Health insurance after an accident on someone else's property?

[Roxrox]

What is the name of your state (only U.S. law)? California

My son was at a trampoline park when he broke his leg. We do not blame the park at all, it happens. My health insurance sent me paperwork asking me to list where the accident happened and their insurance information. My friend told me not to fill it out because then my health insurance will deny the claim and say that I should sue the park for his medical bills. Do I have to put this information down? Can I just ignore it?

 

[racer72]

Don't ignore the paperwork, that would more likely cause a denial of benefits. Your health insurance will seek reimbursement against the other insurance company, that is what they paid to do. That is why we have health insurance.

 

[Ohiogal]

Don't ignore the paperwork, that would more likely cause a denial of benefits. Your health insurance will seek reimbursement against the other insurance company, that is what they paid to do. That is why we have health insurance.

Actually the health insurance might not. There is an assumption of risk with many of these places and there is also most likely a contract that was entered with the purchase of the ticket if not an actual contract that was signed to allow participation.

 

[ecmst12]

The health insurance can't pursue reimbursement on its own. If you were to sue the park, they could put a lein on any settlement or award. But they can't compel you to sue or file a claim with anyone else.

 

[cbg]

They can, however, decline to pay your claim until you complete the paperwork they sent you. I already told you that on another board. Your friend is advising you to commit fraud.

 

[FlyingRon]

It's a coordination of benefits thing. Your insurer wants to make sure that they are not paying something that you are also recovering for the same thing from some other insurance or settlement. They may push you to file a claim if it was clear that it was a negligence issue but more often than not, they are just making sure you're not double dipping at their expense.

 

[justalayman]

They can, however, decline to pay your claim until you complete the paperwork they sent you. I already told you that on another board. Your friend is advising you to commit fraud.

I don't see how this would amount to fraud. It will simply result in the OP's insurance denying the claims. OP would then be stuck paying out of pocket. They surely have a right to sue the municipality. Winning is doubtful but they can sue them, or at least take the initial steps and likely be rebuffed for a variety of reasons, including the immunity the municipality likely enjoys in this situation. By then, the OP's insurance will likely have denied the claims and closed the books on it. That means OP is stuck paying out of pocket for something their insurance would likely cover anyway.

 

[tranquility]

When an insurance company pays a claim, it is said to have rights up to the level of payment of subrogation. That is, the insurance company has the same right as the person paid to damages from another party. That is what is going on here. The insurance company is seeing if there is another who may be responsible for the damages they paid money to fix. Not only would they have rights against the person who committed the damage, but also they would have the right to sue that person on their own.

However, that "right" is limited in CA to when the insured has been fully compensated for the loss. Since that is not clear without litigation, the insurance company rarely sues for subrogation without an underlying suit by the insured against the third party. For a greater explanation of how that works, see:
http://californiainsurancelawblog.wordpress.com/2011/03/25/23/

 

[justalayman]

When an insurance company pays a claim, it is said to have rights up to the level of payment of subrogation. That is, the insurance company has the same right as the person paid to damages from another party. That is what is going on here. The insurance company is seeing if there is another who may be responsible for the damages they paid money to fix. Not only would they have rights against the person who committed the damage, but also they would have the right to sue that person on their own.

However, that "right" is limited in CA to when the insured has been fully compensated for the loss. Since that is not clear without litigation, the insurance company rarely sues for subrogation without an underlying suit by the insured against the third party. For a greater explanation of how that works, see:
http://californiainsurancelawblog.wordpress.com/2011/03/25/23/

but if the OP's insurance simple denies payment for failing to provide the information requested, they will have paid nothing. No wrong doing by the OP in any way either.

 

[ecmst12]

I agree that refusing to complete the paperwork wouldn't be fraud. It would, however, be dumb. Filling out the paperwork with inaccurate information would be fraud (trying to collect from the park and put money in your pocket without reimbursing the insurance company). But if you're not pursuing a claim against the park, you just have to tell the insurance company that. All they can do is place a lein IF there is a settlement.

 

[OHRoadwarrior]

If the info is unknown, respond so. Provide the info on the ownership and address of the park as well as liability disclaimer information signed or agreed to.

 

[cbg]

The "friend" is suggesting the deliberate withholding of required information to on the admittedly mistaken belief that by doing so a lawsuit can be filed against an entity that does not, or at least has not been proven to have, primary responsibility. The INTENT is fraud, regardless of whether it would actually work that way or not.

As the OP has now been told on at least 3 boards, the friend is wrong. Assuming there is still a question after three weeks, the claim is not going to be denied because you provide information about how the accident happened. They will, however, deny the claim if the poster refuses to provide the information.

 

[FlyingRon]

Most likely they just want to make sure that you are not collecting from the park as well as submitting the bill to them. This is quite routine when there's potentially an overlap between other insurers (the park's liability insurance or car insurance in the case of an auto accident, or workman's comp if you were at work, etc...).

 

[Roxrox]

Thanks for the information. I have filled out the information requested and sent it in.

I went back to my friend and questioned him further. He said that he was on a bicycle and was hit by a car. His health insurance then refused to pay for his medical care and told him to sue the driver of the car. He didn't have the resources or the time to pursue a lawsuit, so he still has medical bills he is supposed to pay.

Let's hope that isn't the case with my insurance.

 

[tranquility]

Thanks for the information. I have filled out the information requested and sent it in.

I went back to my friend and questioned him further. He said that he was on a bicycle and was hit by a car. His health insurance then refused to pay for his medical care and told him to sue the driver of the car. He didn't have the resources or the time to pursue a lawsuit, so he still has medical bills he is supposed to pay.

Let's hope that isn't the case with my insurance.

Perhaps he might look for an attorney who might litigate for free. Unless the friend did not cooperate or otherwise do some things that could eliminate coverage, the sole fact the injury was caused by another would not allow health insurance to not treat. I suspect there are more facts, but the bare ones laid out scream bad faith.