about 6 months ago I was at a friends house and slipped and fell on his deck stairs. it ended up being pretty awful. I broke 2 ribs and punctured a lung. I was in the hospital for 3 days as one of my lungs had collapsed. i'm not going to sue my friend but my my health insurance is requesting info regarding the incident. I don't understand why my health insurer would be able to file a claim against my friend. I make significantly more money than my friend and can afford the co-pays and parts of my coverage that have been denied by my insurance. should I just throw away the subrogation questionairre?
subrogation: injured badly at a friends house
byu/mecausasui inInsurance
Posted by mecausasui
10 Comments
I’m honestly curious why they are digging into this more? Why isn’t “ i slipped falling down stairs” enough?
Just because it was at a friends house doesn’t mean much. Doesn’t mean he was negligent
I would fill it out, if you friend has insurance, they will handle the demand
Because somebody else is potentially responsible. It doesn’t matter how much you make or what you can afford what matters is who is responsible for them having to pay out that money. If it is someone other than you, then they will certainly get that money back from them, as they should.
They are seeking to subrogate against your friends homeowners insurance, not your friend. You got hurt at your friend’s house, and his homeowners insurance’s liability rightfully owns your health insurance.
They aren’t wanting you to sue your friend, they are wanting to sue your friend/their homeowners insurance for all the money they paid on your behalf. If there’s negligence or liability there they have the right, if it was just an accident then oh well.
> should I throw away the subrogration letter
This is a legal matter and probably should involve your own attorney.
The way your insurance sees it is why should they have to foot the bill for your healthcare if it was caused by someone else? Ideally they aren’t going to sue your friend. They dont like this option either because your friend doesn’t have the money to pay them either. They’re hoping your friend has home insurance that will cover it. If your friend is a renter then the landlord will presumably have insurance.
Will the property insurance cover it?
Maybe. There’s a huge number of variables but it boils down to what caused the fall. Was proper equipment in place? Handrails? Were the steps to code?
Some policies have med pay for claims like this and it is no fault. Meaning the policy will pay regardless of if the insured is at fault for the claim. In this case its a no-brainer for your health insurance to seek the reimbursement for your medical care and recoup some of their spent money .
Your insurance will always try and recover some money to see if negligence was found. Just fill out the forms and let the insurance companies hash it out.
Your insurer is likely trying to rule out if your friend’s homeowner’s policy has a medical payments coverage, which, regardless of fault, pays for medical bills incurred by someone injured on your friend’s property. If that coverage exists (likely), then your health insurance insurance company will work with your friend’s homeowner’s insurance company to determine, who needs to take a primary/secondary stance to your medical bills. This will entail the two carriers comparing each others policy language to determine who pays for what medical bills.
The health insurer would likely file a lien with your friend’s homeowner’s company. This would be to ensure that it was reimbursed for medical bills if you ever decided to file a Bodily Injury claim. To the best of my knowledge, you have no contractual or legal duty to make that bodily injury claim. If you choose not to make it, then the health insurer’s lien is meaningless.
I would strongly suggest that you cooperate with your health insurance company. Make it clear to them that you will not be presenting an injury claim against the homeowner’s policy.
To ensure that there is misunderstanding with your friend, make sure to loop him in on the fact that you are responding to the subrogation letter. Reiterate to him that you will not be making a bodily injury claim against him. Let him know that your health insurance company will likely be reaching out to his homeowner’s policy to coordinate what carrier pays what bills for your medical treatment under the homeowner’s no fault medical payments coverage and your health insurance policy.
Hope this helps!
You’re forgetting the part that your *insurance* is paying for your hospital stay. Behind the cost of the copays you can easily afford, there’s thousands of dollars of treatment. They give you the copay and deductible cost. They’re seeking reimbursement for themselves, not for you.
Say you were careless and it’s all your fault??