My son broke his finger in school yesterday...Question about insurance payment

[Aliceacc]

I would imagine you would have an incredibly hard time proving that the injury was intentional. It's a very fine line between throwing a football AT someone's hand and TO someone's hand.

Hope your son is feeling better.

 

[torinsmom]

I don't think the school is liable. If your son had slipped on an icy curb(like another poster did), then their insurance would pay(like homeowner's insurance would) If you didn't even think that the finger was broken when he got home, they couldn't know hours before that, IMHO. If it hurt that much, he should have asked to call you. They probably assumed it had just been bent back by the football(overextended?) If he had continued to complain, they would have sent him to the nurse. Did he keep playing once the finger was hurt?

Was your son playing football? I really don't know how he could know it was intentional. If it had hit him in the back, that would be another story. Was his hand up to catch the ball or what? I don't know how you would prove intent on that. The other kid was rude to laugh, but maybe he didn't realize your DS was really hurt(noone else did, even you, right) Kids are like that, especially at 9 or 10. Besides, there are two sides to every story, and usually the truth is somewhere in between(speaking as a teacher and a parent here)

When DS was 8 or 9, he got his cornea torn at school. A little girl stuck her finger in his eye, admittedly on purpose. It was not just scratched, but torn and the ER thought they may have to actually suture it They gave us some ointment and a patch, and luckily it healed enough by the following afternoon, so that he didn't need anything except the ointment and patch for a few days. I too thought the school would pay for what insurance didn't. They said they don't cover things like that, but that I could go after the family for the OOP charges and my 1/2 day off work to take him to the Opthamologist. I decided that would be too much drama. My DS and this little girl had been doing the love/hate thing for months and I am sure he did something to her at some point. She didn't have any idea poking someone in the eye could do more than make someone cry, I am sure. Besides, you don't know how someone else's parents may react. Maybe this child is beaten at home and this could cause a really bad scene.

Marsha

 

[bdcp]

Kids break bones occasionally. Why must everything be someone's fault? Kids get hurt, like we all did growing up. Kids don't always use the best judgment, but really the boy didn't take his hand and twist it around til it broke, he threw a ball hard, which kids do. My DS (21) had broken a finger twice when he was in his early teens. One time a boy pushed him onto someone and the second time he broke it playing basketball (someone threw the ball hard). I never once considered it any more than kids fooling around and it being an accident. We just used our insurance and paid our own deductible for our child's injury. If every time someone got hurt, someone was blamed and expected to pay up, no one would ever let their kids play. Oh yeah, that's right, that's why kids can't play tag or anything on the playground anymore. Most kids today are so protected from the world that even the most minor injury is treated as a catastrophic event and everyone feels this great need to get compensation from someone. This is why you have health insurance.

 

[torinsmom]

Kids break bones occasionally. Why must everything be someone's fault? Kids get hurt, like we all did growing up. Kids don't always use the best judgment, but really the boy didn't take his hand and twist it around til it broke, he threw a ball hard, which kids do. My DS (21) had broken a finger twice when he was in his early teens. One time a boy pushed him onto someone and the second time he broke it playing basketball (someone threw the ball hard). I never once considered it any more than kids fooling around and it being an accident. We just used our insurance and paid our own deductible for our child's injury. If every time someone got hurt, someone was blamed and expected to pay up, no one would ever let their kids play. Oh yeah, that's right, that's why kids can't play tag or anything on the playground anymore. Most kids today are so protected from the world that even the most minor injury is treated as a catastrophic event and everyone feels this great need to get compensation from someone. This is why you have health insurance.

Totally agree! Just to add, if schools were liable for accidental injuries like this, the insurance would be sky high, and guess where that money would come from? From the public school budget! To me, that means less money(it's already pitiful enough) to go to our children's education. Unfortunately, accidents like this are just part of having kids. Just be glad it wasn't something more major.....

Marsha

 

[luvdzny]

At the beginning of every school year we had a bunch of forms to fill out. One of them was for supplemental insurance for injuries that happen at school or school related functions. It made if very clear that the school would not be responsible for any injuries. I don't know how all school districts work but if we wanted extra coverage we had to buy it.

As far as the other child being at fault, I agree with others that have said it would be hard to prove. A football thrown at a hand does not sound like it was meant to injury your son, it does sound like a normal playground accident. DS was pushed off of a slide by another child, DS was going down the other boy was crawling up the slide. The other boy pushed him off on purpose and DS broke his arm. I never really thought about who was at fault, we took him to the hospital, said he fell off the slide and our insurance paid for it.

Hope your son heals quickly.

