What would you do?

[laughinplace199]

Every time my graceful ballerina DD has been to the ER (once for stitches and twice for broken arms), we have received a letter and phone calls frmo our insurance co. Basically, they wanted to know where and how it happened to see if there was anyone they could go after to cover the bills. Luckily, all 3 of her accidents happened at home, so there was nothing for them to do but pay the bills.

 

[dawson5]

I would never do it but my cousin's ex-wife did to his brother's family. She tripped going up the stairs and sprained her ankle. Then she played it off worse than it was, milked it for all she could get. She did have a sprained ankle but it was not that bad, she was hobbling around on crutches for a month & a half.... until she went prom dress shopping with my cousin's little sister. She was fine then and tried to get my cousin to not tell the rest of the family (ya right). Next day she was back on crutches, playing it up. It was a big joke around the family during the holidays not to let her in the house.

 

[okeydokey]

If it were me I would pay my own co-pay. Accidents happen.

 

[tinkarooni]

I don't mean to sound harsh, but I almost don't believe I'm reading this. I think this is another spoof! Who would actually file a claim on anyone's home owners insurance because they tripped, not to mention thr own sister. If this is for real, im glad im not in your family, and take personal responsibility!..

Liability Claims Adjuster here....this totally happens all the time. I'm always amazed by it. Sometimes though it is clearly a deal worked out between two parties. For example, father fell on icy sidewalk, says to daughter who owns the house, no big deal I'll sue your insurance, daughter than tells insurance "It was totally my fault, I forgot to shovel the icy walk." Three years later there's a lawsuit and it's gone a little farther than Dad first said because the lawyers and insurance companies can't agree. It can get UGLY!

That being said, OP you will get a letter from your insurance because they want to find someone to go after ALL the bills for. I would never advocate lieing.....but.....they will go after your sister and her insurance. I agree with PP, if you've been there and been on the steps you don't have a clear cut case against her and it was just an accident. Someone isn't always legally responsible when we have accidents. Unfortunately this is part of the reason insurance is so expensive in this country.

 

[KAMKIM]

Accidents happen everyday - it does not always need to end in filing a claim with anyone (this is why we all pay too much for insurance to begin with). If you truly cannot afford the co payments or have no health insurance, or will be out of work because of it, then I'd say yes file a claim (let your sister know first) but if you have health insurance then I would let it go especially since it was family.

 

[MrsPete]

Where does personal responsibility for your own actions come into play? You fell. Big deal, we've all fallen. Sometimes it's because the steps aren't perfect, sometimes we trip over our own feet.

That's why you have health insurance.

 

[Juliet25]

Personally, I would just pay the bills and be done with it. The homeowner's insurance probably has a big deductible. If you have health insurance, just pay the money. I don't see how this is your sister's fault.

That said, I'm sorry you'll be on crutches for a few weeks. I hope it doesn't disrupt your life too much.

 

[mjkacmom]

I would never sue a friend/family member for this. My gf lives across the street - her stairs are so uneven (and narrow at the bottom - her DH built them), so I'm very careful when I walk on them. If I fell, I'd just pay my deductable.

 

[meandmytwogirls]

Where does personal responsibility for your own actions come into play? You fell. Big deal, we've all fallen. Sometimes it's because the steps aren't perfect, sometimes we trip over our own feet.

That's why you have health insurance.

Don't use those words "personal responsibility"! In these times it's become a couple of dirty words.

Come to think of it I slipped on an acorn in my back door the other day. I wonder if I can sue the squirrel for dropping it. I wonder if it carries homeowners on it's tree!

 

[branv]

While I am sorry for your injury, no way would I file against even a strangers insurance in this case. The only thing that would compel me to do this would be if my insurance forced me to.

I might have some sympathy if the steps fell over or caved in showing true maintenance neglect the owner knew about, which I couldn't see before walking up them. But uneven stairs?! That fall could have been avoided by watching where you're walking and holding onto a railing. I think the walker is more to blame than the homeowner. And frankly, even if stairs caved in under me, to file on someone I'm that close to I'd have to feel they absolutely knew it was dangerous and just didn't care if someone was hurt!

