Woman sues nephew for $127K after she fell at his 8th-birthday pa (1 Viewer)

[Ookie Pringle]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant. But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

wellshe did have a choice, pay her own medical bills rather than sue her nephew

So does anyone know if her health insurance company paid her medical bills or did they deny the claim?

 

[thecatch]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant. But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

This and Mr. Ford's posts assume there is a reasonable basis for holding a 8 year old liable in tort for jumping into his family member's arms. That causes me to raise my eyebrows but it could be that there is some sort of authority supporting that proposition, in which case I fully agree with you guys. If there's not, then we're closer to the "frivolous" side of the ledger.

Well, sure. Jumping into people's arms can cause injury. Whether or not that person is related to you doesn't actually change whether or not that person gets injured. It's negligent to launch yourself into someone else's arms without warning because of the aforementioned possibility of causing injury. Connecticut law holds that an 8-year-old can be held liable for negligence, but that there's a lower standard of care. The standard is:"That care which an ordinary prudent child of the same capacity to appreciate and avoid danger of injury would use under similar circumstances" or "such care as may reasonably be expected of children of similar age, judgment, and experience" where judgment is considered the ability to "discretion to heed and power of self control."

So the question for the jury was twofold:

What is the capacity to appreciate and avoid danger of injury of this child based on his age, intelligence, and experience; and

Was launching himself into his 50-year-old aunt's arms consistent with that capacity?

Sounds like the jury decided. But those are complex questions, and could have come out the other way.

Ok, so I mean, they *could* have come out the other way, but given the facts was it reasonable to believe they could have? Is there precedent for that kind of finding under similar circumstances? These questions go to the wisdom of the suit more so than whether it was frivolous, so I probably shouldn't have even used that word tangentially. It just strikes me as a very questionable decision to bring the suit in the first place because the odds of finding an 8 year old negligence on the reported facts seem silly, and open up your client to the kind of online scorn she's apparently receiving.

If it could have, it's reasonable to believe it could have.

What the jury could done as a technical matter /= reasonable expectation, IMO.

So you're wondering about a reasonable expectation or belief that the jury would come out on her side? A reasonable expectation of success is a very high bar to set for frivolous lawsuits. Ridiculously high.

As explained a couple posts ago, I'm not saying that at all. Wouldn't call it frivolous absent authority barring relief. Doesn't mean it wasn't a questionable decision to pursue the case in the first place, which is where I am going with my line of thought.

 

[Henry Ford]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant.

But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

well

she did have a choice, pay her own medical bills rather than sue her nephew

I'm sure she had $40-50K lying around in the couch cushions for the surgeries that have already happened, and another $20K or so in a cookie jar for the remaining one.

 

[Doug B]

Congratulations. You've induced an insurance company to pay a claim based on a fraudulent misrepresentation. How does a few years in prison sound?

They are not clairvoyant. They do not put people in interrogation rooms and play good cop-bad cop for 12 hours. They do not waterboard.

They cannot ever hope to prove it. Of course, the patient must use good sense, no bragging, no details to friends and family, etc. Would an insurance company rep even go around asking family and friends about it?

Aside: I wouldn't call it "fraudulent" unless there was no injury at all. I realize that's not the law.

 

[Henry Ford]

Well, with hindsight ... the aunt probably could have told the first medical professional that she hurt her wrist in her own home. Or out on her sidewalk or something.

Man, this case is so weird and compelling. Hope more details come out eventually.

Right. And if she gets found out doing that, she's guilty of insurance fraud.

How is that insurance fraud? Did I commit fraud when I took my son to the emergency dept and used my insurance?

Because she lied about what happened in order to induce her insurance company to pay benefits. How is that not insurance fraud?

If she said she fell and broke her wrist, that's insurance fraud?

If she said it happened at home or on the sidewalk, yes.

 

[Hang 10]

Why didn't her medical insurance pay her medical bills like any other accident?

They thought they could go after the homeowners insurance for it since it happened at their house?

Whether her insurance company thought they could get money from the homeowners or not, how could they deny a legit claim for her wrist surgeries?

