Groups try to close health insurance loophole – February 12, 2007

By Matt Bolch
Contributing writer
If you or one of your employees is involved in a motorcycle- or ATV-related accident, will your health insurance cover the claim?
Those covered under a dealership health insurance policy probably are OK because the owner more than likely would have checked specifically into possible exclusions from employees riding the units he sells. But what about employees who are covered under a spouse’s policy elsewhere?
The American Motorcyclist Association, the All-Terrain Vehicle Association, Motorcycle Industry Council, Motorcycle Riders Foundation and companion groups devoted to riding snowmobiles, skiing enthusiasts and horseback riders have been trying for more than a decade to erase what they term a discriminatory practice against these groups.
“An injury is an injury is an injury — regardless of how one receives the injury,” said Edward Moreland, vice president, government relations at the AMA, based in Washington, D.C. “But a number of third-party insurers, such as employers and unions, have been denying coverage for employees based on whether they rode a motorcycle, and we think that’s discriminatory.”
The AMA, which has taken a leading role in this issue, is working with House and Senate leaders in the 110th Congress to introduce legislation to fix this inequity. Legislation introduced in the 108th and 109th Congress did not receive final approval. Each Congress corresponds to elections for the House of Representatives, and bills that aren’t passed by one Congress are wiped away when the next Congress convenes.
Other industry supporters of the change include the American Horse Council, the National Ski Areas Association and the American Council of Snowmobile Associations.
Furor around the issue began in 1995 when AMA member Tom Klimek was injured when a woman driving a car pulled out in the path of his motorcycle. The woman was charged in the accident, but since she didn’t have insurance, Klimek filed with his union-provided insurance. It was then Klimek discovered that he wasn’t covered and was personally liable for his medical bills, which ran into the tens of thousands of dollars.
The AMA has been working tirelessly on this issue since that time, leading a nationwide campaign that resulted in federal legislation designed to eliminate this type of health-insurance discrimination as part of the landmark Health Insurance Portability and Accountability Act of 1996. However, federal agencies charged with implementing the new law wrote rules that reversed congressional intent and made the situation worse by allowing insurers to redefine health-care coverage without notifying those insured.
Efforts to change the law came closest in the 108th Congress, where the legislation passed in the Senate. During the 109th Congress, House staffers raised technical questions about the bill, Moreland says.
But this session might well be the turning point for legislation the AMA believes is critical to its mission. “It can take many sessions to build support and reach critical mass on both the House and Senate sides,” Moreland said. “We’re working with staff and leadership and believe we have a great opportunity to pass it.”
Support on the House side is being led by Rep. Michael Burgess (R-TX), a physician and motorcycle rider who believes the current guidelines “fly in the face of the spirit of the law,” said John Martin, legislative director for Burgess. “This is a simple fix with a lot of support,” says Martin, who notes the legislative intent of the comprehensive HIPAA legislation was to prevent such discrimination from occurring.
“Rep. Burgess is concerned about basic fairness,” Martin says of his efforts on this issue. “People should receive the best care regardless of how they were injured.”
Roger Saltamach certainly would agree. In June 2003, the AMA member lost control of his motorcycle and crashed, leaving him with broken ribs, a broken shoulder and a punctured lung. His injuries hurt even more when he learned his insurance company wouldn’t pay, leaving him with $50,000 in medical bills. As AMA officials point out, injuries sustained while driving drunk would have been covered, as would have falling down a flight of stairs.
Although the number of motorcycle riders and others affected by these policies isn’t huge, “The problem is that when an accident does happen, it’s catastrophic,” Moreland says. “To deny coverage for any activity is arbitrary, capricious and discriminatory.”