City Negotiates Health Insurance Snag

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A city firefighter involved in an off-duty motorcycle crash in June was denied well being insurance coverage for his injuries given that the city's health insurance needed him to wear a helmet.

Lt. James Baker waited to see if the city council would accept a negotiated settlement this evening that would pay a reduced quantity.

The Sebring City Council will meet at 6:30 p.m. today at 368 S. Commerce Ave. to vote on this and many other issues.

Baker suffered injuries from a motorcycle crash on U.S. 27 for which the medical claim came to about $86,000. He was airlifted to the Tampa Common Hospital's trauma center.

"I was out for a small much less than two months," mentioned Baker. "I returned to full duty around the initially of August 2009."

Baker's insurance claim was initially denied since a clause added to the city's wellness insurance policy in 2005 on "activities of a hazardous nature," excluded from coverage motor cycle accidents with out helmets.

Baker claimed he would have been injured regardless of whether or not he wore a helmet, and thus the claim really should be paid. He suffered mostly abdominal injuries and no head injuries, he stated Monday.

In 1998 when he was hired, Baker said he received a copy of his insurance policy, and at time the exclusion clause was not there. He had no recollection of getting notified that it was added, he added.

Had he recognized of the exclusion, he would have been wearing a helmet, he said.

At a city Health Insurance Committee meeting, City Clerk Kathy Haley stated she was not sure if the notice of the added exclusions had been handed out to city employees, the minutes of the meeting show.

Mayor George Hensley mentioned a committee or an employee may well take into consideration unique activities "hazardous."
City Administrator Scott Noethlich agreed, but asked how one defined "hazardous."

Representatives of the city's wellness insurance administrator, Anchor Benefit, negotiated a settlement of $46,750, which they will have to pay.

At a special meeting held Feb. 25, the committee suggested that the council accept Anchor Benefit's negotiated discount with the understanding that Baker pays his remaining out-of-pocket maximum for the year of $734.74 and a $745 fee to negotiate the claims.

The tentative agreement further concluded that the basis of the recommendation was that Baker did not obtain any head injuries and that he would have been injured even if he was wearing a helmet at the time of the crash.

On the other hand, it remains up to the city council to approve the deal.

Hensley mentioned Monday that representatives of Anchor Benefit consulting had advised that this exclusion is not often identified in insurance policies, and Hensley believed the city would almost certainly take a closer look at it.

Baker has because stopped riding a motorcycle, citing his really like for his wife and five kids.

He said that his wife told him while he was still in Tampa Common Hospital that she knew how a great deal he loved riding a motorcycle and she would not ask him to quit.

"That was a hobby," stated Baker. "I was ready to give it up, not to put my loved ones through that once again."

On July 1, 2000, Florida exempted adult motorcyclists and moped riders from wearing helmets provided they have $10 000 in medical insurance, according to Andreas Muller, in the April 2004, American Journal of Public Well being.

Because then, Florida statutes have required motorcycle riders younger than 21 years to wear helmets.

The statute was signed into law by former Gov. Jeb Bush.

Prior to that Florida had a helmet law that required all riders to wear safety helmets.