 

[Henry Ford]

As explained a couple posts ago, I'm not saying that at all.

It's unclear. Is it reasonable to believe that it could have? Given that it could have? Yes. Is it reasonable to believe that it would in this case? That's a different question. Which one are you asking.

 

[Ookie Pringle]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant. But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

By who? I doubt she was offered $1 from her medical insurance carrier. They likely paid those medical bills just like it would have paid for any other medical claim. She likely went after the homeowner's policy, and from them was offered the $1. I very much doubt that she was only offered $1 in total from all insurance companies for all of her bills. The statement from the lawyer is very clear - the case was about getting medical bills paid by the homeowners policy. Why should they pay? Why didn't her health insurance carrier pay them?

By the defendant. In an Offer of Compromise on April 1, 2014. It's in the docket.Her health insurance wouldn't pay if there's a tortfeasor (in this case, the 8 year old) who should be legally obligated to pay them. With a judgment against her, she's likely going to get them paid now if that's why the suit was brought.

Isn't the health insurance carrier obligated to pay and then subrogate in this situation? They can't determine guilt of that boy when she is getting treatment. It is her word against someone elses.

 

[matttyl]

They thought they could go after the homeowners insurance for it since it happened at their house?

Man, you have to be right about this. Just seems like the aunt's medical insurance company should have known such a case was pretty much unwinnable. How do you make a child the defendant without prejudicing the case? Did the legal tack they took really seem like it could sway jurors?

I guess it was a Hail Mary, and if it doesn't work, oh well ... we're no worse off than if we hadn't sued.

How did the aunt's insurance get involved at all? If she would have presented at the emergency dept with the injury, her insurance would have had no way to know where the accident happened. The aunt's insurance company only gets a UB with various codes. The aunt decided to sue herself.

Health care providers ask you to tell them what happened before you even see a doctor these days. One of the reasons is that your insurance won't pay for a number of things, particularly if there's what they consider to be a "primary insurance" (tortfeasor, other policy that should pay, etc.) The healthcare provider doesn't want to get stuck with the bill. And they won't see you until you work it out. Remember - this wasn't a life-threatening emergency. And even then, if they treat you, they send all your information (yes, often codes) to the insurance company. Those codes generally identify how things happened. For instance, E8120 - motor vehicle accident. Your health insurance may refuse to pay, based on it being a MVA, until liability is established. Happens a lot.

For instance - when you go see a specialist, they'll always ask you "is this a worker's comp claim?" If it is, they need to discuss it with comp before you go in.

But this in no way was worker's comp - and they don't have a code for "broke wrist cause nephew jumped in her arms" it would have been "broken wrist." I've broken both of my wrists. One falling out of a tree when I was very young - one playing rugby in college. In the later, they never went after the school's policy or the other team's policy.

 

[Henry Ford]

Congratulations. You've induced an insurance company to pay a claim based on a fraudulent misrepresentation. How does a few years in prison sound?

They are not clairvoyant. They do not put people in interrogation rooms and play good cop-bad cop for 12 hours. They do not waterboard.

They cannot ever hope to prove it. Of course, the patient must use good sense, no bragging, no details to friends and family, etc. Would an insurance company rep even go around asking family and friends about it?

Aside: I wouldn't call it "fraudulent" unless there was no injury at all. I realize that's not the law.

Well, as long as they can't prove it, you're not a criminal, right?

 

[Ditkaless Wonders]

Congratulations. You've induced an insurance company to pay a claim based on a fraudulent misrepresentation. How does a few years in prison sound?

They are not clairvoyant. They do not put people in interrogation rooms and play good cop-bad cop for 12 hours. They do not waterboard.

They cannot ever hope to prove it. Of course, the patient must use good sense, no bragging, no details to friends and family, etc. Would an insurance company rep even go around asking family and friends about it?

Aside: I wouldn't call it "fraudulent" unless there was no injury at all. I realize that's not the law.

Are you contemplating going down the road of defending the morality of insurance fraud in a thread about impugning the moral compass of others, specifically lawyers?

