Geico v. United Health Care Claim
January 13, 2009 1:40 PM   Subscribe

I slammed my thumb in the car door and medical bills went to United Health Care instead of Geico. Geico is pissed I never notified them. Now what?

I slammed my thumb in my car door back in October. It was pretty bad (broken in three places and minor surgery to reassemble the nailbed), and required a couple visits to a hand surgeon in addition to the regular ER visit.

My FIL mentioned that we could probably put it in as a car insurance claim (Geico), but that it would also be covered through our regular health insurance (United Health Care). I received a letter in the mail from a company that verifies claims on behalf of UHC, and it seems that they are now trying to recoup their losses by going after Geico.

I just got off the phone with a liability rep who wanted to verify the car make/model (not the no fault person who had already left for the day), and the guy really got on my case about not 'informing Geico on a timely basis about the accident'. He said that they 'frown upon claims not brought to their attention within 30 days of an incident' and that this should've gone in under a PIP claim.

I told him that the hospital automatically billed to UHC, and the hand surgeon did as well since it wasn't a motor vehicle accident. I, too, was under the impression that it could go in either direction since the car wasn't moving and there were no other parties involved. I also wasn't too keen about putting in a claim and having my insurance rates go up (I live in NJ - land of the insane insurance rates). He blew me off after that, telling me that I had to deal with the no fault rep tomorrow.

Am I screwed?
posted by dancinglamb to Law & Government (10 answers total) 4 users marked this as a favorite
Who cares if it was in the car or in a house door? If it wasn't a car accident, it should not be processed by your car insurance. Really, I mean, if you were walking down the street and absentmindedly tripped and fell into a parked car, would you file that claim with that person's car company? No. It was a medical-only claim, so it should be covered in full by UHC.
posted by banannafish at 1:49 PM on January 13, 2009

Response by poster: Banannafish, that's what I thought, since the car *was* parked. Apparently, UHC feels otherwise, as does Geico. I just have this awful feeling that they're going to point finger, saying it was a car incident=car claim, then Geico is going to say that they had the 30 day notice rule, and then I'll be fucked.

What was even stranger, when I talked to the company that was investigating the claim on behalf of UHG (Ingenix?), they asked what state the accident occurred. Strange...
posted by dancinglamb at 2:01 PM on January 13, 2009

First, IANYL, this is not legal advice.

Second, I hope that your thumb heals well and that you are physically ok.

This is bizarre. My feeling is that your FIL's advice was poor. Whose car is it? Anyway, Ingenix is a subrogation company, so they have been hired by UHC to try to find someone to get some money out of. They contacted Geico to try to get them to pay for something. Geico is understandably peeved that they are getting subrogation inquiries for an "accident" that they never heard about. It sounds like UHC is probably going to try to recover medical expenses from Geico, which will be a claim against the policy.

The specifics probably depend on the state you are in and the kind of coverage, but you can probably expect that a claim will show up on the insurance. That may not be a big deal, but it could be very expensive. You should probably try to clarify with UHC that there is no compensable liability on the part of the policy holder.
posted by iknowizbirfmark at 2:33 PM on January 13, 2009

Any chance of getting a call placed to UHC +/or Geico by an admin at the hand surgeon's office? I'm guessing they've seen just about everything as far as insurance companies are concerned. Or, assuming UHC health insurance is through work, have the benefits dept look into it? Perhaps advice from a NJ consumer advocate?
posted by woodway at 2:47 PM on January 13, 2009

Response by poster: iknowizbirfmark, it is our car, so it's our auto policy. And the UHC policy is through Mr. dancinglamb's employer. So, either way, it's coming out of our pocket. I just *really* don't want to have to deal with our auto policy increasing. The car is leased, and as I mentioned, we're in NJ. We're paying an arm and a leg for insurance already. I don't want to find out how much it costs to add a thumb, too.
posted by dancinglamb at 2:50 PM on January 13, 2009

Best answer: I work with health insurance at a large hospital, and I deal with this kind of situation all the time. Like, daily.

First, yes, this should have gone thru your auto insurance. Any injury involving a vehicle, whether or not it is in motion, will need to be billed thru your PIP coverage. (This doesn't apply if you don't have PIP. In my state, PIP is mandatory and automatically is included in car insurance policies. In other states, it is not. If you don't have PIP, the health insurance company will want to know this specifically before they pay a claim.) This sounds crazy and non-intuitive, but that's insurance for you.

My disclaimer is that specifics may vary from state to state. But if Geico wanted you to file a claim, I am guessing the same rules apply in your state as in mine.

PIP coverage is not liability related. It is medical coverage that is available to you as a policyholder. At least in my state, it covers you regardless of which vehicle you were in and whose fault the injury was.

I see this all the time where a surgeon will schedule someone for surgery on an auto-related injury and their staff does not check with the car insurance. Health insurance companies always want to shift primary coverage off on someone else if at all possible, and this kind of situation is a good example. UHC might even pay at first if the claims person doesn't catch that it's auto-related. But then eventually it gets caught and they try to recoup from the auto insurance. I work on the urgent-admission side of things, so if you had gone to the ER for this, I'd have been the person at the hospital to call you asking you for your auto insurance in order to properly set up the ER claim. At my office, we pursue an auto insurance claim rabidly as soon as we know the injury is in any way, shape, or form auto-related, and this is precisely why.

Now, I don't see why you shouldn't be able to file a PIP claim with Geico now. I know they said they like to know within 30 days, but does this mean that you can't file at all now? At the end of the day, UHC won't be paying unless the claim goes thru Geico first.
posted by DrGirlfriend at 3:00 PM on January 13, 2009

....and I see now that you are worried about your premium increasing if you file the claim. Unfortunately I can't offer any insight into that because I'm not sure if PIP claims affect the premium. I have asked claims adjustors in the past because patients ask me that all the time and, unsurprisingly, none of them wanted to answer the question.
posted by DrGirlfriend at 3:05 PM on January 13, 2009

Was the door damaged?
posted by ChurchHatesTucker at 5:40 PM on January 13, 2009

Response by poster: Was the door damaged?

Um, no. When it comes to a Volvo door versus thumb, I can assuredly say that the door wins.

My thumb was in there far enough that I had to actually *open* the door to get my hand free.
posted by dancinglamb at 7:23 PM on January 13, 2009

Best answer: This doesn't have anything at all to do with whether or not the car suffered damage. PIP = Personal Injury Protection, and it is not liability based. It is medical coverage that covers people on the policy.

If you hurt yourself and a car is involved, your PIP coverage gets billed first, before your health insurance.
posted by DrGirlfriend at 7:57 PM on January 13, 2009

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