Protocol for an injury from a practical joke?
September 4, 2013 11:34 AM   Subscribe

My friend's wife pushed me from their deck into their in-ground pool on Sunday at a party. Now my knee is damaged. I could barely walk back to my car; saw a doctor tuesday; complete tear of the ACL + more (evil triad if that means anything to you.) I'm married, have a 21 month old and work for myself (I make money when I'm mostly on the road, although I do some writing/consulting from home.) Minimum I'm off my feet for a month....yes, I'm consulting lawyers, but I'd like to keep the friendship, if possible. Help!

Here's the greater details: Full ACL tear, an occult fracture of the tibia, partial Medial Ligament + meniscus tear.

I'm really not sure what to do here. Is his homeowners supposed to cover some/any of this? Yes, if she hadn't knocked me into the pool, I wouldn't be injured. But I also know, his wife didn't mean to have me get hurt.

I'd like to keep the friendship, and I'm not sure how he/they are going to handle the news.

What's the protocol on this? I'm going to call and tell them tonight....but after I tell them I got hurt, what should I be saying next?

Yes, You are not my lawyer or doctor. I'd like to keep the friendship; they're good people - she didn't intend this to happen; and I'm sure they didn't mean for me to need a (possible) 50k surgery, be out of work (because I'm not able to travel to clients - I freelance), or be unable to pick up my daughter. I'm not really sure what to do here.

(Yes, I'm also trying to reach a friend who is a personal injury lawyer for advice as well.)

But I can't be the first person who got injured at a friend's house due to intentional behavior like this. What's the protocol to talking to them? And what I should do for my family?
posted by Towelie to Human Relations (32 answers total) 11 users marked this as a favorite
Yeah homeowners' insurance should take care of that.

Put your health above your friendship and pursue the claim.

At least that's what I would do.

I would not want as friends people who thought pushing other people into pools was a fun thing to do. But that's me.
posted by dfriedman at 11:47 AM on September 4, 2013 [9 favorites]

A few points that would be useful to clarify, just in terms of the bigger picture of what this all may mean for you financially:

I'm sure they didn't mean for me to need a (possible) 50k surgery

If I'm reading this (and the rest of your question) correctly, I'm inferring that you have no health insurance and that all costs will be coming out of pocket. Is that right?

be out of work (because I'm not able to travel to clients - I freelance)

Have you checked to see if you qualify for any disability benefits through your state? (Note: I am definitely not talking about Social Security Disability, which is not for this sort of thing, but rather the short- or medium-term disability programs that states often administer in conjunction with unemployment.)
posted by scody at 11:56 AM on September 4, 2013 [1 favorite]

Calling her out of the blue about lawyers and she may go off the deep end.

Get a full assessment on your end first before talking to her. Inform her with your friend (her husband) present as well.
posted by Kruger5 at 11:59 AM on September 4, 2013 [5 favorites]

Wow, how terrible! I'm so sorry.

Will the medical expenses be totally out of pocket?

I guess if it were me, I'd do something like this:

1) Call them and tell them what happened. Tell them you know it's an accident. At the same time, this is going to be a huge ordeal and expense for you. Let them know you have to pursue the homeowner insurance claim. Do so. (Not really sure how this works.) If you have quantifiable expenses that come with a receipt and are not covered by insurance, ask them if they'd consider splitting the cost with you.

2) Probably avoid this person for a while if not permanently. She clearly has bad judgement. If they are unwilling to cooperate/help with expenses, consider ending the friendship with both of them.

What I would not do:

Sue them. Life is full of accidents, some much more unfortunate than others. This was terrible luck after a very bad decision (not yours), but it was not intentional.

Good luck. I'm really sorry.
posted by latkes at 11:59 AM on September 4, 2013

Here's what I would do. I would call the friend and say, hey you know what, I was actually really injured -- not just a muscle strain -- that limp to the car was serious.

Then I would say, I know you didn't intend it, and I don't blame you, but I also know that the whole reason behind insurance is so that the burden of cost is lifted from the insured and placed on the insurer. So that means that if I put in a claim on your insurance, neither of us is stuck with the cost. And whooo boy, this injury is a doozy! (all in a nice tone of voice)

See if you can slip past the possible increase in their premiums.
posted by janey47 at 12:00 PM on September 4, 2013 [11 favorites]

If I'm reading this (and the rest of your question) correctly, I'm inferring that you have no health insurance and that all costs will be coming out of pocket. Is that right?

