# Anyone been sued by a health insurance company?



## AC/BC (Jun 22, 2006)

I'm curious if this really happens. I never hear about it happening but it's always brought up when anything larger is proposed to be built here. People think they're going to get sued so they end up building very sanitized trail without any progressive features. I've even heard people say they're worried "someone might actually get airborne on accident" :skep:


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## Silentfoe (May 9, 2008)

Most states have laws that protect cities and landowners that allow recreation on their property. As long as you aren't charging for access.


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## formica (Jul 4, 2004)

We've gotten those form numerous times after Hub's accidents. He's had multiple serious ones. He always fills them out to the tune of he did it to himself. 

But, ya, your state should have some sort of recreation law that protects owners/managers from liability if they aren't charging.


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## indytrekracer (Feb 13, 2004)

We have two pending lawsuits. Our States recreational immunity laws protect landowners, but since we are not a land owner, we are not protected.


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## ki5ka (Dec 17, 2006)

indytrekracer said:


> We have two pending lawsuits. ....


I am interested in hearing the details. Is there anymore that you can share?


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## indytrekracer (Feb 13, 2004)

Both cases involve wooden Technical Trail Features. This seems to be the trend, that most mtb related litigation is around wooden features.

In both cases individual, including myself where named. Our insurance company's lawyers where able to pull all but one name off the suit and replace individual names with HMBA as an organization.

Recreational immunity protects land owners. It does not in any way help us as a 501 C 3 volunteer organization. What this means is that we have no mechanism to dismiss the law suits. The suits remain open as long as the plantifs lawyers hit their dead lines throughout the process. keep in mind that they can file for extensions at many parts of the process. In our cases the plantifs lawyers have invested very little time and money on dispositions and expert witnesses, but they keep hitting dead lines. It appears there goal is to get our insurance company to offer a settlement or have to continue to pay lawyers to defend. (FYI we and our expert witnesses are confident that there is no merit to either case).

The importance of insurance isn't just the coverage amount. The importance of insurance is that your insurance company handles the legal part of the litigation. It is a normal part of their world. If we were not insured, we as individuals, would be paying for our legal defense.

In both cases we were able to provide documentation for the features. Plans, approvals, post build inspections. If you build wood features and bridges, it is in you best interest to have a paper trail to defend the feature. We use National Forest Standards for construction of bridges. As a result they often appear over built to the average person. But If sued for a bridge, I can defend the number and size of stringers, based on National Forest Standards. 

We do every thing we can to avoid building with wood. We would rather use rocks or dirt to cross ravines or add challenges. But if you must use wood, you have to do it right up front and then inspect the wood features each year. We just did major repairs to two bridges, as the result of spring inspections. 

Couple more parting comments

Add challenge, not risk. a feature that is 12" off the ground is just as technically challenging as a feature that is 4' off the ground. But the risk is much greater on the feature 4' off the ground. Strive to add challenge while minimizing risk.

Those who sue are typically not part of the mtb community. They are every day citizens who ride on a public trail, but not enough that they or their families would be considered mountain bikers. So they are not like to understand or care about the negative impact of a law suit to the mtb community.

Since the suits we have built trails that are more technically challenging than the trails involved in the litigation. My advice is to be insured, have a risk management plan, and continue to build technical trails (while mitigating any unnecessary risk for riders).


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## ki5ka (Dec 17, 2006)

Indy, thanks for the great write-up and meaningful insights. Sounds like you do a very good job or protecting yourself. You have done a great service here educating the rest of us how to do the same, Kudos!


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## Nubster (May 15, 2009)

How far can signed waivers go to help protect you in reality? Or highly visible signs stating that you are engaging in a potentially dangerous activity at your own risk?