 

[hinodis]

I have been through this exact situation. DD just broke her pinky and her growth plate at school when someone threw a basketball at her. Her finger looked horrible and looked obviously broken. I personally, never though to hold any other party responsible. She tried to catch the ball, so she accidently broke it. She had a cast for 7 weeks and she is fine. I have paid the out of pocket expenses. My insurance can go after someone else if they choose. Now, the OP said it was "on purpose". I also have experience here too. DD was hit in the face with a rock and was very seriously injured. In this case I contacted a lawyer as she will have a scar on her face for the rest of her life. The rock incident was considered an accident as the boy that threw the rock did not intend to harm our daughter. However, the lawyer said if there was intent to harm then it is a criminal activity and for this the person who intended to harm should be formally charged for battery. My advice is to let the school know that your child was injured and you feel that it was handled very poorly and would like them to go over the procedure for handling something like this with all facult and staff members. Did your son let someone know that he was injured badley? Did he ask to go to the nurse? My DD asked to go to the nurse when she broke her finger. Kids get hurt often. My son broke 2 bones wrestling and had 2 surgeries as a result. He also broke a finger swimming next door. I hope things turn out well for your child. Let us know what the other Dr. says. Another poster mentioned that the ER Dr. could be wrong. I agree with that from experience. Let the expert handle it.

 

[pepperderr]

At the begining of the year, we have the option to buy insurance for only when the kids are at school if they get hurt. So if I don't buy it and the kids get hurt, the school is not going to pay the money...that is why the offer the insurance. I would definitely report it though! My brother broke his pinkey when he was really young, playing football. My my said that is what you get for playing with the big kids and sent him to bed. The next day she said his whole arm was swollen. So the same kinda thing happened. She didn't see it as anything major or that it might have been broken. I think if you didn't think it was broken and didn't take him in the first day, then the school probably didn't either. They probably thought it was just a bruise too. BUT they definitely should have written up a report and took him to the nurse. Maybe the nurse would have thought he should be seen at the hospital because she would be more knowledgable about broken fingers. Sorry. I HATE insurance companies and hospitals!

 

[Mike N Kathy]

i think the OOP costs the op is talking about must be co-pays.. not the actual visits.

 

[KelNottAt]

Call your insurance first thing on Monday. Do it!

Notify them that you have been referred to a hand specialist/plastic surgeon by the ER.

Get the insurance company to confirm that the surgeon is in their network.

If he's in network, you're probably fine. Minimal copays.

If he's out of network, think VERY SERIOUSLY about finding a different doc. Out of network is where you'll incur all those expenses you're worried about.

My DD broke her collarbone in PE 3 weeks ago. Wrestling, another kid "fell" on her. No one has named the other kid b/c they were all out on the mat at once and it was chaos. However, there's some speculation that it was a certain former friend who has since turned into a girl bully. I believe it was intentional, but there's absolutely nothing to be gained by pursuing it. I think you're in the same situation.

 

[mamalle]

that is why I said hand surgeon- it is a speciality and if we are talking about surgery with a open reduction they are more specialized then just a orthopedic. It is a speciality that is hard to find and take insurance or at least it is down here in south fla.

 

[mrsmiller]

that I am trying to make anybody (school or child) responsible for what happened

That was not in my mind....I just wanted to know in case my insurance denied the claim..then what? I was concern because my ER copy states that the injury to his hand was sustained in school, Like I said this is the first time that I have something like this happen to me, and I want to be prepared, and have it in my budget in case that we have to pay other than out of pocket expenses. Again I am not thinking Lawsuits or going after the other child.

Regarding the accident ... I spoke to my son's friend and he told me (just like my son also told me) that the other boy had been harassing the children in the playground using a football to hit the kids, they were not playing, he hit my son's friend in the head and came back later and threw the ball at my son
My son put his hand up to protect his face and the ball hit him pulling his fingers back. The other mother and I are going to see the principal Monday, my concern is that the two boys went to the person in the playard and both were ignored and something has to be done with this boy (he has violent history)

Thank you for clarifying about the Plastic Surgeon, and thank you all for also reminding me about calling the insurance (I did not think of doing so...) sometimes you get caught up in other things and forget basics...Thank you all once again for all your advise
Linnette

 

[rainy~daze]

the insurance should have no problem covering the bills, doesn't matter that it happened at school. you don't have to tell the insurance that you think it was intentional, he had an accident and he got hurt.
but I would report it to the school that they dropped the ball by dismissing him without having him looked at by the nurse. they need to be doing reports anytime a child complains of an injury whether they think it is valid or not. case in point...the schoolyard worker thought it was just a boo boo, no big deal and it turns out they were very wrong.
i wouldn't think the school has any reason to pay out insurance wise for the injury, but depending on how much the bills add up and if, IF, the injury was inflicted intentionally, I would consider looking up that boys parents.

