What would you do?

[Sanchez]

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..

Not following your logic. Are you saying that your daughter's health insurance provider is refusing to pay claims unrelated to the accident because of the accident in which someone else was at fault? I suspect that there are other reasons why her health insurance provider is refusing to pay.

In any event, your prior statements simply are not true. I think your advice to the OP is not very good. The OP should provide all necessary information related to the accident to avoid a fraud claim and to make certain that her insurance company pays. The OP has no choice as to whether her health insurance provider chooses to subrogate, but the subrogation claim in and of itself will not stop the health insurance provider from paying the claim.

In any event, the OP should not be convinced by message board wisdom (mine included) and anecdotes and should speak to her insurance company and/or a lawyer.

 

[ILuvTigger]

Say you are at a party and you fall because the steps are uneven and you end up in the ER with torn ligaments in your ankle, Do you ask the person who owns the home to contact their Homeowners insurance so they can pay the co payments for your insurance? Or do you let it go? I am going to be stuck on crutches for the next 4-6 weeks. The really awkward part is it was at my sisters house.

All I can say is wow!! Accidents happen all of the time.....if you file against your sisters insurance....you may not be invited to any family parties. They will be scared you may fall or something....and be sued.

I would never file a claim against anyone in my family or stranger, if I fell on their property.....something that was just me, no one else involved. You may want to watch where your walking in the future....I don't say that to be rude. About 6 years ago, I took my kids to the park and fell. I torn the ligaments in my knee, and lost my ACL (looking to have ACL reconstruction surgery). I should have been more careful....the cement walkway was much higher than the grass way (I was walking in the grass and went to get on the sidewalk), and I didn't realize it. These things happen!

 

[derocas]

I read most of the posts, my two cents is if I get hurt at a friend's/family member's house it was an accident and I'll handle it (including copays) through my health insurance. When the insurance company calls to see if they can collect money from someone else, I would explain that I accidently fell. I wouldn't LIE but I wouldn't offer any extra information such as uneven steps, etc.

My dog scratched my son with his paw. My son was undressing to take a shower and the scratch was around his groin area. We visited the ER and they glued the area and prescribed antibiotics. Several months later I received a letter from my health insurance to either fill out the forms online or call. I called explained that the dog scratched him and that was it. I think if you make a bigger deal about it by giving a lot of details, they will pursue the other party. Just don't raise the red flag. 9 times out of 10 the person receiving the calls is just plugging information into the computer, they are not attorneys who work for the insurance company

It's just sad when have to worry about having guests entering your home, especially family.

 

[C.Ann]

Not following your logic. Are you saying that your daughter's health insurance provider is refusing to pay claims unrelated to the accident because of the accident in which someone else was at fault? I suspect that there are other reasons why her health insurance provider is refusing to pay.

Initially, I believe it was due to the no-fault.. Now that her bills have far exceeded the no-fault amount, one can only assume it is due to the pending lawsuit.. There is no rhyme or reason to denying unassociated claims, but they have held fast and done so.. There is no "other" reason.. Perhaps it is her particular health insurer.. The difference between her insurer and mine (in terms of how they operate) is about 4 planets apart.. Prior to receiving Medicare, she was fully insured through her DH's employer and there have been no issues with healthcare claims being paid for her DH and her DD..

In any event, the OP should not be convinced by message board wisdom (mine included) and anecdotes and should speak to her insurance company and/or a lawyer.

This I will agree with.. As previously mentioned (when one of my children was injured at my parents home) it was not handled in the manner you have presented here.. I can only speak from personal experience - and if things have changed since then, that's good to know..

 

[HsvTeacher]

This same exact situation happened to me a few years ago. I fell down the stairs at my BIL and SIL's house, because the staircase is steep and has short steps. I broke my leg and was on crutches for six weeks. I didn't even begin to think about asking them to pay for anything. I could never do that to family.

My health insurance paid for everything, except copays. I told the doctor exactly what happened and never received a letter from my insurance company (BC/BS) asking any more questions. It was an accident, and I took full responsibility for my clumsiness.

 

[ski_mom]

In February this year, my DH was helping our nephew put a new roof on his house. Long story short, he fell off the roof and broke 3 bones in his foot and 2 ribs. I'm thankful that's all it was, because I know it could have been much worse.

Anyway, we filled out the forms stating that he fell off the roof and our insurance company asked basically if we were going to sue. We told that that we weren't, and they have paid everything.

My nephew contacted his insurance company and his insurance company then contacted us too. They asked what our intentions were and we told them that we were running everything through our insurance. Nothing has been finalized yet, but from my understanding, we are getting $2,000 from his insurance for what they call med-pay (I think). They basically said that it is a "no-fault" amount that they can offer without any legal action being taken.

