Why Your Health Insurance May Not Pay For Gym Injuries

If you are into working out, there is a chance of injury at the gym. But will health insurance cover it? Let us take a look.

Most health plans will cover you for accidental injuries, but it is crucial to understand where the thin line is. Muscle strains or fractures would usually be covered. Claims can get turned down if the injury is tied to alcohol or drug use, professional or risky sports, or even pre-existing conditions that flare up during workouts. Costs like bandages or other non-medical consumables are usually not covered either.

What Is Not Covered

It is uncommon, but gym injuries occasionally encounter claim denials. “Typically, this occurs when there has been a history of drug use, if the accident happened while engaging in professional sports not included on the policy, or if pre-existing medical conditions elevate the risk. Claims have also been rejected when hospital records indicate alcohol or steroid abuse, or if the forms are ambiguous or missing,” says Pankaj Verma, Chief Technical Officer (underwriting & products), Zurich Kotak General Insurance Company.

So, activity under substance influence, such as steroid misuse, intoxication, or illegal drug use, will not be covered. “Reckless behaviour contrary to medical advice, such as overexertion with known heart conditions or workouts against doctor’s recommendations may also not be covered,” says Siddharth Singhal, head, health insurance, Policybazaar.

How To Ensure Coverage For Gym Injuries 

The active lifestyle also has its set of risks, and hence it is essential to invest more in policies that cover accidents or injuries related to your fitness routine. Riders such as consumables and Outpatient Department (OPD)/physiotherapy riders can pay for the usual shortfalls of basic policies.

“A customer will need to purchase the OPD add-on to get coverage for outpatient treatments and physiotherapy costs for minor gym injuries - since minor gym injuries may not require hospital admissions, and hence would not be covered under hospitalization coverage,” says Singhal.

Opt for plans that also cover accidents or injuries due to fitness regimes and cover physiotherapy or rehabilitation expenses. Most insurers promote healthier living today by providing wellness benefits like discounts, wellness programs, or even reimbursements for health checks and gym memberships.

Physiotherapy may be covered if it is recommended post-hospitalization, subject to post-hospitalization days as per the customer's policy. “Having a policy that covers preventive care and screening ensures you stay on top of your health instead of waiting for problems to arise,” says Verma.