This is not relevant to whether OP files a claim. There are deductibles, copays, yearly caps, etc. Once the insurance companies have duked it out, OP's health insurance company may pay part of the medical costs, but the homeowner's liability insurance should at a minimum cover deductibles and copays and ensure that OP is not put into a bad position by any yearly cap.
posted by rocketpup at 12:00 PM on September 4, 2013 [1 favorite]

What I would not do:

Sue them.

Getting money out of their insurers might require that you sue them. Be prepared for that eventuality.
posted by pharm at 12:26 PM on September 4, 2013 [2 favorites]

You sue their homeowner's insurance. Will your friendship survive? Maybe. It's clearly their fault though, so they must recognize they've earned this.
posted by tylerkaraszewski at 12:29 PM on September 4, 2013 [1 favorite]

I'd call and be straight with them.

You: "Hey, Friend, I wanted to let you know that as a result of the accident at your house last weekend, I'm actually quite injured. [Tell horrible injury here.]"

Friend: "Oh my gosh, I'm so sorry! [Other sympathetic noises.]"

You: "Yeah, thanks. I know it wasn't intentional, but the injury is bad enough that I need to file a claim against your homeowners insurance. I wish there was another way, but this is so massive and so expensive, it's best thing for both of us."

Friend: "Wow, yeah, I understand. Here's the info."

Of course, that's the best possible scenario, but if this is any kind of friend, they will hopefully feel hugely guilty and be as helpful as possible to get this resolved. Yes, their premiums will go up, but honestly, it WAS their fault, and the financial burden shouldn't be on you. If they fight you on it, well, now you have a better look at what kind of friendship this actually is, and you can act accordingly.

This seems painful and awkward and all-around bad. So sorry you're going through it, good luck getting it resolved quickly!
posted by Bella Sebastian at 12:32 PM on September 4, 2013 [25 favorites]

Can you start like what janey47 says: "You know how when I left your place I was limping? The pain got worse so I went to a doctor and it turns out it's actually a pretty serious injury - I might even need surgery. I'm not entirely sure how this all works out but my insurance company (and/or doctor) needs your home-owner's policy information. Can you email it to me/send to their office at ____? I wish I had more info for you but I really am just aware of the medical/treatment stuff and not how all the insurance works. Sucks, right?"

If they refuse to send it you can just keep saying it's the other party that needs it (true) and then put your docs/your insurance on them. Friendship may be gone at that point but at least you tried. If they send it and then get kinda huffy over the claim, you can just keep saying you don't know how it all works but that as soon as you said Friend's Wife playfully pushed you into the pool, the companies immediately asked for their insurance. Then try to not talk too much about it.

Basically, put it all in the hands of others. That's their job.
posted by adorap0621 at 12:35 PM on September 4, 2013 [10 favorites]

I'd talk to a lawyer before you talk to them, definitely. Because otherwise, how are you going to handle it when they say "how awful! Well we'll definitely want to help out with that... but gosh what with our reasons, we don't have an extra blah blah blah." First find out what you are going to do, and how it's going to play out. Then, let them know, being as blameless as you can about it.
posted by fingersandtoes at 12:35 PM on September 4, 2013 [1 favorite]

Assuming that you have insurance, there's basically no way they won't claim against your friend's homeowner's insurance, so that's just going to happen.

If you don't have insurance, you would be insane to pay for this out of pocket just to be nice.

You can't make your friend enjoy that process or be cool about it. On top of everything, he's going to be getting a really embarrassing lesson in acting like a grownup, and a lot of people react poorly to that.

You can be kind, warn them to whatever extent your insurance company's lawyer allows, not bring any unnecessary drama or antipathy into it, but saving the friendship isn't really in your court.

And...if your friends cared about your personal safety or their pool/home safety, they wouldn't have physically assaulted you. So, you know. Don't make any sacrifices on their behalf.
posted by Lyn Never at 12:35 PM on September 4, 2013 [7 favorites]

If there is a lawsuit, it might be a suit brought by you against them. Not all states allow a direct action against someone else's insurer. Also, the act of deliberately pushing you could keep them from being covered by insurance. This all depends on state law and the specifics of the insurance policy, of course, but this situation could be much messier than you just making a claim against their policy. Given all of that, talk to a lawyer and get some legal advice before you talk to your friends. I think it would make sense to ask your friend the lawyer for a referral to someone he respects.

