meds. She paid £750 ish I think for treatment with card.
She bought wintersports insurance in UK (Admiral who use CEGA), but also got cover with her lift pass for a few Euros extra. Her UK policy looks comprehensive, and should cover everything, with modest excess. I can't work out whats covered with the lift pass insurance, which is with Snow Risk/ Europ Assistance
Question is which to claim from? We reported to the Uk insurers already just to ensure wee did all the right things, but looking at reviews their reputation looks uncertain. She could claim form the lift pass policy, but that might not cover everything and might have higher excesses, plus might be more difficualt to deal with given not UK based. If claiming with them it looks like the claim has to be logged during the period of insurance which only leaves 2 days.
To complicate things further, I'm pretty sure if either insurer was aware of a second policy they wouldn't pay, and would say to claim from the other - I had this situation once before and lost money.
so - what to do? Grateful for any ideas.

A snowHead

If you're worried about the 2 policies point being played off you've already committed somewhat by telling the UK insurer. Did she not use GHIC as that might be a factor in declining reimbursement although if she had no choice of using a private clinic that might be moot.

I thought the main advantage of Carte/ Carre Neige was you presented it and rescue/ clinc billed directly to them?

Well, the person's real but it's just a made up name, see?

Carte/ Carre Neige just covers you to get off the mountain I thought? It doesn't cover treatment. Provided the 750 is treatment I would expect my ski insurance to cover it

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Claim from Admiral.

If they muck you about threaten them with the ombudsman.

If there are 2 policies, it's up to them to sort that out with the other insurer - it doesn't absolve them of paying your claim

Anyway, snowHeads is much more fun if you do.

It would be better to advise both insurance policies of the possibility of double coverage. People who are trying to defraud insurance companies, do not generally inform them of double coverage.

The principle of insurance is that you are indeminified against your costs, not that you can profit from an accident.

If the insurance company becomes aware of another potential claim for the same accident, you may find your claim is delayed whilst investigations occur.

If there is any overlap of insurance coverage, then then insurers will likely split the payment (rather than pay you twice).

Best to own up in the long run, or face the possibility of being found omitting to tell them of the possible double claim.

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Hey Guys thanks for the prompt responses. Comms between me and my daughter tricky - she's struggling to use phone and I'm not in UK at the moment - so I'm not sure of the whole story.

I dont think she uses GHIC, although it was mentioned. I think she suggested it wold cover the excess if claiming from the local insurer, but unclear. I think she just had to get treatment then and their and couldnt really evaluate the insurance options beforehand.

Yes my impression is the local insurer may only cover getting off the mountain - it seems to inlcude "emergency medial aid" but not sure what that means. The add-on cost was a few Euros per day, so hard to believe that will cover much.

I agree claiming from Admiral seems the sensible thing to do - the idea of splitting the claim seems fraught with issues, and yes I've already started process with them so probably best to continue. TBH I dont think she realsied initially that the lift pass offered any cover - her friend bought the passes.

I dont have much sympathy with insurance companies, but I can see they are rightly sensitive to double claiming, and wont allow that to happen. But then I'm also sensitive to insurance companies not paying up!

Then you can post your own questions or snow reports...

After all it is free

Yeah I don't think that's what she has though. Hers is with Snow Risk. But as you say it does seem to cover more than the basics. But probably not better than the Admiral policy.

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I'd agree with the consensus here. Claim through Admiral. I had the local "lift pass" insurance when I broke my pelvis, so no cost for getting me off the mountain but my UK insurer covered getting me home to UK (which was weeks later, as I had my own apartment, and they paid for two drivers to come up and drive me home in my own car, as they'd not have paid to get the car home if I was medi-vacced. They never asked whether I had the local insurance and I never told them. If your daughter paid for the medical treatment in a private clinic I don't think the local insurance would cover it anyway. She most definitely SHOULD have had GHIC - everybody based in UK should - but, again, that would not, as I understand it, cover treatment in a private resort clinic. They can knock up the costs even for simple things (with masses of completely unnecessary medication) and they'll also have charged for more important things, like X-rays. I hope she will be OK - it's so worrying when they're so far away.

Wrist guards - vital for beginner snowboarders!!

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There is no GHIC discount in Morzine - its all treated as private for non residents so insurance payout should be straight forward.

