Mom pushing me to file homeowners ins. claim 4 months after slipping
February 12, 2012 7:39 PM   Subscribe

My mother stumbled in my home while getting out of the shower, and twisted her knee. She is uninsured and doesn't have the money to get an MRI or receive physical therapy. She wants to make an an injury claim against my homeowner's insurance to pay for her medical treatment.

This is all going on after someone else said they'd be willing to help with her medical expenses.

Unfortunately, I'm not in a position to support her financially. She didn't outright fall but stumbled(slipped?) enough to hurt her knee.

The incident happened about 4 months ago. She is just now pushing me to file a claim against my homeowner's insurance. Is this an appropriate use for homeowner's insurance? What happens to me as a homeowner and my policy if a claim is made?

Of course I love my mother and want her to feel better - I just don't know if this is an appropriate course of action. I'm naive to this process.
posted by anonymous to Human Relations (12 answers total) 2 users marked this as a favorite
I'm pretty sure that this is what insurance is for. Something went wrong and luckily you were insured against it.
posted by unliteral at 7:48 PM on February 12, 2012 [1 favorite]

Are you in the US? She could be eligible for Medicare and/or public health programs in her area. Has she seen a doctor at all? If you do make a claim, you almost certainly will see your rates go up, and your insurer could elect to no longer renew your policy. The amount you may have to pay as a deductible is also a factor to consider.

I'd make sure that she's exhausted her available public health services before getting your homeowner's policy involved.
posted by quince at 7:56 PM on February 12, 2012 [2 favorites]

Oh boy. Yeah, your homeowner's insurance probably includes some kind of medical expenses coverage. Your agent, if you have one, will be able to tell you for sure. I wouldn't worry about whether or not it's an appropriate use, as long as you are honest and tell any representative from your insurance company the truth. They will typically look for any reason to deny the claim, so they will for sure tell you if you aren't covered in that way.

The other thing that sometimes happens is that your mother sues you. Then your liability insurance, which you almost certainly have, kicks in. I know of a couple where one spouse sued the other with the insurance company handling the litigation, all completely aboveboard.

One thing I would consider, if I were in your position, would be whether it would be financially advantageous to you just to pay your mother's expenses outright. Typically there's a deductible that you would be responsible for before the insurance pays dollar 1 (again, check your policy), and then there are frequently premium increases after a claim is made. Medical care is really expensive out of pocket, as I'm sure you are all too familiar with, and the expenses are uncertain, so for your own peace of mind you might prefer having the insurance company handle it.

The above is not legal or insurance advice, your mileage may vary, etc., etc. I hope you and your mom are both doing better after this is over.
posted by wnissen at 7:59 PM on February 12, 2012

First step: call your homeowners insurance and ask.
posted by bq at 7:59 PM on February 12, 2012 [1 favorite]

Your rate will likely go up and it's also not unusual for your policy not to be renewed after a claim of any size. Google around -- IIRC the l.a. Times did some recent articles about this. If there's any possible way for you and others to pay mom's bills that would definitely be the way to go. If they're hospital bills, in particular, it's usually quite easy to set up a payment plan. My sis paid off a surgery $50 a month for a long, long time.
posted by BlahLaLa at 7:59 PM on February 12, 2012

I agree with quince. You should only file against your homeowner's insurance if there is no other way to pay for the medical expenses. Repeated claims against your insurance can cause your insurer to refuse to renew your policy in the future, so make those claims count.
posted by cabingirl at 8:00 PM on February 12, 2012

Your agent, if you have one, will be able to tell you for sure.

I called to ask something like this once. The next thing I knew, the claims adjuster was calling to schedule a time to interview me. If you have a hypothetical question, be extremely clear that you are not at this time filing a claim.
posted by slidell at 8:18 PM on February 12, 2012 [1 favorite]

The claimant typically does not have a deductible to pay. This means in this case, neither your mom nor you would be out anything for the claim. When I was a claims adjuster (a long time ago now), the max coverage for this type of incident was $5000 (your policy and your state may have different limits).

I handled a claim with a mom falling in a daughter's house that was fraudulent (mom got hurt elsewhere). Adjusters tend to be suspicious of claims of a relative falling in a relative's home (should be familiar with the home's quirks). That isn't to say your mom didn't get hurt there, though (just a perspective for the type of questions an adjuster will ask).

Another concern the adjuster will have is why the long delay in filing a claim (4 months is a long time in the claims world) and if treatment was sought immediately after the injury. A gap of more than a day or two between the date of injury and any treatment will ring alarm bells of possible fraud.

Underwriters make the decision whether to renew a policy or not; the claims adjuster doesn't. However, the adjuster may be asked by the adjuster if there was any suggestion of fraud, which will almost certainly lead to a non-renewal of the policy.

If it were my mom and I knew the claim to be legitimate and that I couldn't pay it myself, I would start with my insurance agent. They are not employees of the insurance company and are much better informed as to your chances of a non-renewal. The agent can also fight for you and make a case to keep you in the fold.

I have had to file a large claim (not an injury claim but burst pipes) and am still insured by the same company. I think a lot depends on how long you have had the insurance, your credit score, and the quality of the insurance company (some really do try to do the right thing; others not so much).
posted by daneflute at 8:30 PM on February 12, 2012 [3 favorites]

First step: call your homeowners insurance and ask.

I have been told -- here, I think? -- that this is actually not the best procedure, because all questions are noted as "events" in your file and a certain number of events can lead to premiums going up, or other unwanted changes.

If you can find out by reading your insurance documents what you are covered for, that should be your first move.
posted by LobsterMitten at 8:39 PM on February 12, 2012

If you have a hypothetical question, be extremely clear that you are not at this time filing a claim.

Even that won't necessarily help. I called with a hypothetical question once and they told me they had to treat it as a possible claim and investigate. (Luckily for me it was genuinely hypothetical, so all they did was waste an afternoon.) My current agent is great and I can ask him all kinds of weird questions with no consequences, but I'd be very careful about asking these questions if you didn't already have a good relationship with the agent.
posted by Forktine at 9:13 PM on February 12, 2012 [1 favorite]

Are there any free clinics in your area? Also, check out local hospitals to see if they have some sort of charity care program. Granted these services are usually handed out to people with very little in any sort of assets, but your mom may qualify.
posted by thorny at 9:49 PM on February 12, 2012 [3 favorites]

My mom and I were carrying a sofabed out my front steps, the spring kicked out and knocked off part of her front tooth (coincidentally, the same one I kicked off as a baby when she was changing my diaper; it's a wonder she speaks to me). We filed a claim on my homeowner's insurance, it was straightforward and my rates didn't go up. (My mom isn't insured either). But again, this will all depend on your policy. I'd try calling the finance department of your local hospital and look at self-pay discounts/payment plans/charity programs first. It's amazing how much the price can come down for self-pay, even on stuff like MRIs.
posted by at 8:48 AM on February 13, 2012

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