What if he doesn't want them to pay his medical bills?
November 2, 2014 12:33 PM   Subscribe

Looking for someone who's had this experience to tell me the end of your story: you injured yourself (through personal clumsiness) while at a friend's house, your health insurance paid for your ER visit. Your insurance company asks you "where did this accident occur?" and you reply... something... in the hopes that neither your friend nor your friend's property insurance is held liable.

The health insurance form is specifically a request for information about the accident so that the insurance company can try to pass the costs along to a different party's insurance, options including things like malpractice, workplace injury, etc as well as the two relevant choices: "injury occurred at home" and "injury occurred on property owned by another party". In either case, there's a paragraph space to describe how it happened; in the second case, you must give address and contact info for the property owner.

Have you ever filled out such a form?
If you selected the not-home option, what kind of accident was it and did they contact your friend?
If you selected the at-home option, was there ever a request for verification or a cross-matching with what story you may have told the ER doctor?

Challenge mode: not black and white whose fault it would be if a claim were pressed, e.g. trip and fall over own feet while in the woods on their property, an imperfect dimly lit path.
posted by aimedwander to Law & Government (12 answers total)
I have not been a patient, but I am a homeowner who had a friend injured on my property. We filed a claim with our homeowners insurance to cover her expenses. The expense and bother were negligible. This is what insurance is for.
posted by bq at 12:43 PM on November 2, 2014 [1 favorite]

Best answer: I've filled out such a form... a bunch of times. It really is true when they say most accidents happen at home. Fortunately (?) they happened at my home, so my medical insurance decided not to subrogate my homeowner's insurance.

And when an accident happened neither at my home nor on someone else's private property, I indicated this on the form as well. You have to fill out those forms completely, but answering "I don't know" to a question counts as a complete answer.
posted by infinitewindow at 12:44 PM on November 2, 2014

I would probably say the injury happened at home unless it was a very specific circumstance where it had to have taken place on a friend's property. Like if you fell out of a tree and you have no trees at home, hm, better just own up to it. (Though you could probably say the tree was in a park or something and nobody would care.) But what's the difference between cutting yourself chopping vegetables in your kitchen vs. a friend's kitchen?
posted by Sara C. at 12:45 PM on November 2, 2014 [1 favorite]

Your insurance contract will require you to provide the information requested to your insurance provider. Insurance providers have the right of subrogation and it will be guaranteed by both state law and your insurance contract. If you lie on this form, you will be committing insurance fraud. No one here can/should be telling you to lie to your insurance company, since it is both illegal and raises insurance rates for everybody (your insurance rates assume subrogation will happen when possible; if it doesn't happen, your insurance company has to increase your rates to compensate).

Do note that simply asking for this information in no way implies that any subrogation will actually happen. Your friend's homeowner's insurance equally has an interest in paying your health insurance company nothing, so any subrogation claim made by your health insurance company has to be sufficiently clear to win in court. If there really is no clear at-fault party here, your insurance company will likely not bother, since they'd be wasting their lawyers' (valuable) time.
posted by saeculorum at 1:12 PM on November 2, 2014 [4 favorites]

It appears you're asking for advice about lying to the insurance company which, if you haven't totally thought it through, is illegal, unethical and, just prudentially, a bad idea.
posted by jayder at 5:05 PM on November 2, 2014 [7 favorites]

A friend of mine in a very similar circumstance told her insurance company that her injury happened in a nearby city park. I'm not advocating lying though.
posted by yellowcandy at 5:10 PM on November 2, 2014

Disregard Sara C's advice. Don't commit insurance fraud.
posted by ewiar at 6:11 PM on November 2, 2014 [5 favorites]

Before deciding not to tell the insurance company the truth, you should look into whether that would be insurance fraud.
posted by J. Wilson at 6:58 PM on November 2, 2014 [1 favorite]

Best answer: I slipped and fell in a stairway at school. I just said so on the form and nothing can from it. If it happened at a friend's house, I would be accurate but make it clear that it was just accident and not the homeowner's fault. For example: "Wasn't careful enough in the dark and took a wrong step walking down a path at night." And maybe add "No negligence on the homeowner's part."
posted by metahawk at 9:36 PM on November 2, 2014 [2 favorites]

If anyone answering you had identified any expertise than I would listen to them else I'd say your on your own. Logic, (which does not always attend,) would seem to argue that if there was no negligence on your friends part and you infact claim it was your own clumsiness than there shouldn't really be any liability for them. I would imagine, ( I have no expertise remember,) that subrogation of homeowners is much less of an issue than determining if you had an accident at work as personal health insurance in my limited experience expressly does not cover this.
posted by Pembquist at 10:08 PM on November 2, 2014

Yes, I have done this twice. Once I fell and broke my leg while inside a building where I don't live. The medical costs were significant. My insurance paid. They wanted to know who they could subrogate. I gave them the address but truthfully said I didn't know who owns the building. Couldn't tell you what happened after that. Maybe they investigated for code violations and sued, maybe not. But I had letter after letter for several years afterward asking me for the name of the apartment building owner. I always answered "please check the tax records, as I have no way of finding out other than myself checking the tax records."

The second time, my house caught on fire. My insurance company let me know a condition of payment for repairs and hotel costs for 3 months was cooperating with their investigation into how they might recoup their costs. I got subrogation questionnaires for a few years after the fire; they even sent an arson investigator. A few months later I inquired about the outcome and was told it's not my business. I assume they sued the dryer manufacturer and possibly the handyman who claimed to have fixed it before I moved in.

Every communication I received about subrogation came from law firms acting on behalf of my insurance companies. I wouldn't have dreamed of lying on those forms lest I myself be sued into the 22nd century, or risk having my claims go unpaid. I think you should assume a law firm is willing to check your ER story. I think you should tell the truth.
posted by ImproviseOrDie at 1:11 AM on November 3, 2014

Best answer: The purpose of these questions is to flag situations in which a lawsuit or a claim under med pay coverage might be made by the injured person. In that case, the health insurer will want its money repaid out of what the injured person receives.

The health insurer theoretically can, but usually does not, assert a claim in its own right, or as subrogee (substituting for the injured person), if the injured person does not make a claim.

A lot depends on how extensive and expensive the treatment is, and of course the rules can vary by state.
posted by yclipse at 4:54 AM on November 3, 2014 [1 favorite]

« Older Mattress Missteps: Is Ikea the Answer?   |   winterize my windows please! Newer »
This thread is closed to new comments.