A football player has lost her bid for a physiotherapy expenses payout after her insurer argued its policy did not cover her ankle joint disorder.  

The player initially suffered a left ankle injury, but during X-rays doctors found an “anomalous bony structure” in her right ankle, diagnosed as osteochondritis dissecans.  

She had surgery on the right ankle and lodged a claim for recovery costs under a group personal accident and illness policy issued to soccer governing body Football NSW.  

But AIG Australia said its policy would not respond because the condition did not meet its definition of injury.  

The policy required an injury to be “caused by violent, external and visible means” and to have “occurred independently from any other cause”.  

The insurer noted the player’s GP said the osteochondritis dissecans was “not technically a fracture but a bony deformity from repetitive stress/exercise (football)”.  

The claimant did not dispute that but argued the physical exertion of playing football constituted “violent, external and visible means”, and the injury was unforeseen and unintentional.  

In a dispute ruling, the Australian Financial Complaints Authority says the policy requires an injury to be caused by a standalone event involving a “strong visible force, external to the insured person”.

“Applying those conclusions to the circumstances of this complaint, I am not satisfied that a repetitive strain injury that has developed gradually due to the complainant’s physical exertion from training and playing football ... meets the policy definition of injury,” the ruling ombudsman said.  

“The osteochondritis dissecans was not the result of a standalone event, and nor was it caused by a strong visible force, external to the complainant.

“As the complainant’s claim condition does not fall within the policy definition of injury, she has not established a claimable loss.”  

Click here for the ruling.