I know that's not what you want to hear, but it is worth waiting a day or two and getting advice so that you don't inadvertantly say something now that hurts your claim in the future.
posted by Area Man at 12:50 PM on September 4, 2013 [1 favorite]

there was an undercurrent of hostility in her action. good friends don't do shit like this. as a result, you have three significant elements of damages: medical bills, lost income, and pain and suffering, including possible permanent disability.

most places won't let you sue the homeowner's insurance company, you're gonna have to sue the homeowner, unless you want to accept the carrier's lowball offer.

you're feeling an inappropriate sense of embarrassment and awkwardness over this. the perpetrator is the only party who should rightfully be feeling embarrassed.

i would lawyer up and stick it to her with extreme prejudice. generally, i would limit communication in the interim, knowing that it is discoverable and perhaps admissible, but in this specific instance, there may be some value in documenting what happened in a tangible medium, such as email, so she can't turn around and say you fell in the pool all by yourself.

consult experienced local counsel, and do what he or she says, because THAT'S WHAT LAWYERS ARE FOR.
posted by bruce at 12:51 PM on September 4, 2013 [3 favorites]

nthing talking to your lawyer(s) first. There may be things that you shouldn't say when you talk to Friend & Wife.

A couple of other things before you talk to Friend & Wife about this:

1. Homeowner's policies have limits. What will you do if Friend & Wife's homeowners policy will not cover the full extent of your injury/lost wages? Would you expect them to cover the rest? What if it bankrupts them? If this were me, the answer to those questions would change based on which of my friends was involved here. You may want to have the answer to that question prepared before you talk to Friend & Wife. But it may or not be a good idea to share it with them yet.

2. Suing their "homeowner's policy" really involves suing Friend & Wife. Depending on their policy language/jurisdiction, Friend & Wife might be called to testify against you in court. Be prepared for this. Also be prepared for them being told by their lawyers/their insurance companies' lawyers that they cannot continue to be friends with you while this is being resolved.

I'm sorry that this happened to you, but remember that this really was Wife's fault.
posted by sparklemotion at 12:53 PM on September 4, 2013 [3 favorites]

This is not relevant to whether OP files a claim. There are deductibles, copays, yearly caps, etc. Once the insurance companies have duked it out, OP's health insurance company may pay part of the medical costs, but the homeowner's liability insurance should at a minimum cover deductibles and copays and ensure that OP is not put into a bad position by any yearly cap.

I didn't say it was relevant to whether the OP files a claim. I'm asking for clarification to get a better sense of what the financial burden is likely to be, as that may affect the OP's options and approach.
posted by scody at 1:05 PM on September 4, 2013

Here's a very similar situation that came up here last month.

If you have health insurance, they might actually require you to file a claim against your friends’ home insurance. If so, you can just explain that this is a required part of the insurance process, not your personal choice.
posted by mbrubeck at 1:12 PM on September 4, 2013

This is the reason people have insurance. Their homeowners insurance should/will cover expenses, that's the whole point of it.

What to me is concerning is the thought that you might lose a friendship over this. Your friendship should have nothing to do with the injury, and everything to do with the prank. If you weren't hurt, would the prank cause you to not be their friends? If so, there's your answer. If not, than why would the injury change things? It was an accident, they did not mean to hurt you, if they know it would hurt you they wouldn't have done it.

Similarly, having to file a claim with their insurance should have nothing to do with your friendship. You are going to be hurt financially, and any friend would gladly do what it takes to help fix that. They may not be in a position to pay your costs, but their insurance is. If my friend were hurt on my property, I wouldn't think twice about calling my insurance to get it paid for.

It is unfortunate that this happened, but you are wrapping two different things (friendship and the insurance/money/etc.) into one question. By keeping these two things separate, it will be easier to figure out how it should be approached.
posted by markblasco at 1:42 PM on September 4, 2013 [6 favorites]

You can be sure that if your friend and/or their insurance are called upon to pay for your injuries, they'll question why you walked to the car, why you waited until Tuesday to see a doctor, etc. Your friendship may or may not survive this but that's totally irrelevant. You're injured & it has & will affect your ability to earn. I'm not a stick-it-to-em kind of person, but this is a big deal and your health, earning potential, and family's financial stability have to take precedence over anything else. You're in lawyer territory.
posted by headnsouth at 1:51 PM on September 4, 2013 [1 favorite]

You can be sure that if your friend and/or their insurance are called upon to pay for your injuries, they'll question why you walked to the car, why you waited until Tuesday to see a doctor, etc.