I still need to check into it a bit, because I really don't want anything to come about to our nephew over this. He is just moving into his first house and getting everything going for himself. If this is going to leave any kind of "mark" on him, I'd really rather not even take it. The adjustor we've been dealing with says that this will not affect his insurance in anyway. It's just kind of a given if anything happens on his property.

I guess we'll see how all of this plays out. If we do end up with the $2,000 we will get back most of what we've paid for the injuries DH got up there. We're not completely done with the bills though because he just had another x-ray a couple of weeks ago.

Not that this answers anything, but I just thought I'd throw our experience in the mix.

 

[rockundergirl]

I don't understand why its the home owners responsibility if you hurt yourself. If I catch the flu at my moms house while she has is, should i make a claim? Thr are way to many lawsuits in this country, we all move through life with a certain level of assumed risk, any danger you are in while in someones house, they are also subjecting themselves to. Home owners insurance should be for if you have a fire or a flood, not if you have a money grubber.

 

[stitchlovestink]

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..

Well I went to the ER w/ serious injuries sustained from a fall on common sidewalk owned by our homeowner's assn. the ER never said a word, my ins co never said a word. And YES, technically the HOA should've paid all the bills incl my copays because it was a fall on an uneven section of sidewalk that had been reported MANY MANY times. They had even gotten a contractor's bid to fix it, but never followed thru. It was directly in the section in front of my house. I took 2 bad falls (1 time fractured both bones in lower arm and damaged nerves, 2nd time busted my left knee even had to do PT) on it in the 12 years I lived there. different ins co each time as falls were about 4 years apart. Neither time was it questioned.

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

bolding is mine...
While I agree w/ Jane's whole post...
I was thinking this myself.
And being that it is your sister's home, it would not be unusual for you to be there multiple times and know about this 'uneveness'

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.

Personally, I think it is forward for you to think that the Girl Scout troop leader should offer to pay the bill. It's things like this that keep people from volunteering. That would be like me expecting my DD's coach to pay our medical bills for DD when she got hurt playing softball, because he didn't 'coach' them correctly.
My question to you would be if this was a Girl Scout function, what was your son doing there? I understand it was her son that injured yours, but I think it is a little much to expect her to pay bills for your son when he really didn't belong there. And if your son was only 4, why weren't you watching him?
I think that is a classic case of contributory negligence. It's your job to keep him safe and playing w/ multiple older boys doesn't scream safe in my book. If you knew these boys weren't listening, you should've removed your 4yo from the situation. If you asked me for $$, I've told you take your child and go home. And YES, I was a GS TROOP LEADER for multiple years. And It's parents that act like this that we weeded out of our troop. Once we got rid of our trouble making parents, we had a near perfect troop. It was wonderful!

 

[TnTWalter]

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..

Actually the OP never mentioned that she stated or had to state at the ER where she fell etc. Others have discussed that the health insurer will go to the Homeowner's Insurance IF she said where she fell. But the OP wanted to know if she should ask her sister to pay or not.

Do you ask the person who owns the home to contact their Homeowners insurance so they can pay the co payments for your insurance? Or do you let it go?

 

[C.Ann]

Actually the OP never mentioned that she stated or had to state at the ER where she fell etc. Others have discussed that the health insurer will go to the Homeowner's Insurance IF she said where she fell. But the OP wanted to know if she should ask her sister to pay or not.

I've already readdressed all of this - but wasn't the OP asking only about the co-pays? If so, I have already stated that I would not ask my sister for co-pays..

 

[Ashley Kees]

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!..

Well put. I'm in charge of my own legs, not the people on whose floor I am walking.

 

[sk!mom]

I would not sue anyone over an accident. If my insurance asked for details (mine never has) then I would be honest. Don't need insurance troubles.

Similar situation...My DD13 slipped on a slick spot on the ballet floor two months ago and fractured her elbow. When it's all said and done, we will be out around $1000 out of pocket. It never crossed my mind to sue the ballet school. We are simply using our medical insurance. It was an accident- no one's fault. If my insurance were to send me a form asking for details, I would be honest about how and where the injury occurred but mine never has.

 

[mom of princessx2]

Just be happy you have medical insurance and only have to pay co-pays and let it go

 

[StephMK]

And YES, I was a GS TROOP LEADER for multiple years. And It's parents that act like this that we weeded out of our troop. Once we got rid of our trouble making parents, we had a near perfect troop. It was wonderful!

I'm sorry but I was a GS leader for years also & still a volunteer in my younger DD's troop. I think that is a very sad comment on your troop. The girls with the "trouble making" parents are quite possibly the ones most in need of the program and it's sad if they were "weeded" out so the troop would be smoother. We had our share of difficult parents and kids too but I'd never ask a girl to leave that wanted to be a Scout.