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I think most clinics in French ski resorts are private - some people just reckon the GHIC and Carré Neige or Carte Neige insurance covers everything - but they can come badly unstuck. The local insurance is so cheap (cost of a cup of coffee) it's a no-brainer, and simplifies getting off the mountain, which can be very expensive, but for the rest, a UK insurance policy makes sense. But I'd not pay extra to insure for things like losing money or cameras or having skis stolen because those clauses are full of conditions. And we can all afford to pay for those things for ourselves. Insurance only exists to make money. If you injure somebody and they sue you successfully, or you are flown home in an air ambulance, that is the sort of cost few of us can afford to cover ourselves.

Once you're in a French public hospital, GHIC comes into its own. But you don't necessarily need the bit of plastic - that just proves you're covered. If you forget about the plastic you can still get the info you need. But when somebody's hurt, you really don't want to be faffing with that. And I imagine a broken wrist is very painful.

Brilliant advice, thanks so much everyone. Main thing is she's ok and seems comfortable. We messaged this evening and she seems in good spirits... possibly mostly of the alcoholic variety!
We'll claim through Admiral and hopefully all will be good. If you want a laugh check out the reviews for CEGA. It might be a long haul!
BTW she was advised about wrist protection but didn't get around to sorting it. I think next time she will revert to skis!

You know it makes sense.

Most insurance claim forms that I have seen ( and I have completed a few) ask the question "Have you any other form of cover?" or something similar. At that point you reply yes and give full details of who is providing the cover then leave it up to them to sort out. Inform both companies of the possibility of a claim.

I have varied experiences with CEGA. Simple but expensive claim (£30k ish), physical injury repatriation to UK they were brilliant and quick, super support and organisation.
Debatable cancellation claim (£1k), they took their time and argued but eventually paid.

GHIC isn't perfect in France all it does is give the same level of cover (80%) as a French resident would receive who didn't subscribe to their top-up policies.
Under EHIC rules in 2016 my wife spent 4 days in a surgical hospital bed at €1,250 per night reduced by 80% leaving us/our insurance company to pay €1,000 before they would let her leave.

Otherwise you'll just go on seeing the one name:

@Tommohawk, there's some bad reviews, but also some people on here that say they had a decent experience, just use the search facility.

A snowHead

[quote=At that point you reply yes and give full details..[/quote]

In principle I agree but my previous experience was that once one company becomes aware of the existence of the other they simply say to claim from the other. That was only one experience, but not one to be forgotten.

In any event it looks like CEGA should cover it all, so simplest just to claim all from them I think. When I logged the claim I was unaware of the secondary policy, so when asked f there was any other insurance in place I simply said no. In fact my daughter was unaware too as her friend bought the lift passes.

Hells Bells - to be fair the CEGA assistant I spoke with was really lovely - helpful and sympathetic. But one of the big review sites only gives them 1.5/5, which isnt promising for actaul results. But reviews are of course notoriously unreliable. Anyohw I post my progress on here.

Thanks again for the replies!

A snowHead

I claimed through admiral last year for xray costs (at a doctor's surgery, so no GHIC) + loss of ski pass usage. Took a while to get the money back, but it wasn't too painful, just a waiting game - they did require quite a lot of proof, eg receipts at point of payment as well as bank statements.

The lift pass company were able to write me an email saying they confirmed I didn't use the pass for the final 3 days it was valid, which I sent over to admiral with scans of all my receipts from the doctor's, as well as a letter from the doctor confirming that I was fine to travel home and also that I wasn't "supposed" to ski with my injury.

Well, the person's real but it's just a made up name, see?

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Did she have many days left on the lift pass, having used it to get back to Avoriaz? That will have knocked off a day.

When I had my claim I don't remember being asked about my Carré Neige insurance. I certainly wouldn't have told any lies - lying to an insurance company is idiotic.

Anyway, snowHeads is much more fun if you do.

Lift pass was for 4 days, she ski'd for 1 day, but had to use the pass on the following day to get to the treatment centre for review. Cost approx 200E total. So refund should be 3 days if claiming for days she couldnt ski, or 2 days if claiming for days she didnt use it at all.

Not sure of the exact wording - my daughter is doing the online forms now - but Admiral ask if there is any other policy.

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@Tommohawk, the pass was used for 2 days - doesn't matter whether she skied or not. Declare the other policy. One company shoudl lead and split the claim with the other company behind the scenes, ask Admiral.

Then you can post your own questions or snow reports...

Rightly or wrongly, my instinct is to be totally honest about things.

An Insurance contract is one of "Utmost good faith", where if you don't declare something that the Insurance Co feels they should have been told, they can declare the contract void.

Now, they may well never find out that there was a secondary policy taken out and it is possible that it could complicate matters.....but I'm sure they are well used to dealing with double cover.