You could also be questioned about things you said to your friends. Perfectly nice things you say to try to make them feel better about the incident could be twisted and used against you. You don't have to be rude or unkind to your friends, but you should discuss this with a good lawyer before having a conversation with them.
posted by Area Man at 1:54 PM on September 4, 2013 [6 favorites]

This is so rotten for you and I hope you're well soon. Your insurance company or the hospital is going to ask you how you were injured, and they're likely to seek reimbursement from your friends' homeowner's insurance. So load the blame on the insurance companies. Call your insurance company to verify coverage for injury and to ask about coverage for lost pay. They're going to ask for information about the accident and where it happened. Then you can call your friend and say your insurance company is likely to contact their insurance company, and share your feeling of awkwardness about it, as well as informing them that this is happening. This may affect their coverage, which is unfortunate, but also a consequence of a prank gone haywire. If your friends don't express serious concern for your health, and bring baked goods, liquor, etc., I would wonder about the friendship. You should have all medical bills paid and lost wages reimbursed. Your insurance company should be able to help you with everything. It will be awkward, but surely you and your friends are awesome people, and will get over it.
posted by theora55 at 2:30 PM on September 4, 2013

If you have health insurance, they WILL go after your friend's homeowners. If you don't, and are paying out of pocket, it's simply not reasonable on their part that they would not be expected to stand a claim on account of this. If a guest of mine were injured in this way, I would be taking the lead in making sure their needs were covered.

I would present it to them as a problem that has to be faced up to and solved. Whether it turns adversarial is up to them.

As to whether it goes to court, on the one hand things like this are settled without involving courts every day, but in any communication you should still have it in the back of your mind "this could go to court," because that is part of the odds the insurance company is playing against.
posted by randomkeystrike at 2:33 PM on September 4, 2013

I ended up getting asked to rephrase my post, but i'm entirely with bruce on this.

This is not how adults act, and there is an undercurrent of bully-like hostility, agression, and childish acting-without-thinking to this action.

You should not feel at all bad about going "hey, this is your fault, own up to it". Don't try and sugar coat the call not only because of the issues with that Area Man brought up, but because they don't deserve it. Friends do not treat friends this way. This would be unacceptable behavior for a 12 year old.

Put your health before a friendship with someone who honestly probably isn't even that much of your friend if they treated you this way. Every time you think of slow-pedalling any sort of response to them remind yourself "would i treat a friend this way?" because this sounds an awful lot like what a kid would do to another kid they didn't really like that much in a teasing way.

And all that said, i wouldn't say anything to them unless they contacted me at this point. And even then, i'd keep it very short. I'd be talking to a lawyer and seeing what my options were before i even did.

This is the kind of injury that could screw up your mobility for the rest of your life, and leave you with fairly constant twinges and aches even if you were my age. This goes way, way beyond "haha oops you spilled wine on my favorite shirt" or even "you tossed a bottle at the recycling and it bounced and gave me a huge bruise" for a multitude of reasons, and i think you know that.

Really, read the line in bruces post about embarrassment over and over until it sinks in. Your attitude about this is way more calm and cowing than it should be towards someone who did something thoughtless and hostile out of nowhere. Right now they don't know what really happened, but i'd honestly doubt they're going to step up to the plate and own up to it without someone twisting their arm when they do.

Insurance, then lawyer. Do not pass go, do not collect $200. Trying to hash it out with them may very well screw you later and will also likely result in even more minimizing and questioning of your story and the facts than you'll get in court.

i'm trying my hardest, by the way, to not bring a bunch of personal history or specific stories in to this post... but i've seen these types of situations play out many times including when real injury was involved. No one has ever "stepped up".
posted by emptythought at 2:36 PM on September 4, 2013 [3 favorites]

His wife pushed you. Don't worry about the friendship, I'm sure even HE knows how stupid his wife was in pushing you.
posted by driedmango at 4:09 PM on September 4, 2013 [1 favorite]

I'm not necessarily adding to the answer here, but my understanding with the affordable care act is that you can't be turned down for a preexisting condition. Enrollment starts in a month and coverage starts on the first of the year. If you're looking at a $50,000 bill, is there a possibility of putting off surgery until early in the year? There are probably things I don't understand, but it's what I read about ACA.

And yeah, you're almost certainly going to lose the friendship when you go after their homeowner's insurance for the money. Be as nice as you can, but don't expect the friendship to last.