 

[CletiusMaximus]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant. But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

wellshe did have a choice, pay her own medical bills rather than sue her nephew

So does anyone know if her health insurance company paid her medical bills or did they deny the claim?

The lawyer's statement seems oddly vague on that point. From experience, in some cases the health insurer will pay for a major surgery, but then deny the additional therapy or follow-up procedures they deem not medically necessary. Perhaps that is the case here.

 

[Doug B]

Because she lied about what happened in order to induce her insurance company to pay benefits. How is that not insurance fraud?

Not to speak for James Daulton ... but if I am following him right, he took his kid to the ER after a bad fall at another child's birthday party. He did not volunteer where the injury happened, he just presented his child with an injury. Was he commiting fraud not to volunteer details about how and where the injury happened?

 

[Henry Ford]

They thought they could go after the homeowners insurance for it since it happened at their house?

Man, you have to be right about this. Just seems like the aunt's medical insurance company should have known such a case was pretty much unwinnable. How do you make a child the defendant without prejudicing the case? Did the legal tack they took really seem like it could sway jurors?

I guess it was a Hail Mary, and if it doesn't work, oh well ... we're no worse off than if we hadn't sued.

How did the aunt's insurance get involved at all? If she would have presented at the emergency dept with the injury, her insurance would have had no way to know where the accident happened. The aunt's insurance company only gets a UB with various codes. The aunt decided to sue herself.

Health care providers ask you to tell them what happened before you even see a doctor these days. One of the reasons is that your insurance won't pay for a number of things, particularly if there's what they consider to be a "primary insurance" (tortfeasor, other policy that should pay, etc.) The healthcare provider doesn't want to get stuck with the bill. And they won't see you until you work it out. Remember - this wasn't a life-threatening emergency. And even then, if they treat you, they send all your information (yes, often codes) to the insurance company. Those codes generally identify how things happened. For instance, E8120 - motor vehicle accident. Your health insurance may refuse to pay, based on it being a MVA, until liability is established. Happens a lot.

For instance - when you go see a specialist, they'll always ask you "is this a worker's comp claim?" If it is, they need to discuss it with comp before you go in.

But this in no way was worker's comp - and they don't have a code for "broke wrist cause nephew jumped in her arms" it would have been "broken wrist." I've broken both of my wrists. One falling out of a tree when I was very young - one playing rugby in college. In the later, they never went after the school's policy or the other team's policy.

UB Occurrence Code 03 - accident, tort liability. "My nephew knocked me down and my wrist hurts" should lead to this code.

 

[B-Deep]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant.

But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

By who? I doubt she was offered $1 from her medical insurance carrier. They likely paid those medical bills just like it would have paid for any other medical claim. She likely went after the homeowner's policy, and from them was offered the $1. I very much doubt that she was only offered $1 in total from all insurance companies for all of her bills.

The statement from the lawyer is very clear - the case was about getting medical bills paid by the homeowners policy. Why should they pay? Why didn't her health insurance carrier pay them?

By the defendant. In an Offer of Compromise on April 1, 2014. It's in the docket.

Her health insurance wouldn't pay if there's a tortfeasor (in this case, the 8 year old) who should be legally obligated to pay them. With a judgment against her, she's likely going to get them paid now if that's why the suit was brought.

something seems amiss

i've had my kids get hurt multiple times due to actions of other kids and never has a medical insurance company sought more info to litigate with the home owners

it does make sense if she went through homeowners insurance instead. It makes sense if she saw a lawyer and he said "their homeowners insurance should pay it, won;t impact you at all" and then this got out of control

if this was standard for the medical insurance industry I'd think we'd be seeing these all the time

 

[Henry Ford]

Because she lied about what happened in order to induce her insurance company to pay benefits. How is that not insurance fraud?

Not to speak for James Daulton ... but if I am following him right, he took his kid to the ER after a bad fall at another child's birthday party. He did not volunteer where the injury happened, he just presented his child with an injury. Was he commiting fraud not to volunteer details about how and where the injury happened?

