Worsening insurance crisis

[Subfiend]

@Subfiend - Please give us specific examples of what you think needs to happen to avoid the iceberg, there's practical in the real world (where instructors don't make much, customers aren't willing to pay much more, many dive shops struggle, etc...).

Also, I sense that there are 2 different (albeit with some overlap) issues here - recreational dive instructors teaching classes, and recreational dive boats offering dive trips and rental gear. Are both of these in similarly dire straights?

This is a question with a complex answer. First, the dive industry needs to find ways to immediately reduce claims. You talk about problems that require solutions on SB all the time, even if you are not aware you are doing so. If you employ solutions, you will reduce claims. Here are a few examples:

• 50-60% of all underwater fatalities involve underlying medical conditions, both known and unknown. Maybe it’s time to have an honest discussion about fitness and diving? I will never fault an operator for turning away an unfit diver. I’d take that bad review on Trip Advisor over a dead diver case any day.
• A staggering number of claims involve people lying on their medical forms. This has become the norm, not the exception. I have had multiple cases where the diver died on the first or second dive from the medical condition they knew they had, and also knew it was a contraindication to diving. Requiring a medical sign off is worthless if it can be from anybody who simply has letters after their name. The vast majority of medical professionals in the US have no idea what they are signing and saying their patients are fit to do. As a dive professional, I would not be afraid to ask the customer more questions about their doctor’s experience level before I accepted their medical form.
• Let’s be honest about instructors’ fitness to teach. I have had cases where the instructor lost a student because he didn’t like cold water and he didn’t want to descend below the thermocline; the instructor was taking opiates prior to an impending hip replacement surgery; the instructor accepted the diver’s word that their doctor had signed off on the medical (the diver’s medical records revealed the exact opposite); the instructor was known to be haphazard and rushed, and he jumped into the water with an empty air tank; etc. In Mills, one of Snow’s IDC instructors told us he was opposed to passing her through the IDC, so another instructor signed off on her instead.
• Let’s be honest about skills the students are required to learn. In the rebreather realm, the manufacturers realized a large number of fatalities involved divers who had not been taught the minimum skills necessary to dive their products. Worse, divers did not know the minimum skills they were supposed to learn. So, RESA developed and published minimum training standards for all units of rebreathers for all manufacturers. Holy hell! From the hue and cry that rose up from certain training agencies, you’d think the manufacturers were attacking babies with pitchforks! “You can’t tell student divers what they are supposed to learn!,” they said. The training agencies published their own minimum standards, which were below the manufacturers’ minimum standards. RESA promptly rejected them. The bottom line: Manufacturers took a stand to solve a problem and they rejected the status quo. The result: There has not been a rebreather claim since then, and fatalities are down.

So, here are a few specific examples. From what I see, day after day, dive professionals know what the problems are. They know or can develop solutions. They just have to reject the status quo, because it clearly is not working. If you don’t, you will all pay for other people’s mistakes. Don’t be naive enough to believe that the settlements and verdicts you read about are not being paid for with your money. If you don’t mind watch your livelihood shrink, just keep doing what your doing.

 

[kammel78]

This is a question with a complex answer. First, the dive industry needs to find ways to immediately reduce claims. You talk about problems that require solutions on SB all the time, even if you are not aware you are doing so. If you employ solutions, you will reduce claims. Here are a few examples:

• 50-60% of all underwater fatalities involve underlying medical conditions, both known and unknown. Maybe it’s time to have an honest discussion about fitness and diving? I will never fault an operator for turning away an unfit diver. I’d take that bad review on Trip Advisor over a dead diver case any day.
• A staggering number of claims involve people lying on their medical forms. This has become the norm, not the exception. I have had multiple cases where the diver died on the first or second dive from the medical condition they knew they had, and also knew it was a contraindication to diving. Requiring a medical sign off is worthless if it can be from anybody who simply has letters after their name. The vast majority of medical professionals in the US have no idea what they are signing and saying their patients are fit to do. As a dive professional, I would not be afraid to ask the customer more questions about their doctor’s experience level before I accepted their medical form.
• Let’s be honest about instructors’ fitness to teach. I have had cases where the instructor lost a student because he didn’t like cold water and he didn’t want to descend below the thermocline; the instructor was taking opiates prior to an impending hip replacement surgery; the instructor accepted the diver’s word that their doctor had signed off on the medical (the diver’s medical records revealed the exact opposite); the instructor was known to be haphazard and rushed, and he jumped into the water with an empty air tank; etc. In Mills, one of Snow’s IDC instructors told us he was opposed to passing her through the IDC, so another instructor signed off on her instead.
• Let’s be honest about skills the students are required to learn. In the rebreather realm, the manufacturers realized a large number of fatalities involved divers who had not been taught the minimum skills necessary to dive their products. Worse, divers did not know the minimum skills they were supposed to learn. So, RESA developed and published minimum training standards for all units of rebreathers for all manufacturers. Holy hell! From the hue and cry that rose up from certain training agencies, you’d think the manufacturers were attacking babies with pitchforks! “You can’t tell student divers what they are supposed to learn!,” they said. The training agencies published their own minimum standards, which were below the manufacturers’ minimum standards. RESA promptly rejected them. The bottom line: Manufacturers took a stand to solve a problem and they rejected the status quo. The result: There has not been a rebreather claim since then, and fatalities are down.

So, here are a few specific examples. From what I see, day after day, dive professionals know what the problems are. They know or can develop solutions. They just have to reject the status quo, because it clearly is not working. If you don’t, you will all pay for other people’s mistakes. Don’t be naive enough to believe that the settlements and verdicts you read about are not being paid for with your money. If you don’t mind watch your livelihood shrink, just keep doing what your doing.

Can we please sticky this...

 

[Cthippo]

This is a question with a complex answer. First, the dive industry needs to find ways to immediately reduce claims. You talk about problems that require solutions on SB all the time, even if you are not aware you are doing so. If you employ solutions, you will reduce claims. Here are a few examples:

• 50-60% of all underwater fatalities involve underlying medical conditions, both known and unknown. Maybe it’s time to have an honest discussion about fitness and diving? I will never fault an operator for turning away an unfit diver. I’d take that bad review on Trip Advisor over a dead diver case any day.
• A staggering number of claims involve people lying on their medical forms. This has become the norm, not the exception. I have had multiple cases where the diver died on the first or second dive from the medical condition they knew they had, and also knew it was a contraindication to diving. Requiring a medical sign off is worthless if it can be from anybody who simply has letters after their name. The vast majority of medical professionals in the US have no idea what they are signing and saying their patients are fit to do. As a dive professional, I would not be afraid to ask the customer more questions about their doctor’s experience level before I accepted their medical form.
• Let’s be honest about instructors’ fitness to teach. I have had cases where the instructor lost a student because he didn’t like cold water and he didn’t want to descend below the thermocline; the instructor was taking opiates prior to an impending hip replacement surgery; the instructor accepted the diver’s word that their doctor had signed off on the medical (the diver’s medical records revealed the exact opposite); the instructor was known to be haphazard and rushed, and he jumped into the water with an empty air tank; etc. In Mills, one of Snow’s IDC instructors told us he was opposed to passing her through the IDC, so another instructor signed off on her instead.
• Let’s be honest about skills the students are required to learn. In the rebreather realm, the manufacturers realized a large number of fatalities involved divers who had not been taught the minimum skills necessary to dive their products. Worse, divers did not know the minimum skills they were supposed to learn. So, RESA developed and published minimum training standards for all units of rebreathers for all manufacturers. Holy hell! From the hue and cry that rose up from certain training agencies, you’d think the manufacturers were attacking babies with pitchforks! “You can’t tell student divers what they are supposed to learn!,” they said. The training agencies published their own minimum standards, which were below the manufacturers’ minimum standards. RESA promptly rejected them. The bottom line: Manufacturers took a stand to solve a problem and they rejected the status quo. The result: There has not been a rebreather claim since then, and fatalities are down.

So, here are a few specific examples. From what I see, day after day, dive professionals know what the problems are. They know or can develop solutions. They just have to reject the status quo, because it clearly is not working. If you don’t, you will all pay for other people’s mistakes. Don’t be naive enough to believe that the settlements and verdicts you read about are not being paid for with your money. If you don’t mind watch your livelihood shrink, just keep doing what your doing.

In the first two cases, who is getting sued?