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## watts888 (Oct 2, 2012)

Our local trails are basically all rock/dirt, no wood. Only a couple of our trails have wood features (man made wood, not logs that conveniently fell in a completely un-planned manner), and as time goes by, those are getting worked on with re-routes or structural checks.

we had an issue a couple years ago where a cool ride area was made up with wooden ramps, walls, and platforms. Once the insurance unwritter saw them, done. Thousands of dollars spent on materials, approved by the park, engineering checks made, etc... If insurance won't cover it, not even worth starting. Rocks and roots are completely natural though, so it goes between the land owner and rider.


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## Cotharyus (Jun 21, 2012)

indytrekracer said:


> Both cases involve wooden Technical Trail Features. This seems to be the trend, that most mtb related litigation is around wooden features.
> 
> In both cases individual, including myself where named. Our insurance company's lawyers where able to pull all but one name off the suit and replace individual names with HMBA as an organization.
> 
> ...


I've had my methods of building questioned - people ask why I don't build bridges (I have some very challenging crossings, but all very rideable even on a single speed) and wooden ramps (dirt is very easy to come by...) and wall rides - I repeatedly tell them it's because I don't want to maintain those things. It's not because I'm lazy, but because I don't want to document every aspect, as you've done, and have to come in and replace sections every couple years, etc. In spite of being told (by someone who knows nothing about trail building or sustainability) that my crossings would wash out the first time it rained and I should build bridges, the only thing I've had to do with my crossings in 3 years is cut trees that washed into them out with a chainsaw twice. Yep. Enough water to wash a tree big enough to need a chainsaw down the ditch the crossing is in, and no need to rework any of the dirt. Surely it will wash out just any time now....


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## ki5ka (Dec 17, 2006)

Cotharyus said:


> I've had my methods of building questioned -.... by someone who knows nothing about trail building or sustainability


That seems to be the way it goes. Aggravating ain't it! Keep calm and carry on.


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## andytiedye (Jul 26, 2014)

indytrekracer said:


> Those who sue are typically not part of the mtb community. They are every day citizens who ride on a public trail, but not enough that they or their families would be considered mountain bikers. So they are not like to understand or care about the negative impact of a law suit to the mtb community.


Those who sue are probably being forced to do so by their insurer under the subrogation clause in their policy. If they refuse, they have to pay all their medical bills themselves, and pay back the insurance company whatever it already paid out for the incident. That would bankrupt most people if it was a serious injury.


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## indytrekracer (Feb 13, 2004)

andytiedye said:


> Those who sue are probably being forced to do so by their insurer under the subrogation clause in their policy. If they refuse, they have to pay all their medical bills themselves, and pay back the insurance company whatever it already paid out for the incident. That would bankrupt most people if it was a serious injury.


This is not the case in either of our suits. In one case the person did not have health insurance, so he decided to sue to cover medical expenses. In the other it was the family of the rider.


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## andytiedye (Jul 26, 2014)

indytrekracer said:


> This is not the case in either of our suits. In one case the person did not have health insurance, so he decided to sue to cover medical expenses.


Even less likely that such a person would have the resources to pay the medical bills himself.



indytrekracer said:


> In the other it was the family of the rider.


Was the rider a minor?


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## indytrekracer (Feb 13, 2004)

andytiedye said:


> Was the rider a minor?


Unfortunately, it was a fatality.


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## Shark (Feb 4, 2006)

andytiedye said:


> Even less likely that such a person would have the resources to pay the medical bills himself.
> 
> Was the rider a minor?


At some point people have to take responsibility for their own actions.
If you do not have health insurance, perhaps riding a mountain bike in the woods is not the best idea.


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## old_MTBer (Feb 16, 2014)

Shark said:


> At some point people have to take responsibility for their own actions. If you do not have health insurance, perhaps riding a mountain bike in the woods is not the best idea.