Not if he didn't lie about it, unless he intentionally omitted information specifically to defraud the insurance company, which I doubt. I addressed your suggestion, which is absolutely insurance fraud.

 

[B-Deep]

They thought they could go after the homeowners insurance for it since it happened at their house?

Man, you have to be right about this. Just seems like the aunt's medical insurance company should have known such a case was pretty much unwinnable. How do you make a child the defendant without prejudicing the case? Did the legal tack they took really seem like it could sway jurors?

I guess it was a Hail Mary, and if it doesn't work, oh well ... we're no worse off than if we hadn't sued.

How did the aunt's insurance get involved at all? If she would have presented at the emergency dept with the injury, her insurance would have had no way to know where the accident happened. The aunt's insurance company only gets a UB with various codes. The aunt decided to sue herself.

Health care providers ask you to tell them what happened before you even see a doctor these days. One of the reasons is that your insurance won't pay for a number of things, particularly if there's what they consider to be a "primary insurance" (tortfeasor, other policy that should pay, etc.) The healthcare provider doesn't want to get stuck with the bill. And they won't see you until you work it out. Remember - this wasn't a life-threatening emergency. And even then, if they treat you, they send all your information (yes, often codes) to the insurance company. Those codes generally identify how things happened. For instance, E8120 - motor vehicle accident. Your health insurance may refuse to pay, based on it being a MVA, until liability is established. Happens a lot.

For instance - when you go see a specialist, they'll always ask you "is this a worker's comp claim?" If it is, they need to discuss it with comp before you go in.

But this in no way was worker's comp - and they don't have a code for "broke wrist cause nephew jumped in her arms" it would have been "broken wrist." I've broken both of my wrists. One falling out of a tree when I was very young - one playing rugby in college. In the later, they never went after the school's policy or the other team's policy.

UB Occurrence Code 03 - accident, tort liability. "My nephew knocked me down and my wrist hurts" should lead to this code.

has anyone here ever had this happen or heard of this happening to someone they know?

 

[Henry Ford]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant.

But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

By who? I doubt she was offered $1 from her medical insurance carrier. They likely paid those medical bills just like it would have paid for any other medical claim. She likely went after the homeowner's policy, and from them was offered the $1. I very much doubt that she was only offered $1 in total from all insurance companies for all of her bills.

The statement from the lawyer is very clear - the case was about getting medical bills paid by the homeowners policy. Why should they pay? Why didn't her health insurance carrier pay them?

By the defendant. In an Offer of Compromise on April 1, 2014. It's in the docket.

Her health insurance wouldn't pay if there's a tortfeasor (in this case, the 8 year old) who should be legally obligated to pay them. With a judgment against her, she's likely going to get them paid now if that's why the suit was brought.

something seems amiss

i've had my kids get hurt multiple times due to actions of other kids and never has a medical insurance company sought more info to litigate with the home owners

it does make sense if she went through homeowners insurance instead. It makes sense if she saw a lawyer and he said "their homeowners insurance should pay it, won;t impact you at all" and then this got out of control

if this was standard for the medical insurance industry I'd think we'd be seeing these all the time

I do.

 

[SWC]

so can the kid sue her now or what laywer brohans

 

[matttyl]

Well, with hindsight ... the aunt probably could have told the first medical professional that she hurt her wrist in her own home. Or out on her sidewalk or something.

Man, this case is so weird and compelling. Hope more details come out eventually.

Right. And if she gets found out doing that, she's guilty of insurance fraud.

How is that insurance fraud? Did I commit fraud when I took my son to the emergency dept and used my insurance?

If he's not on that insurance policy and they paid the claim, then of course you did.

 

[B-Deep]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant.

But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

By who? I doubt she was offered $1 from her medical insurance carrier. They likely paid those medical bills just like it would have paid for any other medical claim. She likely went after the homeowner's policy, and from them was offered the $1. I very much doubt that she was only offered $1 in total from all insurance companies for all of her bills.

The statement from the lawyer is very clear - the case was about getting medical bills paid by the homeowners policy. Why should they pay? Why didn't her health insurance carrier pay them?

