Definitions

Severe & Moderate Brain Injury Definitions

Severe Traumatic Brain Injury means a traumatically-induced structural injury to the brain with physiological disruption of brain function resulting directly and independently of all other causes from a Covered Accident:

  1. Indicated by the presence of the following clinical signs:

    • a Glasgow Coma Scale (GCS) score of eight (8) or less or an equivalent result on another coma severity scale as approved by Us; and either:

    • loss of consciousness for a period of twenty-four (24) hours or more; or

    • Post Traumatic Amnesia (PTA) persisting for seven (7) days or more as measured by the Galveston Orientation and Amnesia Test (GOAT); PTA is considered to have ended when a GOAT score of seventy-five (75) or more is achieved on three (3) consecutive administrations.

  2. Directly and independently resulting in:

    • physical, cognitive, emotional or behavioral functional impairment requiring admission to a Long Term Acute Care Hospital; and

    • subsequent rehabilitative treatment by any or all of the following: Physicians, psychologists, physical therapists, occupational therapists, speech language pathologists.

Moderate Traumatic Brain Injury means a traumatically-induced structural injury to the brain with physiological disruption of brain function resulting directly and independently of all other causes from a Covered Accident:

  1. Indicated by the presence of the following clinical signs:

    • a Glasgow Coma Scale (GCS) score of nine (9) to twelve (12) or an equivalent result on another coma severity scale as approved by Us; and

    • loss of consciousness for a period of at least thirty (30) minutes.

  2. Directly and independently resulting in:

    • physical, cognitive, emotional, or behavioral functional impairment requiring admission to a Hospital; and

    • subsequent rehabilitative treatment by any or all of the following: Physicians, psychologist, physical therapist, occupational therapists, speech language pathologists.

 

Paralysis Definition

Paralysis means total loss of use. A physician must determine the loss of use to be complete and not reversible.

  • Hemiplegia means total paralysis of upper and lower limbs on one side of the body.

  • Paraplegia means total paralysis of both lower limbs or both upper limbs.

  • Quadriplegia means total paralysis of both upper and lower limbs.

  • Uniplegia means total paralysis of one lower limb or one upper limb.

 

Dismemberment Definition

Dismemberment means the loss of:

  • Two or More Members - 100% of benefit amount selected.

  • One Member - 50% of benefit amount selected.

  • Thumb and Index Finger of the Same Hand - 25% of benefit amount selected.

"Member" means loss of hand or foot, loss of arm or leg, loss of sight, loss of speech and loss of hearing.

"Loss of Hand or Foot" means complete severance through or above the wrist or ankle joint.

"Loss of Arm or Leg" means complete severance through or above the elbow or knee joint.

"Loss of Sight" means total and permanent loss of sight of one eye that is irrecoverable, including by surgical and artificial means.

"Loss of Speech" means total and permanent loss of audible communication that is irrecoverable by natural, surgical or artificial means.

"Loss of Hearing" means permanent total deafness in both ears such that it cannot be corrected by any aid or device.

"Loss of Thumb and Index Finger of the Same Hand" means complete severance of each through or above the metacarpophalangeal joint of both digits of the same hand.

"Severance" means the complete separation and dismemberment of the part from the body.

 

Covered Accident Definition

Depending on the type of policy issued, Covered Accident means one of the following:

for Individual or Group Policies:

Covered Accident means an Accident that occurs while:

  • coverage is in force for a Covered Person; and

  • riding a Bicycle for pleasure or training purposes or participating in a Cycling Event; and

  • results in an Injury for which benefits are payable.  Riding a Bicycle includes getting on and off the Bicycle and riding as a passenger only on a Bicycle specifically built or adapted to carry a passenger.

for Event/Tour Policies:

Covered Accident means an Accident that occurs while:

  • coverage is in force for a Covered Person; and

  • participating in a Cycling Event while wearing a helmet; and

  • results in an Injury for which benefits are payable. Riding a Bicycle includes getting on and off the Bicycle and riding as a passenger only on a Bicycle specifically built or adapted to carry a passenger. Verification of proper use of a Helmet at the time of the Covered Accident must be part of an official police report of the Covered Accident or be certified, in writing, by a Physician. 

for Bikeshare/ Bike Rental Policies:

Covered Accident means an Accident that occurs while:

  • coverage is in force for a Covered Person; and

  • riding a Bicycle; and

  • results in an Injury for which benefits are payable.  Riding a Bicycle includes getting on and off the Bicycle and riding as a passenger only on a Bicycle specifically built or adapted to carry a passenger.

 

Covered Person Definition

Covered Person means an eligible person who is within the covered class(es) listed in this Policy and for whom the required premium is paid when due.

 

Bicycle Definition

Bicycle means a two or three wheeled vehicle designed for transport by pedaling including a Pedelec (Pedal Electric Cycle) or E-Bike which is a bicycle with electrically motorized assistance not exceeding a maximum of 1200 watts and that does not require a motor vehicle, moped or motorcycle license to operate. It includes bicycles specifically built or adapted to carry a passenger.

 

Helmet Definition

Helmet means protective headgear which meets or exceeds the impact standards for bicycle helmets set by the United States Consumer Product Safety Commission or such successor organization or standard as designated by the insurer.

 

Professional Bicycle Racer Definition

Professional Bicycle Racer means a person who, in the previous 12 months prior to enrollment, has received any form of remuneration totaling more than $1,000 for bicycle racing and/or is a registered rider on a Union Cycliste Internationale (UCI) team.

 

Gravity Events Definition

Gravity Events means riding a Bicycle while participating in a cycling discipline that is primarily characterized by the starting line of the activity being at a higher altitude than the finish line. These disciplines include, but are not limited to, Downhill, Enduro, Dual Slalom, Mountain Cross (Four Cross or 4x) and Super D as defined by the 2017 USA Cycling Rulebook.

 

Stunt or Acrobatic Act Definition

 Stunts or Acrobatic Act means a difficult or dangerous feat or trick requiring extreme agility and characterized by one or more of the following:

  • Freeriding or BMX-style Riding;

  • Rotations purposefully conducted while in the air.

 

Bicycle Park Definition

Bicycle Park means a purpose-built recreational environment made for Freeriding, BMX-style Riding, skiing, snowboarding, skateboarding, scooter, wheelchair, and aggressive inline skating.

 

Freeriding Definition

Freeriding means a discipline of mountain biking closely related to Downhill with a focus on dirt jumping, tricks, style, and technical terrain features without a set course, goals, or rules.

 

BMX-Style Riding Definition

BMX-style Riding means riding a Bicycle while engaging in, training for, or participating in any sub-discipline of BMX-style Riding, including but not limited to:

  • Park - Characterized by riding a Bicycle on a series of wooden or cement ramps designed specifically for BMX bicycles or skateboards.

  • Street - Characterized by riding a Bicycle on natural or man-made terrains within cities, such as ledges, curbs, broken glass, and burns, or anything on-street not made specifically to be ridden on.

  • Dirt - Characterized by riding a Bicycle on jumps formed from packed dirt, rollers, berms, and doubles.

  • Flatland - Characterized by riding a Bicycle on flat ground and including various balancing and spinning techniques while standing in awkward positions on various parts of the bike, including the pegs, handlebars, and seat.

  • Racing - Characterized by riding a Bicycle in formally or informally organized heats, also called motos.