 

[MiniGirl]

Regarding the accident ... I spoke to my son's friend and he told me (just like my son also told me) that the other boy had been harassing the children in the playground using a football to hit the kids, they were not playing, he hit my son's friend in the head and came back later and threw the ball at my son
My son put his hand up to protect his face and the ball hit him pulling his fingers back. The other mother and I are going to see the principal Monday, my concern is that the two boys went to the person in the playard and both were ignored and something has to be done with this boy (he has violent history)

See, this is where I do have a problem with the school and would consider them negligent. If the OP has an accurate account of the events, then the behavior should've been stopped before it reached this point -- esp if the child they complained about has a history.

 

[seashoreCM]

My Our insurance refused to cover the costs since they determined someone else to be at fault. The school district refused to pay for the bills as well because in IL, they are protected through the "tort immunity act". !

Generally the health insurance company is responsible for covering the medical costs. The insurance comapany might have a case to deny the coverage if the injuries were self inflicted but not if some other party, known or unknown, caused the injuries.

The insurance company at its option, may go after the responsible party, that is what subrogation is all about. Before you can collect the insurance settlement you do have to give up your right to go after the responsible party(ies) at that time so the insurance company cang et first dibs from the responsible party. If the insurance company's subrogation does not succeed, that is not your problem.

Disney hints: http://members.aol.com/ajaynejr/disney.htm

 

[Green Tea]

I have had it happen both ways. DS broke a bone at school, the teacher didn't even let him go to office, never reported, etc. I paid my copay with ortho surgeon and that that was that. Another time he came home with an injury. Had a paper that said he needed to be seen by doctor and give them the paper to file with the county's insurance. I never got a bill from ortho so I assume they picked up the tab.

 

[daughtersrus]

Generally the health insurance company is responsible for covering the medical costs. The insurance comapany might have a case to deny the coverage if the injuries were self inflicted but not if some other party, known or unknown, caused the injuries.

The insurance company at its option, may go after the responsible party, that is what subrogation is all about. Before you can collect the insurance settlement you do have to give up your right to go after the responsible party(ies) at that time so the insurance company cang et first dibs from the responsible party. If the insurance company's subrogation does not succeed, that is not your problem.

Disney hints: http://members.aol.com/ajaynejr/disney.htm

Our health insurance is provided by the union that DH is a member of. The union is "self insured" and at least in IL, that's a whole other ball game. They get away with doing this that traditional insurance plans are not allowed to.

 

[Massillon Dad]

WE are the school district. WE the people ARE THE GOVERNMENT. Whenever someone sues a school district or government agency: they just don't go out and "print-up" the settlement money. It is "passed-on" to you and I to be financed. I'd rather finance more teachers/ better curriculum supplies.

 

[bumbershoot]

"Kids break bones occasionally. Why must everything be someone's fault?.....
This is why you have health insurance."

It can turn into being someone else's fault b/c of the forms that many insurance companies send after accidents. They ask who else might be at fault. If you put someone down, the insurance company is going to go after that person.

Two examples, not health insurance related but a similar deal.

Ages ago when I was in HS, two life-long friends were at a party. Parents were gone but had left booze, very typical for the wealthy and popular kids in my area (I was not one of either group, LOL, but I knew these guys from elementary school so I know the story). One guy had a fancy car, and it needed to be moved. Owner of the car had already had too much booze so his friend offered to move it. While moving it, he ran it off the road. When the insurance company found out that it was not the owner of the car who did it, the insurance company forced the one family to sue the other family. It was awful. The families were such friends, but they had to go to court to satisfy the insurance companies.

Hmm, also related to car insurance...I had a discussion with my insurance agent about uninsured coverage, after my MIL had an accident with someone who not only didn't have insurance, but after the accident moved from the driver's seat to the passenger's, so that the insured person was behind the wheel. Ultimately the accident was my MIL's fault legally, so her insurance paid for her damage. But if it had been the other guy's fault, her insurance company would have paid under the uninsured part of her policy, but then they would have gone after the guy, to get the 8K they paid for the repairs (Toyotas hold their value very well...MIL was hoping it would be "totaled" but even with 8K in repairs it wasn't "totaled"!).

So insurance companies do not like paying out when someone else is at fault, which is why they send out forms asking who might else be responsible for the problem.

 

[malibuconlee]

(And why is your first appt with a plastic surgeon?)

Here the plastic surgeon is in practice with the other ortho doctors. He takes call every 5th day, so if you go to the ER and they call ortho in to consult that's who you get. If that's who they saw in the ER, that's probably who they'll do the follow up with. Just the way it works some places.

 

[Green Tea]

Our health insurance is provided by the union that DH is a member of. The union is "self insured" and at least in IL, that's a whole other ball game. They get away with doing this that traditional insurance plans are not allowed to.

My DH's company self insures as well. But that doesn't make them immune to insurance regulations in place in the state. Is the policy administered by a company, Blue Cross, Aetna? While they can set the parameters of the plan they offer to employees, they should have to follow the insurance regs.