By the defendant. In an Offer of Compromise on April 1, 2014. It's in the docket.

Her health insurance wouldn't pay if there's a tortfeasor (in this case, the 8 year old) who should be legally obligated to pay them. With a judgment against her, she's likely going to get them paid now if that's why the suit was brought.

something seems amiss

i've had my kids get hurt multiple times due to actions of other kids and never has a medical insurance company sought more info to litigate with the home owners

it does make sense if she went through homeowners insurance instead. It makes sense if she saw a lawyer and he said "their homeowners insurance should pay it, won;t impact you at all" and then this got out of control

if this was standard for the medical insurance industry I'd think we'd be seeing these all the time

I do.

where someone cannot get their medical bills paid by health insurance?

crazy

my kid was knocked off a bench by another kid and his arm broke, never had an issue

 

[Henry Ford]

UB Occurrence Code 03 - accident, tort liability. "My nephew knocked me down and my wrist hurts" should lead to this code.

has anyone here ever had this happen or heard of this happening to someone they know?

Didn't there used to be an emoticon with a guy raising his hand? I'm looking for it.

 

[Doug B]

Congratulations. You've induced an insurance company to pay a claim based on a fraudulent misrepresentation. How does a few years in prison sound?

Legally: any account other than detailed play-by-play (kid ran up, jumped at me, I caught him, I fell, etc,) is fraudulent?

What about a white lie? "After hugging, kid started to run off but I tripped on his foot?" So the basics of the locale are the same, but you frame the story to give the kid a pass? Or heck: "He hugged me, then I lost my balance?" She has an affirmative obligation to closely detail the kid's specific actions?

 

[Henry Ford]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant.

But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

By who? I doubt she was offered $1 from her medical insurance carrier. They likely paid those medical bills just like it would have paid for any other medical claim. She likely went after the homeowner's policy, and from them was offered the $1. I very much doubt that she was only offered $1 in total from all insurance companies for all of her bills.

The statement from the lawyer is very clear - the case was about getting medical bills paid by the homeowners policy. Why should they pay? Why didn't her health insurance carrier pay them?

By the defendant. In an Offer of Compromise on April 1, 2014. It's in the docket.

Her health insurance wouldn't pay if there's a tortfeasor (in this case, the 8 year old) who should be legally obligated to pay them. With a judgment against her, she's likely going to get them paid now if that's why the suit was brought.

something seems amiss

i've had my kids get hurt multiple times due to actions of other kids and never has a medical insurance company sought more info to litigate with the home owners

it does make sense if she went through homeowners insurance instead. It makes sense if she saw a lawyer and he said "their homeowners insurance should pay it, won;t impact you at all" and then this got out of control

if this was standard for the medical insurance industry I'd think we'd be seeing these all the time

I do.

where someone cannot get their medical bills paid by health insurance?

crazy

my kid was knocked off a bench by another kid and his arm broke, never had an issue

Most of the time, a stern letter does the trick. Sometimes I have to have a long conversation with an idiot and explain that they're going to get killed in court. On rare occasions, there's a genuine, bona fide coverage dispute and it leads to litigation.

 

[lod01]

UB Occurrence Code 03 - accident, tort liability. "My nephew knocked me down and my wrist hurts" should lead to this code.

has anyone here ever had this happen or heard of this happening to someone they know?

Didn't there used to be an emoticon with a guy raising his hand? I'm looking for it.

 

[matttyl]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant.

But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

By who? I doubt she was offered $1 from her medical insurance carrier. They likely paid those medical bills just like it would have paid for any other medical claim. She likely went after the homeowner's policy, and from them was offered the $1. I very much doubt that she was only offered $1 in total from all insurance companies for all of her bills.

The statement from the lawyer is very clear - the case was about getting medical bills paid by the homeowners policy. Why should they pay? Why didn't her health insurance carrier pay them?

By the defendant. In an Offer of Compromise on April 1, 2014. It's in the docket.

Her health insurance wouldn't pay if there's a tortfeasor (in this case, the 8 year old) who should be legally obligated to pay them. With a judgment against her, she's likely going to get them paid now if that's why the suit was brought.

