City Negotiates Health Insurance Snag

City Negotiates Health Insurance Snag

A city firefighter involved in an off-duty motorcycle crash in June was denied health insurance coverage for his injuries because the city’s health insurance required 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 amount.

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

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

“I was out for a little less than two months,” said Baker. “I returned to full duty around the first of August 2009.”

Baker’s insurance claim was initially denied because a clause added to the city’s health insurance policy in 2005 on “activities of a hazardous nature,” excluded from coverage motor cycle accidents without helmets.

Baker claimed he would have been injured regardless of whether he wore a helmet, and thus the claim should be paid. He suffered mostly abdominal injuries and no head injuries, he said 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 being notified that it was added, he added.

Had he known of the exclusion, he would have been