This discussion started as "Anyone been sued by a health insurance company?" And in fact you can be sued that way. It does not have to be the actual injured person bringing a lawsuit. The official term is SUBROGATION. This is where a rider who does have insurance which pays to treat injuries received. Then the insurance company turns the claim over for subrogation. A department or contractor investigates the claim to see if there is some entity that can be sued to recover the money the health insurance company spent. In the case of an MTB incident it can be all concerned, the land owner, the trail builder (professional or volunteer group), and the group maintaining the trail. You are just as likely to be sued by an insurance company as an uninsured person.


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## lazarus2405 (Jul 16, 2011)

old_MTBer said:


> Then the insurance company turns the claim over for subrogation. A department or contractor investigates the claim to see if there is some entity that can be sued to recover the money the health insurance company spent. In the case of an MTB incident it can be all concerned, the land owner, the trail builder (professional or volunteer group), and the group maintaining the trail.


On a tangential note, if I'm a rider who gets seriously injured on public trails, how can I protect my club/trail builder/landowner from my own insurance company during subrogation? Are there things I can say or do, short of perjuring myself?


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## old_MTBer (Feb 16, 2014)

That is a question for an attorney. Do we have one in the forum?


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## ki5ka (Dec 17, 2006)

lazarus2405 said:


> On a tangential note, if I'm a rider who gets seriously injured on public trails, how can I protect my club/trail builder/landowner from my own insurance company during subrogation? Are there things I can say or do, short of perjuring myself?


Really good question!


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## Miker J (Nov 4, 2003)

Great.

Health insurance companies can't sue the tobacco company for costs from its clients lung cancer, but they can sue a club who builds trails that keep people active and healthy.

Lawyers and insurance companies - two entities whose only interest is turning a profit or proving themselves right.

It what's running the country.


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## Shark (Feb 4, 2006)

A few years ago I had a bad wreck, on private land.
Broke collar bone and concussion. I had good insurance through work.

The insurance co wanted to know where the accident took place.

I told them, in the forest.


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## Bruce in SoCal (Apr 21, 2013)

I was going to answer lazarus2405's question, but saw Miker J's comment. Since I don't want to appear to be seen as trying to turn a profit, I won't. Nor will I give my views on how trail builders can protect themselves. Sorry.

Edit to add:

Miker J, if you ever get in trouble with the law remember that a lawyer is only interested in turning a profit, so don't trust a lawyer and represent yourself.


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## Terranaut (Jun 9, 2014)

Bruce in SoCal said:


> I was going to answer lazarus2405's question, but saw Miker J's comment. Since I don't want to appear to be seen as trying to turn a profit, I won't. Nor will I give my views on how trail builders can protect themselves. Sorry.
> 
> Edit to add:
> 
> Miker J, if you ever get in trouble with the law remember that a lawyer is only interested in turning a profit, so don't trust a lawyer and represent yourself.


Took that one a little personally don't you think? Sorry you were painted with the same brush but your reply here kind of supports MJ's claim doesn't it?


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## Bruce in SoCal (Apr 21, 2013)

Terranaut said:


> Took that one a little personally don't you think? Sorry you were painted with the same brush but your reply here kind of supports MJ's claim doesn't it?


I don't know if my reply supports his claim or not. And, yes, I did take it personally, very personally. And there is no need for you to apologize about what brush I was painted with.

The bottom line is that if what I say is going to be interpreted as being so I can turn a profit, then I won't say it. That way, no one can say I said it to turn a profit.

Now, im going riding.


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## watts888 (Oct 2, 2012)

Bruce in SoCal said:


> ... if what I say is going to be interpreted as being so I can turn a profit, then I won't say it. That way, no one can say I said it to turn a profit.


That sounds like lawyer speak. Must be from New York City (temporarily riding in SoCal)


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## leeboh (Aug 5, 2011)

indytrekracer said:


> This is not the case in either of our suits. In one case the person did not have health insurance, so he decided to sue to cover medical expenses. In the other it was the family of the rider.


Indytrek, looking for some info without getting too personal. You did trail work in public park/forest? With a mt bike group? Just basics would be helpful.


