Should I help my insurance company subrogate?

October 9, 2008 5:39 PM

Should I help my health insurance company pursue subrogation? Is not helping letting sleeping dogs lie?

The backstory: a while ago I passed out onto a radiator in my apartment and suffered severe burns. Thanks to good health insurance paying for expensive skin graft surgeries, I am scarred but healthy again.

Today I received a letter from a firm hired by my insurance company to investigate whether they can recover costs for my treatment from... someone else. I would assume that a primary candidate would be my apartment leasing agency---perhaps leaving radiators uncovered in certain parts of an apartment could be considered negligent. I'm not litigious by nature and believe that sometimes accidents just happen. I'm also concerned that there is some risk that any subrogation action against the leasing agency's insurance could cause the leasing agency trouble, which might in turn cause them to resent having me as a tenant somehow and then encourage them to make my life more difficult in some way (vague, yes, but such is my concern).

In any case, the letter instructs me to call the firm and answer questions about the burn incident. I did call them, actually---long enough to learn without giving my name that I am not obliged to actually assist them in their investigation. Basically things are fine now as I see it. I am better; I can't get unburned. What happened to me seems like a freak mishap, so I'm not convinced that anything that increases my lease agency's insurance costs will actually help anyone in the end. I am happy with the situation the way it is now, and I'm worried that any action on my part is more likely to make things more difficult than less. Am I looking at things the right way? Should I help this company out?

posted by anonymous to health & fitness (4 comments total)

Check the terms of your insurance. I am sure that you have already agreed to subrogate to them the right to sue for anything you accept their payment for.

I'd give correct answers to their factual questions, and tell them you don't think anyone is to blame for the accident. They haven't decided whether to sue yet. From your description of the situation, I don't think they have much of a case (IANAL but is every landlord with exposed radiators negligent?) and it's even more difficult if the injured is going to say under cross-examination that it's not the defendant's fault.

Give them the information they need for their investigation -- this doesn't mean you're encouraging them to sue. After all, they can subpoena you anyway.
posted by winston at 6:49 PM on October 9, 2008 [1 favorite has favorites]

Helping them to sue will help other people not get burned by negligence, and the recovery of their spending will help keep your and your fellows' premiums down. Sadly this is an important mechanism of public health in a privatised health system..
posted by By The Grace of God at 1:57 AM on October 10, 2008

I'm not litigious by nature and believe that sometimes accidents just happen.

Honey, if you think this through, the conclusion you get to is that accidents just happen and you shouldn't have asked your insurance company to cover your the claim of your insured ass.

Help keep other people's premiums down so they can be as fortunate as you are.

(This all sounds way snarkier than I mean it to but seriously: return the call. Please.)
posted by DarlingBri at 3:12 AM on October 10, 2008

This is completely usual business for any health insurance company. If a claim comes in that could be an accident, you are going to get a letter asking for more information about the circumstances of the accident.

This has happened to me several times. I have gotten these letters after self-inflicted accidents (falling down the stairs) and even after my appendectomy (how that could have wound up as an accident, I don't know!). My husband got them after he underwent epidurals for chronic back pain, which was not accident related. You would probably also get one if you sought care under your health insurance for injuries sustained during a car accident, for instance.

Any time I get these letters, I just call and tell them what happened. This information helps your insurance company recover the costs associated with treating you as a result of an accident due, perhaps, to someone else's negligence.

It's not useful to worry about your landlord's insurance premiums going up as a result of this; you're not the landlord, and insurance is a cost of doing business. Hopefully your information will help prevent this from happening to someone else.
posted by FergieBelle at 7:18 AM on October 10, 2008