I'm assuming people just aren't as litigious in Europe, b/c frankly imagine all the lawsuits from cobble stone streets and uneven stairs/walkways over there!

 

[cnlmom]

We had a slightly similar situation a year or two back. My daughter was at girlscouts at our church. During girlscouts, my DS4 was playing on a teetertauter type thing with the girlscout troop leaders sons who were about 8. The older boys were really fooling around not listening and long story short, my son got smacked in the chin with a metal teeter taughter.....had 10 stitches at the emergency room.
I did not sue/claim on the insurance of the the church (happened on their property), I did not go after the girlscout troop leaders, stuff happens, that is life. However I have to admit I was a bit disapointed that the girlscout troop leader's family did not offer to help with the bills at all. She is a doctor and knows how much out of pocket we had to pay with co-pays. I think it would have been the right thing for her to do to offer at least something monetary to help with the bill, but I had to deal that she did not make that choice. (I would have done that) She did however have her boys write an apology note taking full responsiblity. We figured in the long run our relationship with the church and girlscouts was worth more than petty bickering over an accident.

 

[janey99]

If it were me -

I would not file a claim against my sister for co-pays. Unless your coverage is minimal, I would guess the co-pays are not that high. (good family relations)

If questions start getting asked, it would emerge that it was your sister's house, you had been there multiple times before, and were probably aware of the "uneven-ness" of the stairs. (prior knowledge)

"Uneven-ness" of stairs is pretty much a judgment call and not necessarily a hazard or a dangerous condition. (no liability)

I would also hope fervently that I had not taken a sip of alcohol at this party, and that no one there could say they had seen me do so. (contributory negligence)

JMHO

Jane

 

[C.Ann]

I think some people are missing the point here.. If the OP stated at the ER that she fell at her sister's house - that is the report that the OP's health insurance company is going to receive.. At that point, the health insurer is going to refuse to pay the bill and request info regarding the sisters homeowners insurance.. The health insurer will then go after the HO for payment.. It has nothing to do with what the OP wants or doesn't want..

Now if the OP didn't mention "where" she fell, that's a different story..

As for the co-pays, I would definitely pay them myself..

 

[tinkarooni]

I think some people are missing the point here.. If the OP stated at the ER that she fell at her sister's house - that is the report that the OP's health insurance company is going to receive.. At that point, the health insurer is going to refuse to pay the bill and request info regarding the sisters homeowners insurance.. The health insurer will then go after the HO for payment.. It has nothing to do with what the OP wants or doesn't want..

Now if the OP didn't mention "where" she fell, that's a different story..

As for the co-pays, I would definitely pay them myself..

Claims Adjuster here again....I have never seen a health carrier refuse to pay a bill. They simply pay the bills and than go through a process called subrogation. Once they pay the bills they assume the right of the patient to go after the at fault party for what they paid. I don't think OP is in any danger of the bills not getting paid, she is however stuck with the co-pays and any other out of pocket expenses.

I didn't give my opinion before, but I wouldn't go after my sister. Makes you afraid to let anybody in your house these days. I have instructed my kids to tell everyone that the trampoline in our yard is missing a part and it's on back order, because I don't want anyone but my own kids on it. I'm not accepting that kind of risk.

 

[*Seanaci*]

Just some food for thought:

I stepped on one of my sons toys coming down the stairs at our house back in April. Rolled my ankle...sounds very similar to what happend to you as far as the injury goes. Back in June, I got a letter from my insurance company asking what and where it happend. If it hadn't happened at my own house (actually my parents house, but we live with them and pay them rent), I'd of filled it out accordingly.

In your case, I would do as someone else suggested, just mention to your sister that your insurance company sent a letter asking what/where/why of the injury and see what she says.

 

[pearlieq]

While I wouldn't lie if asked on my insurance forms, I would never bring action against a family member or friend for something like this. It would seem petty an unnecessarily litigious to me. People are so much more important than money.

I would, however, expect my sister to be driving me to all my doctor appointments and bringing me takeout whenever I had a craving!