 

[wetb4igetinthewater]

I'd like to have a discussion on emergency response plans (but that's for a separate thread). I will remember when I crossed over to SSI to teach at one of the shop's for a local chain. My IT informed me that SSI required that I have an ERP for every dive site where I would teach a course. Given that one of this chain's location was teaching SSI for a while, I said "Great! What does the shop have already?" because logic would tell me that this would be something shared and fine tuned.

"Oh no, you need your own. The shop would never take that kind of liability."

This is one of the reasons why I am so cynical about the industry. It is set up to throw the instructor under the bus. The agency has the paperwork that instructors are not agents, the dive shop blames the instructor's judgment, etc., etc..

This is a question with a complex answer. First, the dive industry needs to find ways to immediately reduce claims. You talk about problems that require solutions on SB all the time, even if you are not aware you are doing so. If you employ solutions, you will reduce claims. Here are a few examples:

• 50-60% of all underwater fatalities involve underlying medical conditions, both known and unknown. Maybe it’s time to have an honest discussion about fitness and diving? I will never fault an operator for turning away an unfit diver. I’d take that bad review on Trip Advisor over a dead diver case any day.

I think for open water courses, too many students who struggle to swim are given a pass. If someone looks overweight, but they fly through the water like a fish and are first to finish (which happened once for me), then I'm not worried about their fitness. My worse case swim test was someone I wouldn't certify, but they were certified in the next month's class.

But what does this mean as an instructor? For open water, I think being able to swim 200 yards without mask/fins/snorkesl (though it is allowed, I think that needs to be tossed). For con ed, what are things to look for to give a student a refund? I have some ideas, but I'd like you and others chime in

• A staggering number of claims involve people lying on their medical forms. This has become the norm, not the exception. I have had multiple cases where the diver died on the first or second dive from the medical condition they knew they had, and also knew it was a contraindication to diving. Requiring a medical sign off is worthless if it can be from anybody who simply has letters after their name. The vast majority of medical professionals in the US have no idea what they are signing and saying their patients are fit to do. As a dive professional, I would not be afraid to ask the customer more questions about their doctor’s experience level before I accepted their medical form.

My volume is low enough that I can do this. When I run a dive center in Greece, I need to think about how to address this as I'll have customers from all over Europe.

• Let’s be honest about instructors’ fitness to teach. I have had cases where the instructor lost a student because he didn’t like cold water and he didn’t want to descend below the thermocline; the instructor was taking opiates prior to an impending hip replacement surgery; the instructor accepted the diver’s word that their doctor had signed off on the medical (the diver’s medical records revealed the exact opposite); the instructor was known to be haphazard and rushed, and he jumped into the water with an empty air tank; etc. In Mills, one of Snow’s IDC instructors told us he was opposed to passing her through the IDC, so another instructor signed off on her instead.

I absolutely agree with this problem. I don't know how to address it. There is a lack of professionalism that is unacceptable given the risks from deviating from safety procedures.

• Let’s be honest about skills the students are required to learn. In the rebreather realm, the manufacturers realized a large number of fatalities involved divers who had not been taught the minimum skills necessary to dive their products. Worse, divers did not know the minimum skills they were supposed to learn. So, RESA developed and published minimum training standards for all units of rebreathers for all manufacturers. Holy hell! From the hue and cry that rose up from certain training agencies, you’d think the manufacturers were attacking babies with pitchforks! “You can’t tell student divers what they are supposed to learn!,” they said. The training agencies published their own minimum standards, which were below the manufacturers’ minimum standards. RESA promptly rejected them. The bottom line: Manufacturers took a stand to solve a problem and they rejected the status quo. The result: There has not been a rebreather claim since then, and fatalities are down.

One of the things I do with my students is show them standards. I need to create the list of skills for the entire course, as well as the skills covered on each dive. The point is for thoroughness, and not "trust me bro, I'm teaching you everything you need to learn" like my open water course. Yes, the skills are in the materials, but I didn't have a final exam in my open water course, so a lot of things were not done correctly.

So, here are a few specific examples. From what I see, day after day, dive professionals know what the problems are. They know or can develop solutions. They just have to reject the status quo, because it clearly is not working. If you don’t, you will all pay for other people’s mistakes. Don’t be naive enough to believe that the settlements and verdicts you read about are not being paid for with your money. If you don’t mind watch your livelihood shrink, just keep doing what your doing.