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## indytrekracer (Feb 13, 2004)

*lawsuit*



leeboh said:


> Indytrek, looking for some info without getting too personal. You did trail work in public park/forest? With a mt bike group? Just basics would be helpful.


We are a 501 c group. We built and maintain a local trail. The feature in question was an eagle scout project that we assisted with. It is City Park.

Basically, if someone approaches a lawyer, they will google search the trail and and anyone's name who comes up. They want to name as many people as possible. This put the effort on everyone to argue why they shouldn't be on the suit. They also are hoping that those named will start finger pointing.

In our case they named individuals from our group and our legal representatives had to get the individual's name rolled under our organization's name.


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## leeboh (Aug 5, 2011)

Yikes. We are in a 501(3)c group as well. We do trail work and bridges as well. All over the place. How could they sue? Mt biking has risks.


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## Miker J (Nov 4, 2003)

Bruce in SoCal said:


> I was going to answer lazarus2405's question, but saw Miker J's comment. Since I don't want to appear to be seen as trying to turn a profit, I won't. Nor will I give my views on how trail builders can protect themselves. Sorry.
> 
> Edit to add:
> 
> Miker J, if you ever get in trouble with the law remember that a lawyer is only interested in turning a profit, so don't trust a lawyer and represent yourself.


Correct me if I'm wrong but isn't a public defendant's primary role to prove their side is "right". They do this even if they know their side is at fault.

Of course there will be grey cases where arbitration is needed, but fighting for something that is plain wrong, when you know it, seems very not cool.

Look outside the box at our twisted system.


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## Joules (Oct 12, 2005)

Miker J said:


> Of course there will be grey cases where arbitration is needed, but when fighting for something that is plain wrong, when you know it, seems very not cool.
> 
> Look outside the box at our twisted system.


you're totally right. If I'm ever sued or falsely charged with a crime, I definitely want the lawyer I hire to decide the merit of even defending me. I mean, if one person isn't instantly convinced of my innocence, why should I even get a trial, right?


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## 127.0.0.1 (Nov 19, 2013)

Here

it is the landowner that gets sued for allowing stunts to exist

every once in a while a feature gets built, lasts for a summer, then the town
crews go in and chainsaw them down because locals complain 'looks dangerous' and the town knows it is responsible for that feature to be taken out


so, landowner is ultimately responsible

man we had some fun stuff set up back in the day when life was much simpler


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## Terranaut (Jun 9, 2014)

Miker J said:


> Correct me if I'm wrong but isn't a public defendant's primary role to prove their side is "right". They do this even if they know their side is at fault.
> 
> Of course there will be grey cases where arbitration is needed, but fighting for something that is plain wrong, when you know it, seems very not cool.
> 
> Look outside the box at our twisted system.


I believe the public defenders primary role is to ensure you are given the best defense possible and the prosecution is to bring the strongest case against you. Somewhere in between these is where the truth lies and it is the judges responsibility to figure out where that is.

I always hated the "think outside the box" statement. In reality, there is no box!


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## aero901 (Apr 11, 2012)

It sounds like there is some confusion surrounding how the US legal system works in these matters. Being sued is a civil matter. In the US, you don't get a public defended for civil cases; you pay for your own lawyer or represent yourself. One of the legal system's checks and balances is putting court costs and lawyer fees, both Plaintiff's and Defendant's (and at the discretion of a Judge/Jury), on the loser of a civil case. This is supposed to deter unreasonable "frivolous" cases from arising in the first place. This might not be a huge deterrent to a large insurance company though. Courts also have discretion on which civil cases even go to trial. If a Judge thinks the plaintiff has little legal ground to stand on, the case will likely be dismissed.

Civil cases are also more lax on the standards of evidence necessary for a ruling. The "preponderance of evidence" standard only requires 51% of the evidence support one side's case before a judgement can be made.