 

[stella27]

If you want to ruin your relationship with your sister, her husband, and her children; and then watch the rest of your family and friends choose sides and have many be critical of you for your actions, then you should ask her to file a claim on her homeowner's insurance.

These types of actions can really ruin a family.

 

[Sanchez]

I think some people are missing the point here.. If the OP stated at the ER that she fell at her sister's house - that is the report that the OP's health insurance company is going to receive.. At that point, the health insurer is going to refuse to pay the bill and request info regarding the sisters homeowners insurance.. The health insurer will then go after the HO for payment.. It has nothing to do with what the OP wants or doesn't want..

Now if the OP didn't mention "where" she fell, that's a different story..

As for the co-pays, I would definitely pay them myself..

This is absolutely incorrect. The health insurance company must pay according to the terms of the policy. The company MAY then investigate the circumstances and then MAY seek reimbursement from the homeowner's insurer. This is called a subrogation claim.

 

[C.Ann]

Claims Adjuster here again....I have never seen a health carrier refuse to pay a bill. They simply pay the bills and than go through a process called subrogation. Once they pay the bills they assume the right of the patient to go after the at fault party for what they paid. I don't think OP is in any danger of the bills not getting paid, she is however stuck with the co-pays and any other out of pocket expenses.

I didn't give my opinion before, but I wouldn't go after my sister. Makes you afraid to let anybody in your house these days. I have instructed my kids to tell everyone that the trampoline in our yard is missing a part and it's on back order, because I don't want anyone but my own kids on it. I'm not accepting that kind of risk.

This is absolutely incorrect. The health insurance company must pay according to the terms of the policy. The company MAY then investigate the circumstances and then MAY seek reimbursement from the homeowner's insurer. This is called a subrogation claim.

Really? DD was involved in an auto accident back in 2006.. That in turn opened up a no-fault case.. She is also suing the operator of the other vehicle.. Every single health claim has been refused by her health insurance company since then - including an appendectomy and gall bladder removal - which obviously had nothing to do with the auto accident.. They will not pay doctor bills, hospital bills, counseling (that she was receiving prior to the accident), any kind of blood work or testing (such as the work she had done a few weeks ago for a kidney infection), etc..

They can - and will - refuse to pay - and that is exactly what they have done.. It may be different because there's a no-fault case involved - but they will not pay any type of health insurance claim at all - even if it's for an obvious illness (bronchitis; strep; etc.)

The only reason they haven't gone "under" is because her lawyer is holding all the unpaid bills at bay - and now that she has been declared totally disabled (as of late last fall), she qualifies for Medicare..

Interesting..

 

[tinkarooni]

Really? DD was involved in an auto accident back in 2006.. That in turn opened up a no-fault case.. She is also suing the operator of the other vehicle.. Every single health claim has been refused by her health insurance company since then - including an appendectomy and gall bladder removal - which obviously had nothing to do with the auto accident.. They will not pay doctor bills, hospital bills, counseling (that she was receiving prior to the accident), any kind of blood work or testing (such as the work she had done a few weeks ago for a kidney infection), etc..

They can - and will - refuse to pay - and that is exactly what they have done.. It may be different because there's a no-fault case involved - but they will not pay any type of health insurance claim at all - even if it's for an obvious illness (bronchitis; strep; etc.)

The only reason they haven't gone "under" is because her lawyer is holding all the unpaid bills at bay - and now that she has been declared totally disabled (as of late last fall), she qualifies for Medicare..

Interesting..

I don't know what state you are in but I will tell you that in PA where I am if someone is in a car accident the injured party must use their own auto insurance policy to pay their own bills, regardless of who is at fault. When they have exhausted their benefits there than they go to their health insurance. That is a reason that health insurance will refuse to pay, when the injured party has other insurance that is primary. A health carrier can not refuse to pay a claim "if" someone else may be held legally liable. They must pay the bills and than subrogate in an attempt to recover. I also would have no idea or valid reason for why a health carrier would refuse to pay other non-associated medical bills as you mentioned. That seems outrageous to me.