You said earlier that it would like a concerted effort for meaningful change. What can someone like me do to help? I have tried some things, like publishing how I teach open water neutrally buoyant and trimmed and a dive planning document that is used as a workbook by my students as I believe the dive planning resources from all agencies that I have seen so far to be grossly insufficient.

But let's be honest, I don't think my fellow SB'ers would elect someone like me to be the face of the change that is needed! However, I'm willing to put in some work. I just don't see agencies adopting the changes to have a meaningful improvement in safety. I tend to be focused on open water, but you have addressed a wide swath of issues. I feel that there needs to be a set of pillars of improvement in safety that are all developed in parallel. I fear that one of the motivation to resist change is the fear that the agencies would essentially be admitting that their standards were insufficient and that could open them up to liability. Damned if you do, damned if you don't.

 

[drrich2]

The “just a taxi” analogy for dive boats is an absolute lie. I covered this five years ago in a presentation I gave at TekDive.

Thanks for the feedback. I wonder just how close to the taxi analogy an operator can get, and what the bare minimum responsibilities could be pared back to? I'm aware there are 'behind the scenes' things I wouldn't know about, such as the roving night watchman requirement that came out in discussions of the Conception disaster.

I get that a marine vessel is not just a taxi; I'm curious as just how much more it has to be.

The same goes for “personal responsibility.” It does not absolve negligent operators from liability. It may reduce liability through comparative negligence, but it does not get you off the hook.

50-60% of all underwater fatalities involve underlying medical conditions, both known and unknown. Maybe it’s time to have an honest discussion about fitness and diving?

A staggering number of claims involve people lying on their medical forms. This has become the norm, not the exception.

This is a theme that comes up repeatedly in SB discussions, and you identify the product succinctly; divers who consider the final decision one of individual liberty lying on forms required by businesses, insurance companies and such who wish to be able to impose their judgment on that final decision on the diver. They require the form, the diver decides what to put on it. Cue old adage - 'Where you stand on an issue depends on where you sit.'

This brings up a couple of issues. First, as you indicate it could cut the number of claims. Secondly, it could exclude a lot of paying customers (especially if you go for more stringent qualifications for sign-offs).

Another common theme on SB that comes up is the idea that when a diver dives on a dive boat trip, it is plausibly related to a known (to the diver) medical condition, but the diver lied on the medical form and the dive op. had no idea about the condition, that this is a strong (albeit not perfect) defense against being successfully sued (I realize lawsuits are bad news even if one doesn't lose). Any thoughts on that?

I suspect if the recreational dive industry in U.S. waters becomes sufficiently hostile to chubby old divers with stable health problems who don't hit the gym, we'll eventually see threads discussing foreign destinations with more lax requirements.

 

[kammel78]

I'd like to have a discussion on emergency response plans (but that's for a separate thread). I will remember when I crossed over to SSI to teach at one of the shop's for a local chain. My IT informed me that SSI required that I have an ERP for every dive site where I would teach a course. Given that one of this chain's location was teaching SSI for a while, I said "Great! What does the shop have already?" because logic would tell me that this would be something shared and fine tuned.

"Oh no, you need your own. The shop would never take that kind of liability."

This is one of the reasons why I am so cynical about the industry. It is set up to throw the instructor under the bus. The agency has the paperwork that instructors are not agents, the dive shop blames the instructor's judgment, etc., etc..


I think for open water courses, too many students who struggle to swim are given a pass. If someone looks overweight, but they fly through the water like a fish and are first to finish (which happened once for me), then I'm not worried about their fitness. My worse case swim test was someone I wouldn't certify, but they were certified in the next month's class.

But what does this mean as an instructor? For open water, I think being able to swim 200 yards without mask/fins/snorkesl (though it is allowed, I think that needs to be tossed). For con ed, what are things to look for to give a student a refund? I have some ideas, but I'd like you and others chime in

My volume is low enough that I can do this. When I run a dive center in Greece, I need to think about how to address this as I'll have customers from all over Europe.

I absolutely agree with this problem. I don't know how to address it. There is a lack of professionalism that is unacceptable given the risks from deviating from safety procedures.