 

[DisnyMik]

My DBIL who is 79 (my DH is 44!) was visiting from out of town. He went outside to move his car (after my DH told him not to, that he would take care of it) and fell off of one step into the garage. He ended up in the hospital to have surgery and a metal plate in his ankle!

About a month later, the insurance company is wanting to know where it happened. So, my DBIL told them. Next thing we know, he's wanting to know our Homeowners Ins. info! DH was not happy! He gave him the info and never made an issue of it. His thinking was just say "I fell" and let that be that! We have never heard anything from our Ins. Co. so we are assuming nothing happened. The joke now is "Next time, listen to me!" His DB never asked us for anything and we would never do that to our family either. It's like an unwritten law.

And yes, everytime my kids were injured/needed surgery (DD18 has had 3 surgeries on 1 knee) we would get those stinky letters wanting to know who was to blame! Hate those things!!

 

[kacaju]

I got a call from our insurance company once and I lied.

My DD fell while we were on vacation and as it turned out she had a slight concussion. Now the place that she had fallen had no idea she fell. We didn't think anything of it. It was not until a week after we came home and she was complaining of headaches did I take her to the Dr. Dr first told us she had a sinus infection. Then she thought there was a problem with her glasses Rx. After we went to the eye Dr. his first comment was I bet she had a concussion. when this Dr (no, we do not see her anymore!!) finally referred us to a neurologist and based on his exam he felt she did indeed have a concussion. So much time had passed there was no way I wanted to *place the blame* on the place where she fell, Like I said we never told anyone there she fell, how would they even know we were there a few weeks earlier?? I just told them she fell at home.
Nothnig ever became of it.

 

[stitchlovestink]

I'm sorry but I was a GS leader for years also & still a volunteer in my younger DD's troop. I think that is a very sad comment on your troop. The girls with the "trouble making" parents are quite possibly the ones most in need of the program and it's sad if they were "weeded" out so the troop would be smoother. We had our share of difficult parents and kids too but I'd never ask a girl to leave that wanted to be a Scout.

We didn't 'weed' them out. They weeded themselves out. One moved several states away. The other two, well we didn't cower to the parents demands. The rules were what they were. EVERYONE (incl their kids and our own kids) had to follow the rules. We weren't bending the rules for them. And EVERY parent had to have a job to help the troop run smoothly. Each parent had an opportunity to select a job and get the necessary training. Well, they decided it wasn't worth it for them. THEIR time was too precious (like ours was any less valuable) and THEY decided Girl Scouts wasn't right for their daughter. Not Once, did we ask a single girl to leave our troop, even though one of them was as much trouble as her parents. It is very hard to run a troop sucessfully and smoothly long term and you do need the commitment of the parents and their help too. While I enjoyed it at the time, I would think long and hard before I volunteered to do such again. Most of the time it is a thankless job.

I went back and reread my own previous post and I should've worded it better than how I did which is:
And It's parents that act like this that we weeded out of our troop.
I should have said that were weeded out of the troop but not wanting to follow the rules. As we NEVER asked anyone to leave.
Not sure where you are, but our council has a STRICT policy of NO SIBLINGS, not even the troop leaders other kids are to be there. So you would have had to leave. And yes the leader would have been in violation of our council's rules. This is a classic example of why our council instituted this policy, and I can completely understand why.

 

[cnlmom]

Well I went to the ER w/ serious injuries sustained from a fall on common sidewalk owned by our homeowner's assn. the ER never said a word, my ins co never said a word. And YES, technically the HOA should've paid all the bills incl my copays because it was a fall on an uneven section of sidewalk that had been reported MANY MANY times. They had even gotten a contractor's bid to fix it, but never followed thru. It was directly in the section in front of my house. I took 2 bad falls (1 time fractured both bones in lower arm and damaged nerves, 2nd time busted my left knee even had to do PT) on it in the 12 years I lived there. different ins co each time as falls were about 4 years apart. Neither time was it questioned.


bolding is mine...
While I agree w/ Jane's whole post...
I was thinking this myself.
And being that it is your sister's home, it would not be unusual for you to be there multiple times and know about this 'uneveness'


Personally, I think it is forward for you to think that the Girl Scout troop leader should offer to pay the bill. It's things like this that keep people from volunteering. That would be like me expecting my DD's coach to pay our medical bills for DD when she got hurt playing softball, because he didn't 'coach' them correctly.
My question to you would be if this was a Girl Scout function, what was your son doing there? I understand it was her son that injured yours, but I think it is a little much to expect her to pay bills for your son when he really didn't belong there. And if your son was only 4, why weren't you watching him?
I think that is a classic case of contributory negligence. It's your job to keep him safe and playing w/ multiple older boys doesn't scream safe in my book. If you knew these boys weren't listening, you should've removed your 4yo from the situation. If you asked me for $$, I've told you take your child and go home. And YES, I was a GS TROOP LEADER for multiple years. And It's parents that act like this that we weeded out of our troop. Once we got rid of our trouble making parents, we had a near perfect troop. It was wonderful!