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## Terranaut (Jun 9, 2014)

aero901 said:


> It sounds like there is some confusion surrounding how the US legal system works in these matters. Being sued is a civil matter. In the US, you don't get a public defended for civil cases; you pay for your own lawyer or represent yourself. One of the legal system's checks and balances is putting court costs and lawyer fees, both Plaintiff's and Defendant's (and at the discretion of a Judge/Jury), on the loser of a civil case. This is supposed to deter unreasonable "frivolous" cases from arising in the first place. This might not be a huge deterrent to a large insurance company though. Courts also have discretion on which civil cases even go to trial. If a Judge thinks the plaintiff has little legal ground to stand on, the case will likely be dismissed.
> 
> Civil cases are also more lax on the standards of evidence necessary for a ruling. The "preponderance of evidence" standard only requires 51% of the evidence support one side's case before a judgement can be made.


I fully understood the separation even if I am not aware of the fine print(51% is f*#ked). I was merely pointing out the other point of confusion.


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## Miker J (Nov 4, 2003)

Terranaut said:


> I believe the public defenders primary role is to ensure you are given the best defense possible and the prosecution is to bring the strongest case against you. Somewhere in between these is where the truth lies and it is the judges responsibility to figure out where that is.
> 
> I always hated the "think outside the box" statement. In reality, there is no box!


One lawyer fights to "prove" his side is right/innocent. He does this for money, regardless if he felt his side (party) was guilty or innocent.

One lawyer fights to "prove" the other side is right/innocent. He does this for money, regardless if he felt his side (party) was guily or innocent.

In theory, if two informed, eduacted, equally crafty lawyers fight equally hard for their side, all facts will be brought to light and judges and peers can they objectively decide the answer. (That's what many lawyers tell themselves when cashing their checks after they've defended someone they know is guilty.)

In practice it rarely works that way. Lawyers are not equal. If you have more cash you get a better lawyer. Rarely are peers very objective, even if they are your peers at all.

Peers - you are being sued by Blue Cross health insurance as their client has fallen on your trail and fractured his spine, and they want your $$$ to cover the medical bills. When they flash the images of the relatively tame stunts you've placed along the trail, the average person in the jury, who's unlikley even done real mountain biking, will think those relatively mild stunts are extreme and hazzardous. You'll be found guilty.

And, can you afford a lawyer of equal craftiness as Blue Cross?

Its a crooked system, but admittedly I don't have a better solution. Kind of like democracy - the worst form of government, expect for every other one.

The "box" is a person's understanding of a given situation/circumstance. It it limited by their own biases, perspective, experience, and education. Only when we realize there is so much we don't know can we step outside the box.

As we say in my chosen profession...

There are those that know.

There are those that don't know.

There are those that don't know, they don't know.


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## leeboh (Aug 5, 2011)

My trail? Or a trail in the state park system? How would the land sharks( lawyers ) have grounds to go after the trails workers over the land managers/ owners?


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## Terranaut (Jun 9, 2014)

Miker J said:


> The "box" is a person's understanding of a given situation/circumstance. It it limited by their own biases, perspective, experience, and education. Only when we realize there is so much we don't know can we step outside the box.
> 
> As we say in my chosen profession...
> 
> ...


The box is only limited by the individual. The box only exists if you allow it to. Expanding your mind beyond "the box" allows you to know it was never there. YOU are your only limitation. So I think we are on the same page, I just hate the term


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## Bald_Ben (May 2, 2005)

Always exciting to expand my ignore list.

For trail builders, race promoters, etc. who are interested in learning about potential liability issues, I recommend Adventure and the Law. It's a short sampling of cases like the ones being mentioned here in what should be a fairly accessible format for non-legal types.


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## Glide the Clyde (Nov 12, 2009)

Interesting post. 

A few years back, I had a fairly minor injury of a broken thumb during a short track race. When trying to work it out with the insurance co., they wanted the contact names of the promoter and the venue. I said no.


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## dundundata (May 15, 2009)

no good deed goes unpunished


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