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Case Study “Winter-sports” are generally excluded from personal accident insurance

The insured sustained an accident while engaging in ice-skating with his son in a shopping complex in Hong Kong. He was granted a total of 67 days’ sick leave due to fracture of the left tibia and fibula.

As the insured’s injury was caused by participating in ice-skating, the insurer declined his claims for hospital income and disability benefits on the grounds that the policies explicitly excluded any loss caused by or related to participating in or training for wintersports.

Although the policies failed to provide any definition for “wintersports”, the Complaints Panel believed that “winter-sports” generally refer to sports that take place on snow or ice. As such, ice-skating (whether outdoor or indoor) should be a kind of wintersports.

As the policies specifically excluded loss resulting from participating in winter-sports, the Complaints Panel endorsed the insurer’s decision to reject the insured’s claims.

Remarks: for the purposes of the winter-sports exclusion, wintersports are not restricted to sports actually played in winter time, or sports played outdoors.