QUESTION
Can I collect my deductibles and out of pocket expenses from a hospital after an accident in their premises?
Asked on Nov 20th, 2013 on Personal Injury - Michigan
More details to this question:
I was injured in a fall when I stepped off a parking lot curb near the front door of a hospital and my foot slipped on a hole in the pavement. Nothing broken, but it was a severe sprain and I have to wear an air cast and use crutches for a few weeks. I just want to collect my deductible and out of pocket expenses (including some limited loss of work) from the hospital. That's all I want: my work health insurance covered the bulk of the medical bills and I have a good relationship with the hospital (we use it regularly for my wife's cardiac treatment). But my health insurance company is asking questions about the injury, obviously thinking that they want to recover their expenses from the hospital's insurance. Does my quest to get reimbursement of deductibles and out of pocket expenses trigger any obligations on my part to my health insurance company? Do I need to coordinate anything through them as I seek a settlement from the hospital?
9 ANSWERS
Personal Injury Attorney serving Charlotte, NC
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Paul Whitfield and Associates P.A.
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Don't do things half way If the hospital has a major defect in the area then they are liable for all your damages. See a good lawyer. if the matter is minor and you may not be able to make a liability case the hospital may have medical payments coverage. If you have not asked, ask the hospital claims dude.
Answered on Nov 26th, 2013 at 9:04 AM
Ronald A. Steinberg
If you can satisfy the law of your state to prove the responsibility of the hospital for your accident, then you are entitled to collect the reasonable value of all necessary expenses that resulted from their negligence.
Answered on Nov 22nd, 2013 at 11:46 AM
James Eugene Hasser
Yes and yes to the question detail questions. As to your main question, your insurance company is entitled to get its money back out of any settlement with the hospital. You can't just get your deductibles and out of pockets unless the hospital agrees to take care of your insurance carrier separately or they agree to waive their lien. Hope that helps. Good luck.
Answered on Nov 22nd, 2013 at 10:55 AM
1 Award
If you recover compensation from the hospital on the theory the hospital's negligence caused your injury, your health insurer would be entitled to recover the bills it paid as a result of the hospital's negligence. So, yes, the health insurer has a claim in your case.
Answered on Nov 22nd, 2013 at 10:54 AM
Chapter 7 Bankruptcy Attorney serving Syracuse, NY
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Andrew T. Velonis, P.C.
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Good questions all: yes, your health insurance carrier wants to recoup its costs and they want a free ride from you to do it. So, if you do make a liability claim, the health insurance carrier will demand that it gets paid first. The hospital's liability carrier will be aware of this, so they will make sure that the other insurance company gets taken care of. But of course, you have to do all the work, pay for an attorney, negotiate the claim, etc. Finally, a medical liability carrier will fight every claim as if it is the worst claim they've ever had to fight: they will deny, delay, stonewall, throw technicalities, demand extraneous information and gin up defenses that don't make any sense but you will have do deal with anyway.
Answered on Nov 22nd, 2013 at 10:54 AM
You have to read your health insurance policy as to subrogation recovery as to what they require. Normally, if you collect anything they would have the right to go after you unless you were careful to make the settlement state that it is for expenses not covered by your insurance. You probably have a duty to co-operate with them, which would include reporting any tort claim to them. It should not effect your relationship with the Hospital, as the medical suppliers have n connection with the staff handling claims for injuries outside the hospital building. But the might not accept liability so you need to take pictures of the defect and how you stepped into it to give to them.
Answered on Nov 22nd, 2013 at 10:54 AM
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Your insurance policy probably has a subrogation claim which gives them the right to reimbursement in the amount expended on your behalf from any judgment or settlement that you receive form the hospital. Bottom line, you have to obtain enough of a settlement to pay the Health insurer back and to collect your deductible and out-of-pocket expenses.
Answered on Nov 22nd, 2013 at 10:53 AM
Criminal Defense Attorney serving Anderson, SC
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The David F. Stoddard Law Firm
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Yes, your quest for reimbursement will trigger an obligation to reimburse the insurer. It has a subrogation interest against any claim because recovery of your medical bills that they paid is a part of the claim and most health insurance policies state that you must reimburse them if any third party (the hospital) is liable for your injuries. You may want to contact the appropriate person for the health insurer and ask if they would agree to split any settlement with you 50/50, up to the amount of their subrogation interest. Advise them that otherwise you will not pursue it as there would be nothing in it for you.
Answered on Nov 22nd, 2013 at 10:53 AM
Appellate Attorney serving Grosse Pointe Farms, MI
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Musilli Brennan Associates, PLLC
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As you have figured out, this is a not more complex than a simple claim. Have you noticed the hospital? Yes, there should be reimbursement to your health insurance carrier.
Answered on Nov 22nd, 2013 at 10:53 AM