One of the things I do with my students is show them standards. I need to create the list of skills for the entire course, as well as the skills covered on each dive. The point is for thoroughness, and not "trust me bro, I'm teaching you everything you need to learn" like my open water course. Yes, the skills are in the materials, but I didn't have a final exam in my open water course, so a lot of things were not done correctly.

You said earlier that it would like a concerted effort for meaningful change. What can someone like me do to help? I have tried some things, like publishing how I teach open water neutrally buoyant and trimmed and a dive planning document that is used as a workbook by my students as I believe the dive planning resources from all agencies that I have seen so far to be grossly insufficient.

But let's be honest, I don't think my fellow SB'ers would elect someone like me to be the face of the change that is needed! However, I'm willing to put in some work. I just don't see agencies adopting the changes to have a meaningful improvement in safety. I tend to be focused on open water, but you have addressed a wide swath of issues. I feel that there needs to be a set of pillars of improvement in safety that are all developed in parallel. I fear that one of the motivation to resist change is the fear that the agencies would essentially be admitting that their standards were insufficient and that could open them up to liability. Damned if you do, damned if you don't.

Kosta - you make a number of very good points.

I number have already said it...what can we do? I don't think there's a rats chance in hell of us changing multi-million (billion?) dollar global agencies. But, we can possibly change potential students, current divers and current instructor attitudes.

Concerning instructors, I'm gonna go ahead and say the quiet part outloud. I think we need a little more GI3 back. You suck as an instructor, delivering a crappy product to customers and putting people's lives at risk. There's no reason to tiptoe around or apologize for that. It's probably not your fault you're a crappy instructor but you are so let's fix that. Same thing I would tell a cavern/intro student about their BTP if they want to be a cave diver. (Obviously, not in a demeaning way, I'm just illustrating my point with hyperbole).

For potential students, I think we have to educate people on what makes a good instructor/bad instructor (Kosta you're already doing that). It's not an easy road, with dive shops doing most of the marketing but it's something at least. If shops don't want to invest in ensuring their instructors are up to standards, then we need to stop supporting them.

Easier said than done, of course, but I don't see us counting on training agencies fixing anything for us. If we want change, we're going to have to self correct from the inside. Cave divers did it (albeit on a smaller scale) when we got fed up with too many people dying.

If there was one thing I wouldn't mind seeing agencies adopt while I'm dreaming is instructor requals every couple of years. I've got to do it to maintain my FA/CPR. I've seen GUE instructors do it as well, filming themselves doing skills to submit to HQ.

 

[drrich2]

My volume is low enough that I can do this.

My IT informed me that SSI required that I have an ERP for every dive site where I would teach a course. Given that one of this chain's location was teaching SSI for a while, I said "Great! What does the shop have already?" because logic would tell me that this would be something shared and fine tuned.

"Oh no, you need your own. The shop would never take that kind of liability."

These two things are linked and it's important. If it is known you as a business ask screening questions of dive customers (despite them having signed medical clearances), and a diver you take out dies, someone can challenge that had you done a good enough job with your screening that diver would be alive. In trying to run a lower risk dive operation, you can inadvertently raise the standard you are judged against. I've never worked in diving; I have worked in health care, and when a committee is working on hospital policies, it's important to consider how a regulatory agency may hold you to your own policy.

It sounds like the SSI shop didn't have an emergency response plan for the dive sites for just that reason. The shop wasn't required to have one, but if they put one together and somebody died, they could be accused of not having a good enough one, because maybe if it were even better, that death wouldn't have happened.

Maybe Greece's tort system will be friendlier than the U.S.'s?

I just don't see agencies adopting the changes to have a meaningful improvement in safety.

A big question I haven't seen definitive objective parameters for is what level of safety is safe enough. There will always be deaths diving, just as at Walmart, Holiday Inn, on the golf course, etc...

I'm not talking about obvious danger stories that sound ridiculous to most of us hearing them. I'm talking about aggregate numbers, not anecdotes (however scary).

If someone goes on a recreational dive, what % chance of death or serious injury is safe enough? Not 1 in 1,000 (for most of us, anyway), but not 1 in a billion, either. So what's the number? This was discussed way back in comparison to hiking, I think. How do our death and serious injury rates compare to rock climbing and skiing?

