Buddy had an accident, Swisscare denying claim

[DRGringoDutchy]

Hey guys,

My travel companion had an accident in Bolivia, albeit a minor one, that broke his ankle.

He has an insurance with Swisscare (www.swisscare.com) with whom he confirmed beforehand he would be insured on his 650cc bike. (See attached screenshot)

Now, after he's paid the bills, they're denying his claim, saying they only cover up to 125cc. (Which seems to be consistent with their terms & conditions but they are very poorly worded) They're also being very rude to him on the phone and have not once returned his phone calls.

Can anyone with experience in these matters offer a second opinion? What should he do? What are his chances?

Also -- because I'm not sure how else I can help -- I thought tweeting about it might cause them to give him some better service. If you're on twitter could you please help us out by retweeting this tweet:

https://twitter.com/jessems/status/850435084314456066


Thank you for reading!

[xfiltrate]

Originally Posted by DRGringoDutchy

Hey guys,

My travel companion had an accident in Bolivia, albeit a minor one, that broke his ankle.

He has an insurance with Swisscare (www.swisscare.com) with whom he confirmed beforehand he would be insured on his 650cc bike. (See attached screenshot)

Now, after he's paid the bills, they're denying his claim, saying they only cover up to 125cc. (Which seems to be consistent with their terms & conditions but they are very poorly worded) They're also being very rude to him on the phone and have not once returned his phone calls.

Can anyone with experience in these matters offer a second opinion? What should he do? What are his chances?

Also -- because I'm not sure how else I can help -- I thought tweeting about it might cause them to give him some better service. If you're on twitter could you please help us out by retweeting this tweet:

https://twitter.com/jessems/status/850435084314456066


Thank you for reading!

My take on what appears to be a poorly translated letter, is that all your buddy has to do is assure the Swisscare that he was not injured in a race or sporting event and that he only uses his 650 for transportation purposes. According to the letter - he should be covered.
I would hope Tony Lee offers his opinion here.

Keep us posted , but unless he was racing or in a sporting event - the 125cc restriction should not apply - according to the letter from Swisscare.

xfiltrate

[Tony LEE]

Pretty clear to me too.

Sounds like a bit of misunderstanding on both sides may be the problem. Perhaps write again using no conditional clauses and no compound sentences and start each simple sentence as a new paragraph.

ie

I was riding my bike along jones street in fred town.

I was going to the shops to buy some food.

A dog ran out at me.

It got caught in my front wheel.

I fell off my bike

I broke my ankle.

[PanEuropean]

DRGringoDutchy:

As you know from living in Switzerland (as indicated by the address on your Twitter account), the Swiss (and most especially the Swiss-Germans) pay close attention to the "rules", and will not renege on a commitment as long as all the rules are followed. They are the largest insurers and re-insurers in the world, and they didn't get that way by not honouring the commitments made in the policies that they write.

It is clear to me from reading the letter that the insurance does not cover motor racing or "sports" on motorcycles over 125cc.

You did not tell us in your original post exactly what the circumstances of the accident were. Did the bike topple over in a hotel parking lot and land on your friend's ankle? In such a case he should be covered by the policy.

BUT:

If he was off-roading (which could reasonably be considered to be "sports"), or hill-climbing, or doing anything other than riding the bike on a public road, then the insurance company would certainly be well within their rights to decline the claim.

Might be best if you tell us THE WHOLE STORY about the circumstances of how the person broke their ankle before you ask us to support you via Twitter.

Michael

[Tim Cullis]

This was my conversation with WorldwideInsure from a few years back.

My email to them...

Before taking out the most recent policy I spoke to a lady (twice) on the telephone on 11 February. I stated that I normally travelled by motorcycle rather than car and was told the two restrictions that would be applied were
- personal liability cover wouldn't be in place whilst using a motor vehicle
- personal accident cover wouldn't be in place whilst riding a motorcycle.

Accordingly I took out the insurance, however I was then informed by a friend that under 'sports and activities' I needed additional one-off premium of £8 to cover 'motorcycle overland touring'. I was rather concerned about this as I had disclosed my normal form of transport in the telephone conversations of 11 February.

So I telephone today and was told that 'motorcycle overland touring' doesn't mean (in the example I quoted) touring overland from France to Germany and Switzerland, rather than it means touring offroad. Could you please confirm that overland touring as I understand it IS covered.

And then I am uncertain what is meant by touring offroad. In some countries including the USA there are many roads used daily by local 2WD cars and vans that have a macadam surface (stone) rather than a tarmacadam sealed surface. Can you please confirm these local roads are NOT classified as offroad?

The other thing I was told is that if I did want cover for 'touring offroad', then I would need to define in advance how many days I would be offroad and that premium would be as much as £22.

Their response

Thank you for your enquiry. First to confirm off road, this would be travelling off the public highway obviously the road surface / type of road can change depending on the country that you are in but as long as this is the 'public highway ' then you would not be considered off road.

Motor cycle touring is using your motorcycle as your means of transport to travel around.

Due to queries on when this becomes overland touring we have changed the definition. Recreational motor-cycling up to 23 days will not have any additional premium. Over 23 days and / or off road will have an endorsement this is charged at rate A under our sports & activities cover, so for instance 31 day in Europe would be charged at an additional £12. Therefore you trip to Europe if under the 23 day period will be cover with the exception of

- personal liability cover wouldn't be in place whilst using a motor vehicle
- personal accident cover wouldn't be in place whilst riding a motorcycle.

I hope this has clarified the situation for you but if you have any further queries please do not hesitate to contact us.

[swisscare]

Dear community,

We as Swisscare have to add a final contribution to the post to avoid any mistakes.

GOOD NEWS : The case you mention was fully refunded to your motorcycle friend.

In fact, Swisscare's travel insurance is underwritten by the assistance company SOS Evasan SA who is responsible for the risk cover and the claims management. The company decided to not take in charge motorcycle based on an article in which it is mentioned racing. This was the primary refusal sent to your friend.

The concerned terms and conditions article was not clear and put your friend in some troubles. A quick tour on the insurance market will in fact show that it is not a problem to drive a motorcycle and be insured with an emergency medical cover. Some company charge a bit more premiums due to a higher risk.

The assistance company come back to Swisscare after this with additional information to argue the non cover of the case.

Anyway, Swisscare decided from his own to take his responsibilities as we confirmed a cover to your friend. All costs including those who are not covered under an insurance was paid.

From July 2017, a new travel plan will be launched. Swisscare decided to collaborate with another assistance company.

Team Swisscare

[Bucket1960]

Well done to Swisscare for stepping up on this occasion

[horriFfro]

Although I think that now is the time when help is always needed in working with insurance agencies. I needed it after bumped into a cyclist on the road. I immediately jumped out of the car to help him, but thanks Goodness nothing terrible happened to him. Although, the ebike was damaged. Therefore, he demanded compensation for damage, although it was his fault in general. Honestly guys, always watch where you drive. My insurance company was unable to resolve the issue for a long time, so I even started looking for the los Angeles car crash attorney, various agencies that work with similar cases. It's good that one of these agencies helped, and the victim himself will repair his bike.

[Tim Cullis]

They are unlikely to be monitoring this forum, so if you have a question I suggest you ask them directly and then post their response.