• Mike Riska

Accident Plan Claim Checks Soothed My Sprained Ankle

We get a lot of questions about how voluntary benefit plans act at time of claim. Do you get a card to give your doctor? How much does it pay? What does it pay for? I think a good example goes a long way and luckily I once hurt myself pretty badly, so I can give a first hand account of how an Accident Plan works when you make a claim.


My wife and I took a trip for our 5th anniversary. We went to Vieques, an island off of Puerto Rico that had in the recent past been a test bombing site for the US military. The military pulled out, the land was converted into a wildlife refuge and no one was blowing anything up any more, but people weren't really traveling there. So it was exactly my kind of destination and the possibility of stumbling on unexploded ordinance made it extra romantic.


We flew over from Puerto Rico in a plane small enough that the pilot had to climb in through the window. My wife loves these, I usually end up with fingernail shaped scars on my forearm. When we landed the pilot personally carried our luggage over to the terminal, one room with no doors, and put it on a tiny luggage conveyer outside the building, so that we could turn the corner and pick it up off the part of the conveyer that was inside the building.


I like to work a little to get to the good spots.


Soon enough, we picked up our rental Jeep and were driving down roads tunneled by jungle, exploring abandoned and overgrown bunkers and sitting alone on beaches that all seemed to be a perfect semicircle with a single very fancy boat floating in the water. A lot of the roads were unpaved, which always takes a vacation up a notch for me, and we were involved in two different rescues to get cars out of deep sand -- one of which required shoving the car with a bus -- so this quickly became an all time favorite getaway.


On our last night, we kayaked in one of the world's only bioluminescent bays, then cleaned up and walked down to the little town near where we were staying. We spotted the place we wanted to eat and, just as I stepped off the sidewalk to cross the street, I fell. Hard. I fell so hard I didn't realize I was falling until I was on the ground.


I picked myself up off the street, with my wife muttering something about me never being allowed to wear flipflops again. I knew my ankle was injured, maybe badly, but I also knew we were in the kind of place where if you want a doctor you're going to have to knock on someone's door and explain why you're interrupting their dinner. So we hobbled over to the place we were headed for food and drinks. We were flying out in the morning.


Sometimes the things you need appear right when you need them and the first thing on the menu happened to be "Painkillers." I ordered one, then another, then maybe two or three more. They work! But by the time I got off the stool to find the men's room my ankle was swollen and stiff and it was clear that it was somewhere between sprained and broken. I very gently limped back to our place and in the morning managed to get myself through two airports and home.


Not a good trade


The doctor at the walk-in clinic X-rayed my ankle and said "Wow, this is badly sprained. It would hurt less if you broke it. You should really go see your regular doctor." My regular doctor X-rayed my ankle and said "Wow, this is badly sprained. It would hurt less if you broke it. You should really go see an orthopedic specialist." The orthopedic specialist X-rayed my ankle and said "Wow, this is badly sprained. It would hurt less if you broke it. Here's a giant air boot and a prescription for crutches and two months of physical therapy."


So the medical expenses started. Copays for doctor visits, no cost for crutches but half price for the boot, and a fee every time I went to physical therapy twice a week for two and a half months. All in all I was out about $500, which was doable, but was also a decent sized expense I hadn't planned on.


I had an Accident plan and for this situation it first paid me a benefit just for having an injury that required medical attention. Then it paid benefits for the X-rays, the follow up visits to the various doctors, the boot and crutches, plus an amount related to the specific injury. I could have submitted a claim after each of these and the carrier would have kept sending me checks, but I just saved all my documentation for the end, submitted it all at once with a claim form and got a check for about $600. So all my expenses were covered and I had a little extra for my trouble, like having to take a couple hours off work for each physical therapy visit.


Now in the grand scheme of things my little sprained ankle was not a huge deal, which is why I spent more time talking about the trip than the claim. People get much more seriously injured every day and for them an Accident plan would pay a much larger benefit. The amounts paid can get very big when you start needing ambulances and hospital beds. Most plans even have some life insurance built right in.


I just happened to get a little hurt in paradise. I can't wait to go back, this time without flipflops.

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