The defendant was the child, correct? The statement said that she was offered $1 "by the insurance company." My question is what insurance company?

 

[B-Deep]

so HF, now that the case was lost her insurance has to pay it i assume?

 

[Officer Pete Malloy]

This could have all been avoided if the aunt had a CCW.

 

[Henry Ford]

Congratulations. You've induced an insurance company to pay a claim based on a fraudulent misrepresentation. How does a few years in prison sound?

Legally: any account other than detailed play-by-play (kid ran up, jumped at me, I caught him, I fell, etc,) is fraudulent?

What about a white lie? "After hugging, kid started to run off but I tripped on his foot?" So the basics of the locale are the same, but you frame the story to give the kid a pass? Or heck: "He hugged me, then I lost my balance?" She has an affirmative obligation to closely detail the kid's specific actions?

No, any account that intentionally attempts to get an insurance company to pay a claim that they're not legally obligated to pay is insurance fraud.

 

[Henry Ford]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant.

But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

By who? I doubt she was offered $1 from her medical insurance carrier. They likely paid those medical bills just like it would have paid for any other medical claim. She likely went after the homeowner's policy, and from them was offered the $1. I very much doubt that she was only offered $1 in total from all insurance companies for all of her bills.

The statement from the lawyer is very clear - the case was about getting medical bills paid by the homeowners policy. Why should they pay? Why didn't her health insurance carrier pay them?

By the defendant. In an Offer of Compromise on April 1, 2014. It's in the docket.

Her health insurance wouldn't pay if there's a tortfeasor (in this case, the 8 year old) who should be legally obligated to pay them. With a judgment against her, she's likely going to get them paid now if that's why the suit was brought.

The defendant was the child, correct? The statement said that she was offered $1 "by the insurance company." My question is what insurance company?

Homeowners.

 

[matttyl]

I'm sure she had $40-50K lying around in the couch cushions for the surgeries that have already happened, and another $20K or so in a cookie jar for the remaining one.

Again, do we know that her health insurance carrier never paid??? The suit was about getting the homeowner's policy to pay.

 

[James Daulton]

Ok, so maybe I don't know as much about hospital billing as I thought. I just asked our director of patient accounting about this case. She said that anyone presenting at a medical facility will be asked how the accident happened, and a code (much like the one HF noted) accompanies all UB92s to the insurance company. The insurance company will pay my hospital but they then run a scan for all claims with an accident code, and generate a letter to their insured for details on how the accident happened to determine if subjugation is necessary.

So the insurance company could very well initiated the suit.

So, my bad.

 

[Henry Ford]

so HF, now that the case was lost her insurance has to pay it i assume?

If this was about the health insurance not paying, and if the health insurer doesn't require her to appeal, then they should.

She may actually be an unrepentant scumbag who is doing this of her own accord. That's still on the table.

 

[Henry Ford]

Ok, so maybe I don't know as much about hospital billing as I thought. I just asked our director of patient accounting about this case. She said that anyone presenting at a medical facility will be asked how the accident happened, and a code (much like the one HF noted) accompanies all UB92s to the insurance company. The insurance company will pay my hospital but they then run a scan for all claims with an accident code, and generate a letter to their insured for details on how the accident happened to determine if subjugation is necessary.

So the insurance company could very well initiated the suit.

So, my bad.

If we would just use this term, it would be more accurate and people would understand it better.

 

[Ookie Pringle]

so HF, now that the case was lost her insurance has to pay it i assume?

If this was about the health insurance not paying, and if the health insurer doesn't require her to appeal, then they should.She may actually be an unrepentant scumbag who is doing this of her own accord. That's still on the table.

I find it hard to believe her health insurance company didn't pay her medical bills.

 

[Doug B]

Are you contemplating going down the road of defending the morality of insurance fraud in a thread about impugning the moral compass of others, specifically lawyers?

Not me.

But seriously ... the system (law, insurance, subrogation, the whole thing) is incorrect and contempt-worthy if you have to have people make choices between insurance fraud and suing relatives (even if they are proxies for other parties).