Edit: And it was the wife's stupid action that led to this, but their position is going to be that the enormous expense is because you didn't bother to purchase health insurance. I'm not saying they're right or that it should change anything you do, but that's probably what they're going to think.
posted by cnc at 5:33 PM on September 4, 2013

Yeah, talk to your lawyer first. Don't even think about making a large financial sacrifice for these people. Maybe your friendship will survive but that is likely outside your control. I have a feeling the wife may actually have more trouble remaining friends with you than the other way around; seeing you will remind her of what she did. (If she's so boorish that she didn't think she did anything bad, well then screw her.)
posted by BibiRose at 6:30 PM on September 4, 2013

Response by poster: I have decent health insurance....(I probably should have stated that in my question...) Yes, I probably ought to be concerned about yearly (and lifetime) maximums.

I'm likely out a month of freelance work (maybe more like 2 months - one month off my feet is going to equal regular PT no matter what.) And if I re-injure (with or without surgery) or develop arthritis in that knee....

I spoke to him tonight to tell him...but I didn't bring up anything else yet beyond that I got injured pretty seriously; I didn't think it'd be right for them to find out over facebook or via friend in the middle.

While they knew I left limping, they probably weren't prepared for this at all, especially because his wife is tiny (100lbs?) and I'm 250.

I want to think and mull on all of this more; I just told the guy; I may talk to him more after the next doctor appt and break down some costs; I have a Lawyer in the wings ready to send a letter asking for his homeowner's policy number and go down that route; I'm waiting to see if they call/email/etc.

(I'm totally taking Bruce's and emptythoughts advice here.) I'm embarrassed by the whole situation; although, I very much needed to hear about my long term consequences too, as I sit here with an ice pack on my knee and try to keep any weight off my leg. It's only really day 3 of this; and I'm due to see the doc again on monday.
posted by Towelie at 7:19 PM on September 4, 2013

Response by poster: Ah, the mention of the cost is what made people infer that I didn't have coverage. While I have excellent coverage, that's not the point - it's still 30-60k not including all the stress in my life. My wife and I are already under enough stress with a toddler.
posted by Towelie at 7:21 PM on September 4, 2013

From what I understand about the American health insurance situation, you don't actually have a choice to make here anyway. Your health insurance will go after their home insurance to reimburse their costs even if they don't require you to do this personally.

I'm sorry about your knee. My husband got a meniscus tear from ice hockey at age 19 and has had to have four surgeries over the years, has developed arthritis in that knee, and still has limited mobility now at age 42. (His doctor tells him not to run, bicycle, ski, or play sports, and to avoid walking as much as possible. But you can imagine that he didn't really heed that recommendation when he was in his twenties.) He will probably have to have a knee replacement at some point.

I am not saying yours will turn out so badly - in fact one of the main reasons he had so much trouble is that he didn't get the tear treated promptly at the time. But I'm mentioning it so you know that the immediate costs might not be the end of the story, so there's even more need to make sure you aren't paying out of pocket.
posted by lollusc at 9:18 PM on September 4, 2013

I sufferred a compression fracture in the bow of a friends boat. I ended up suing his insurance company after they refused to discuss covering my 10% copay.

He and I were clear that even though the suit was brought against him, it was really his insurance company that I was suing.

We are still friends. He gave me a toy boat for my birthday.
posted by cairnoflore at 12:01 AM on September 5, 2013 [4 favorites]

"... While I have excellent coverage, that's not the point - it's still 30-60k not including all the stress in my life. ..."

It may be "30-60K" if everything goes your way during treatment. Or, you could have any number of complications during treatment, which could adversely affect your life and future income, either for some longer period of time than you anticipate, or for life. Don't be too quick to be too positive in thinking about your situation.

"... I have a Lawyer in the wings ready to send a letter asking for his homeowner's policy number and go down that route; I'm waiting to see if they call/email/etc. ..."

You'll be a lot smarter about your situation in a few weeks, but whatever you do in the meantime, hire a reputable personal injury lawyer, and let them handle all communications about this situation, until that lawyer, who will be bound by your client relationship to seek your best interests, says otherwise. Thinking you have a lawyer "in the wings" while you make phone calls and statements to "friends" in a situation like this is a fool's course.
posted by paulsc at 12:52 AM on September 5, 2013 [2 favorites]

If it was me, I would probably search my memory a little harder and make sure I wasn't remembering it wrong. Am I sure she pushed me, or did we just sort of bump into each other and then I tripped? Because their insurance probably does not cover them for deliberate acts. And since there obviously wasn't intent to injure you, framing the story as you did here to a lawyer will likely send you down a path that would mean you will end up suing your friends for their house.

I value my friendships more than that. YMMV.
posted by gjc at 1:10 AM on September 5, 2013 [3 favorites]

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