Mn. Sister broke leg at home-had 3 drinks-B/C wont pay-say its self inflicted

[flyer1]

Greetings from Mn.
My Sister broke an ankle in 3 places in a kitchen floor slip.
Her Ins. Co. refuses to pay, stating it was self inflicted as she was drinking.
Also The Atty Gen in Mn. said ther's nothing he can do..
This seams strange to me, like a loophole..
She is a single mother who is paying for her own home.

thanks for the chance to ask. Lew

PS. Its her Health Ins. Co. thru Sams club, that refuses to pay. The company seems to participate in extreme measures to infuence rates..

 

[HomeGuru]

Greetings from Mn.
My Sister broke an ankle in 3 places in a kitchen floor slip.
Her Ins. Co. refuses to pay, stating it was self inflicted as she was drinking.
Also The Atty Gen in Mn. said ther's nothing he can do..
This seams strange to me, like a loophole..
She is a single mother who is paying for her own home.

thanks for the chance to ask. Lew

**A: it does not seem strange to us. Tell her to read the limitations (fine print) on the reverse of her homeowner's insurance policy.

 

[flyer1]

home owners policy ?

Are you refering to the chance that this is covered by the home owners policy? If the medical ins. doesn't cover it ?

thanks again, Lew

 

[JETX]

Doesn't seem strange to me at all.
Who does she claim was negligent?? Herself??

 

[I AM ALWAYS LIABLE]

Greetings from Mn.
My Sister broke an ankle in 3 places in a kitchen floor slip.
Her Ins. Co. refuses to pay, stating it was self inflicted as she was drinking.
Also The Atty Gen in Mn. said ther's nothing he can do..
This seams strange to me, like a loophole..
She is a single mother who is paying for her own home.

thanks for the chance to ask. Lew

PS. Its her Health Ins. Co. thru Sams club, that refuses to pay. The company seems to participate in extreme measures to infuence rates..

My response:

1. "Sister broke an ankle in 3 places"

2. "she was drinking"

3. "She is a single mother"

Hmmmm. Sounds like she has a problem with alcohol, and that Child Protective Services should be called into this matter.

Yeah, she sounds like a sloppy drunk.

IAAL

 

[FarmerJ]

If she is in Hennipen ,Ramsey or any of the metro countys she better not mention to anyone else what happened because those countys have fully staffed child protection units that do nothing else but investigate calls from anonymous third partys of possible child abuse and If they find the kids in the house but no answer at the door they will have the police break in the door and the kids will be taken to Saint Josephs childrens home or simmular facility .

 

[I AM ALWAYS LIABLE]

If she is in Hennipen ,Ramsey or any of the metro countys she better not mention to anyone else what happened because those countys have fully staffed child protection units that do nothing else but investigate calls from anonymous third partys of possible child abuse and If they find the kids in the house but no answer at the door they will have the police break in the door and the kids will be taken to Saint Josephs childrens home or simmular facility .

My response:

"simmular"?

Do they also take away people who can't spell?

IAAL

 

[lkc15507]

At the risk of calling down the wrath of all of the afore learned posters, let me give you at least a real attempt to answer your question. Many health insurance policies have clauses / exclusions regarding use of alcohol and / or self inflicted injuries. Simply from what you have posted, I doubt that the injury mentioned can be excluded on either basis. BUT, PLEASE NOTE: I am posting solely on the info in your post and any unavailable info can affect this answer! But, the intent of insurance plans with these provisions is to protect against high-dollar claims resulting from driving under the influence and / or suicide attempts. So, unless she attempted to kill herself by drinking too much in her home and intentionally falling on a banana peel, I doubt what you mention meets both criteria. Look at your health plan book and read it carefully. Likely the operative words are ILLEGAL use of alcohol (I don't see it in what you described, drinking at home is legal) and SELF INFLICTED (would typically mean intentional). My opinion is that falling, even if drunk doesn't fit the bill. Fight this one. You can win. If what you have stated is the case. LKC15507

 

[flyer1]

a sloppy drunk ?

Wow, unless we are back in the 1920's against drinking , your reading way too much into this.. Ruth is a respectable lady who was home alone the day she slipped on turkey greese..not a child endangerment issue. I didn't say she was drunk..I dont know what the leval was. There are no other issues or problems confusing the simple facts that I know of.
She was told the retainer fee was thousands more than she has to fight..
Its hard to find what the options are available against large companies..

Thanks for responding

 

[rmet4nzkx]

If she had a case it would be on contingency.

 

[TalulaRae]

Okay, if this is true and the insurance company can be called upon in this case, then somewhere there's a big fat check waiting for me.

Peerhaps she could sue Jim Bean or Absolute as well for putting a strain on her brain that might have caused her to slip. Maybe even Johnson Wax Floor cleaner. That stuff can create such a slippery floor surface that any unsuspecting, tipsy, single mother might break her neck on.

The possiblities are endliess. Time to hit the bottle and grab a mop!

 

[JETX]

Ruth is a respectable lady who was home alone the day she slipped on turkey greese..not a child endangerment issue. I didn't say she was drunk..I dont know what the leval was.

Okay, lets assume that she does bring a lawsuit against her insurance company (for denying her claim).

Here is how I would defend the insurance company against this claim (abbreviated version):
Me: "And ma'am, how exactly did your injury occur?"
Her: "I was minding my own business, in the kitchen, cooking a turkey. I use a little wine when making my 'world-famous turkey stuffing'.... mind you, I don't use it IN the stuffing, I drink it while making the stuffing. After a few glasses of wine (I believe it was a Merlow), I was trying to move the turkey to the counter and some of the turkey grease got on the floor. I was too busy 'sampling' the wine, to clean it up at the time, and when I went to reach for the wine bottle to refill my glass, I slipped on the turkey grease, fell and broke my ankle."
Me: "Okay, lets see if we have this right... you were drinking, you were negligent in cleaning up the spilled turkey grease, you were negligent in forgetting that the hazard YOU CREATED was there, and slipped, thereby injuring yourself. Correct??"
Her: "Yes, if you say it THAT way!".
Me: "Your Honor, the defense rests. It is clear that this injury was solely due to the negligence of the plaintiff and the insurance exempts self-caused injury claims."
Judge: "The court rules in favor of the defendant, and plaintiff pays all legal expenses incurred by the defendant in this stupid, frivolous lawsuit. Next case!"

Do you understand now?? She was the primary (if not sole) cause of her own injuries and as such, has NO claim against her insurance company.

 

[flyer1]

Thanks for the reply..Yes I understand that by being born, we become part of the problem, and share in the consequences..The measures and extremes used to alter just how we share the burdon is a lesson in inhumanity to me.
The insurance salesman does not represent himself as you your problem , but your friend against the uncertancies of life. When I was young I wanted to be a lawyer, untill I realized that I may have to fight for something that is wrong. The second thought I had was that there are too many words to twist and justify whatever one wants to do, based on how much power and money is involved. Yea I know life isn't fair.. The one who spends the most gets the most fairness. The system is more confusing to me every year..
should we outlaw a spot of turkey greese ? I think this is way bigger than I will ever understand..
After hundreds of rides, I dont give free seaplane rides anymore.
even if I ask for a disclaimer to be sighned by the passenger,ther'r err's didn't sign off..
happy day

 

[JETX]

Gee, in reading that rambling diatribe, it seems that YOU may be sipping the sauce also.

 

[BelizeBreeze]

If she had a case it would be on contingency.

And if Pigs could fly I'd order Pork Wings.