Hypothetical ??

[taximomfor4]

I just want to be prepared in case my health insurance raises a stink. I don't know the protocol in this situation. My dd8 (special Needs) fell today on very uneven sidewalk at her school (right by the front door). She smacked her knee. I informed the school, sent dd to class, and spent the day at home in case dd called. If she was in lots of pain for real, I would have picked her up and taken her to the dr.

Anyway, a walker's mom saw me at the bus stop. The bus was REALLY late bringing the kids home. She told me they finally dismissed the walkers even though one bus hadn't even pulled out yet...and that my dd had severely delayed the bus. Apparently, she couldn't get her knee to bend, and couldn't get up the stairs and onto the bus. She eventually did, and when the bus got to our bus stop she couldn't get DOWN the steps so I entered the bus and carried her down. Her knee is HUGE. Not kidding. It's very, very swollen. (bad mommy moment -- I didn't think she got THAT injured.) So now dh is on the way to the hospital with her.

Now the question comes in: will my health insurance just happily cover this with no prodding, or will they make me try to make the school pay since the sidewalk is definitely faulty and unsafe. I only ask because my mom's homeowners insurance had to pay someone's medical bill when they fell on our uneven sidewalk when I was a kid. If my insurance just pays it, that's easy. If they make me fill out entire files in order to get the school to be liable, I'll be quite annoyed. Insurance paperwork is NEVER fun.

Anyone know?

 

[Disney Doll]

Usually insurance companies have Coordination of Benefits departments that handle this stuff.

 

[Lisa loves Pooh]

Usually when I go to some place--I think the only question they ask was it the result of an auto accident or work related injury.

Since in both cases--the answer is no, you insurance should give you no grief. However--the school does need to be consulted.

Someone I know at our church fell down a double step in the office of the church--the church paid his out of pocket expenses (required surgery and wheelchair usage as I think he tore an ACL or something--it was pretty bad).

Schools have liability policies for that reason. So it is something to check out.

As far as your insurance company--it should be a non-issue and they should be paying their portion.

 

[SC Minnie]

DD broke her arm twice- once at church and once at daycare. She also fell at another daycare and had to have stitches. All instances were covered by my insurance at 100% since they were taken care of as outpatient. The insurance co never even asked where the incident took place,

 

[hlbtimes2]

They will more then likely pay the bill. Then, they will ask you if you feel someone else is at fault or if you are going to sue someone. If you feel the school is responsible they will go after the school. If you tell them that the school was not at fault, they should just let it go.

I just went thru the same time thing this week. My daughter was hit in the head in June at someone elses house. She required 6 stitches. The insurance company contacted me to see if someone else should be paying the bill. I told them the other person at fault was an 8 year old. They laughed and thanked me for my time.

 

[taximomfor4]

thanks all!

Dh just called, and she has a nice bruise, and maybe a sprain as well (hard to understand him but she is on scheduled Motrin doses and must keep the ace wrap on). I already called the school and notified them to check that sidewalk -- I also checked Ohio ordinances finally, and looks like Ohio's "rule of thumb" for liability is usually a 2-inch rule (if the squares are at least 2 inch ht difference). Also found some semi-understandable stuff about liability hinging on whether they had been notified in writing about sidewalk danger at least 15 days before the incident by anyone. I will send a letter, just because the square is very cracked, very old, and quite out of place. Someone else could get hurt much worse!!

Now onto other issues.