And what launched this thread is exploration of the worsening dive industry insurance crisis. The topic of diver deaths only came up peripherally because it's seen to lead expensive lawsuits. If dive insurance were readily available and cheap, we wouldn't be having this conversation even if there were just as many dead divers.

 

[Outbound]

This is a question with a complex answer. First, the dive industry needs to find ways to immediately reduce claims. You talk about problems that require solutions on SB all the time, even if you are not aware you are doing so. If you employ solutions, you will reduce claims. Here are a few examples:

• 50-60% of all underwater fatalities involve underlying medical conditions, both known and unknown. Maybe it’s time to have an honest discussion about fitness and diving? I will never fault an operator for turning away an unfit diver. I’d take that bad review on Trip Advisor over a dead diver case any day.
• A staggering number of claims involve people lying on their medical forms. This has become the norm, not the exception. I have had multiple cases where the diver died on the first or second dive from the medical condition they knew they had, and also knew it was a contraindication to diving. Requiring a medical sign off is worthless if it can be from anybody who simply has letters after their name. The vast majority of medical professionals in the US have no idea what they are signing and saying their patients are fit to do. As a dive professional, I would not be afraid to ask the customer more questions about their doctor’s experience level before I accepted their medical form.

Do you know if, in these first two examples, insurance companies regularly make payouts because of lawsuits/settlements? At least in the US, approximately two-thirds of people are either overweight or clinically obese. Heart disease is the leading cause of death in the US by a fairly wide margin (cancer is second). If insurance companies are seeing claims on these types of cases, I don't see why they should be paying out (at least in terms of liability insurance; life insurance is another issue). Likewise, if someone lies on their medical form, why should a dive pro's or shop's liability insurance policy come into play? The form is intended as a CYA for the pro/shop. If it doesn't actually cover anyone's rear-end, then what's the point?

Lastly, I'll just add that while the insurance crisis in the dive industry is definitely putting the squeeze on a lot of folks, it's not like any other forms of insurance are getting any cheaper. Premiums across just about every type of insurance have gone up significantly in recent years. This is a multi-factorial issue with tendrils that reach beyond just the dive industry. I'm all for tightening up training in the dive industry, but let's not fall into the trap of thinking that this crisis is completely one of the industry's own making. A lot of it has to do with the litigious nature of our society combined with the fact that insurance companies are a necessary but highly greedy evil, akin to the pharmaceutical industry.

 

[Marie13]

On the lying on the medical form issue -

Some years back there was a Boy Scout diving class in the Midwest. The 11-13 year old boy had asthma. His parents lied on the medical form. He died during OW dives. I can’t remember where I read about it. Might have been here. Don’t remember if there was a lawsuit or not. Bad enough when divers themselves lie on the form, but a parent? Those parents didn’t have a leg to stand on for a lawsuit, IMO.

 

[rmssetc]

These two things are linked and it's important. If it is known you as a business ask screening questions of dive customers (despite them having signed medical clearances),

As a customer, I'd want to see those additional screening questions in advance. I don't trust my doctor to evaluate my performance while diving (ie., assembling my gear, buoyancy control, using my PDC properly) and I don't trust my scuba operator to evaluate my medical status. If the questions are respectful of my privacy and germane to SCUBA, there's a chance that I wouldn't choose a different operator.
[PAUSE]
I'm trying to think of additional screening questions -- above & beyond the medical form -- that I'd consider to be acceptable, and I can't come up with any. The very concept of additional screening in the context of warm-water-pretty-fishes elementary recreational diving implies that the operator doesn't trust my answers on the medical form....in which case, why would I give my money and put my trust in some who's accusing me of lying?
[/PAUSE]

I can imagine screening questions being more appropriate in particular circumstances, for example, cave, ice diving, areas with a very strenuous approach/exit, where the basic medical form isn't sufficient.

If someone goes on a recreational dive, what % chance of death or serious injury is safe enough? Not 1 in 1,000 (for most of us, anyway), but not 1 in a billion, either. So what's the number? This was discussed way back in comparison to hiking, I think. How do our death and serious injury rates compare to rock climbing and skiing?

I don't pretend for a moment that these numbers are comprehensive or accurate, but I did find some stats on injury rates in SCUBA vs skiing (of course, I neglected to put in proper citations....).