It was at the begining of girlscouts, we were dropping off my daughter. It is common practice for the girls to play on the playground while awaiting for the other kids to all arrive. Siblings as well play. And this is a Brownie troop where the kids are pretty young. The accident happened in seconds, because the older boys were fooling around, it was not as if they were acting up for a great length of time and I ignored the situation. And since you asked, I along with 6-8 other parents were right there, 10 steps away.

I resent you accusing me of being a "trouble making parent". I actually am very active with the troop and have volunteered as well. The story really was not about the fact she happened to be the girl scout troop leader (actually, it is the type of troop that several of US co-lead) And I did not ask for money and never would. My opinion is that if you know you or your children are neglegant (which they boys admitted in their letter and it was obvious at the time), I personally would have offered to at least help with some of the bills. I would not have accepted the money, I just thought it would have been nice of them to offer. This was not at all like your example of if a kid was hurt playing softball you sue the coach. These were her children who pushed my son off a teetertaugter. I do not think they are horrible kids, they just were kids and they do not always think before they act. Again the fact that she was the troop co-leader really was irrelevant other than to make my point that I did not go after the girlscouts and never ever would have ever done such a thing. I just felt as a parent who saw her children do something wrong, she should have offered. Just my opinion, does not make me a "trouble making parent" with girlscouts. I also mentioned that I just moved on and never stated my opinion as it was less important than continuing to have a good relationship. Again, not sure how that make me "trouble making", I actually think it makes me trouble avoiding.
I also agree with several of the other posters that people are "sue happy" (for lack of a better term) and I relayed my story to say that I think it is wrong to go after people or insurance (ie in my case the church or my collegue who happened to be the troop leader).

 

[My5Mouseketeers]

I can't imagine someone getting hurt on my property and NOT immediately calling my insurance company. That is what we have insurance for.

Also, I don't think someone having their co-pays covered by the home owners insurance is the same thing as "suing". She is not asking for "pain and suffering" she is asking for her expenses to be covered. big difference.

 

[stitchlovestink]

It was at the begining of girlscouts, we were dropping off my daughter. It is common practice for the girls to play on the playground while awaiting for the other kids to all arrive. Siblings as well play. And this is a Brownie troop where the kids are pretty young. The accident happened in seconds, because the older boys were fooling around, it was not as if they were acting up for a great length of time and I ignored the situation. And since you asked, I along with 6-8 other parents were right there, 10 steps away.

I resent you accusing me of being a "trouble making parent". I actually am very active with the troop and have volunteered as well. The story really was not about the fact she happened to be the girl scout troop leader (actually, it is the type of troop that several of US co-lead) And I did not ask for money and never would. My opinion is that if you know you or your children are neglegant (which they boys admitted in their letter and it was obvious at the time), I personally would have offered to at least help with some of the bills. I would not have accepted the money, I just thought it would have been nice of them to offer. This was not at all like your example of if a kid was hurt playing softball you sue the coach. These were her children who pushed my son off a teetertaugter. I do not think they are horrible kids, they just were kids and they do not always think before they act. Again the fact that she was the troop co-leader really was irrelevant other than to make my point that I did not go after the girlscouts and never ever would have ever done such a thing. I just felt as a parent who saw her children do something wrong, she should have offered. Just my opinion, does not make me a "trouble making parent" with girlscouts. I also mentioned that I just moved on and never stated my opinion as it was less important than continuing to have a good relationship. Again, not sure how that make me "trouble making", I actually think it makes me trouble avoiding.
I also agree with several of the other posters that people are "sue happy" (for lack of a better term) and I relayed my story to say that I think it is wrong to go after people or insurance (ie in my case the church or my collegue who happened to be the troop leader).

Originally Posted by 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.

Yes you did state that you felt it was the bigger thing to let it go. But I interpreted your post as such that since she was a Doctor (which IMO is really irrelevant, unless you're talking about salary) and should've known the associated costs. Most Drs don't do their own billing. I still feel and am entitled to my opinion that you as the adult responsible for the 4 yo were as much in the wrong as the boys. I am entitled to see it that way. And you don't have to agree with me. Have a great evening!