I would never tell someone else how to go about this, in case it caused problems.....but thought I'd highlight the " Uberrimae fidei" nature of Insurance contracts, in case it becomes an issue.

After all it is free

Agree. Definitely she will only get, at maximum, the difference between a two day pass and what she paid for 4. Which will be less than 50 per cent. The local rules for refunding lift pass are pretty clear - she should sort that right away. There might be small print and she'll need documentation.

Agree. Definitely she will only get, at maximum, the difference between a two day pass and what she paid for 4. Which will be less than 50 per cent. The local rules for refunding lift pass are pretty clear - she should sort that right away. There might be small print and she'll need documentation.

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OK, well it looks like the lift pass issues is resolved. She tells me she has used again today to get up the mountain cos she was bored stupid and would like to do the same tomorrow - looks like there will be no claim for unused lift pass.

So the simple answer would seem to be to claim from Admiral only, and don't claim for the pass. Still leaves the question of whether to mention the lift pass add on policy. She didn't even know she had it until it came up in conversation, and even then most folk - and I've spoken to a lot now - thought this cover was only to get off the mountain, which wasnt an issue.

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@Tommohawk, I would guess getting off the mountain was not an issue because of the lift pass insurance. If the pisteurs got to see and check the pass then they would do everything without question. Otherwise a trip to the cash machine might have been the case. It maybe that you never see a bill or pay for the getting off the piste and in effect you will be using both policies.

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just a thought but re the lift pass, have you checked that she couldn't get it refunded ? After n accident I got my Dolomiti superski refunded in resort.

You know it makes sense.

Otherwise you'll just go on seeing the one name:

A snowHead

@Tommohawk, you are over thinking it

A snowHead

@Tommohawk, Mrs P has been a regular user of PDS piste services. Roughly a couple of 100 euros for blood wagon. Couple of hundred euros for a short ambulance trip across town and helicopter in the thousands of euros. Workers are keen always to know where the money is coming from. The least hassle is to have the lift pass insurance at that stage as they just accept that and get you off the mountain.

Personally for a weeks holiday I would get travel insurance plus lift pass insurance. I take your point on double insurance but the benefit of getting off the mountain with no hassle can not be over estimated.

We spend most of the season here and my personal solution is to have get off the mountain insurance for 25 euros a year with Vieux Campeur and rely on EHIC / GHIC for medical expenses. There are many other threads on this issue.

Well, the person's real but it's just a made up name, see?

Thanks for that - and I agree that a few Euros per day to cover possible Heli costs is good value. What would help is if that cover didnt extend to cover other stuff - unless it covers everything including repatriation etc

It would be interesting to her from someone who only had the lift pass cover, to know what the extent of the cover actually is. Or someone who is an expert in T and Cs to figure out what the extent of cover really is. It appears to cover getting you off the slope, emergency medical cover, cancelled lessons, cancelled pass. But not medical care back home or repatriation, or meds. Not sure what the excesses are either.

Hard to believe you would get all this for 3 Euros per day, isnt it??? That said the Admiral policy was only about £20 and seemingly covers everything.

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Anyway, snowHeads is much more fun if you do.

@Tommohawk,' you must have a primary or supplementary health care organisation that can refund
partly your medical expenses incurred during your stay in the resort or that can furnish
you a certificate of refusal to reimburse these expenses if necessary (in English or
French only).'

Is a quote from the above quoted terms and conditions. First thought is that GHIC might cover this. However in les Gets and Morzine the immediate medical services are private and GHIC no good. It could therefore be argued you do not fulfill this requirement. If you get transfered to hospital somewhere like Thonon / Cluses / Sallanches the default position is to take you to a private hospital if you have travel insurance but you can ask to go to a public hospital and then use GHIC but you will be responsible for 10 - 20 %.

The common wisdom is to only rely on piste insurance for getting you off the mountain and personally I would stick with that

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Then you can post your own questions or snow reports...

@Tommohawk, I get where you are coming from and I can not guarantee you will never get into an argument re double insurance. However it is very common to have lift pass insurance and holiday insurance. The holiday insurance is usually just happy that they do not pay for you getting off the mountain and lift pass insurance are happy they stop there. If you do not speak the local language this is also the most pragmatic option.

After all it is free

@Tommohawk, Forgot to say, just make sure your daughter gets a fit to fly certificate from the doctor. Sometimes they even split a cast. You will have somebody saying this is not required but I have seen first hand people refused at GVA

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Great advice. As it happens my wife thought of this as she had a leg in plaster some years back in La Palma and had to have cast split. The clinic have given her a fit to fly certificate so shes good to go.

Help!!

Ski Insurance Claim Query

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