It shouldn't work the way it works. That's all.

 

[Henry Ford]

so HF, now that the case was lost her insurance has to pay it i assume?

If this was about the health insurance not paying, and if the health insurer doesn't require her to appeal, then they should.She may actually be an unrepentant scumbag who is doing this of her own accord. That's still on the table.

I find it hard to believe her health insurance company didn't pay her medical bills.

Why?

 

[Henry Ford]

Are you contemplating going down the road of defending the morality of insurance fraud in a thread about impugning the moral compass of others, specifically lawyers?

Not me.

But seriously ... the system (law, insurance, subrogation, the whole thing) is incorrect and contempt-worthy if you have to have people make choices between insurance fraud and suing relatives (even if they are proxies for other parties).

It shouldn't work the way it works. That's all.

Almost like health care should be a basic right, and profit motives should be taken out of the equation of who gets health care entirely.

 

[Ookie Pringle]

so HF, now that the case was lost her insurance has to pay it i assume?

If this was about the health insurance not paying, and if the health insurer doesn't require her to appeal, then they should.She may actually be an unrepentant scumbag who is doing this of her own accord. That's still on the table.

I find it hard to believe her health insurance company didn't pay her medical bills.

Why?

Because of what I said earlier and you didn't respond. Just because she said an 8 year old jumped into her arms doesn't give them reason to not pay. They are assuming he is guilty before hearing any of the other evidence. Aren't they obligated to pay her medical bills and then subrogate?

 

[Henry Ford]

Let me share something, too - if everyone in this country was on Medicare, many if not most of the objectionable suits would disappear. In a moment. If there were a single-payer Medicare system, "scumbag" personal injury lawyers trying to get a quick, small settlement from an opposing party would be nearly non-existent. If you guys knew the minefield PI lawyers have to navigate when the client is on Medicare these days.... it's almost not worth taking an action that's a good case and worth hundreds of thousands of dollars if the client is within 30 months of getting Medicare when he/she gets hurt.

 

[SWC]

i hope they give punitive sublimation on the aunt brochachos

 

[Doug B]

I do.

Different state, though. Young minor defendants (elementary school age and down) in a civil case are super-rare down here, right?

BTW: what, roughly, is the age where a lawyer would tell a plaintiff "C'mon, you can't sue a [blank] year old!". Or is there no hard line?

 

[matttyl]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant.

But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

By who? I doubt she was offered $1 from her medical insurance carrier. They likely paid those medical bills just like it would have paid for any other medical claim. She likely went after the homeowner's policy, and from them was offered the $1. I very much doubt that she was only offered $1 in total from all insurance companies for all of her bills.

The statement from the lawyer is very clear - the case was about getting medical bills paid by the homeowners policy. Why should they pay? Why didn't her health insurance carrier pay them?

By the defendant. In an Offer of Compromise on April 1, 2014. It's in the docket.

Her health insurance wouldn't pay if there's a tortfeasor (in this case, the 8 year old) who should be legally obligated to pay them. With a judgment against her, she's likely going to get them paid now if that's why the suit was brought.

The defendant was the child, correct? The statement said that she was offered $1 "by the insurance company." My question is what insurance company?

Homeowners.

Ok. And how much did her medical insurance carrier pay? And where does the $127k come from? Above you assumed that she needed to have $40k in each couch cushion for each surgery. You're assuming that her health insurance carrier didn't pay anything. Do we know that's the case?

 

[Henry Ford]

so HF, now that the case was lost her insurance has to pay it i assume?

If this was about the health insurance not paying, and if the health insurer doesn't require her to appeal, then they should.She may actually be an unrepentant scumbag who is doing this of her own accord. That's still on the table.

I find it hard to believe her health insurance company didn't pay her medical bills.

Why?

Because of what I said earlier and you didn't respond. Just because she said an 8 year old jumped into her arms doesn't give them reason to not pay. They are assuming he is guilty before hearing any of the other evidence. Aren't they obligated to pay her medical bills and then subrogate?

Depends on the contract of insurance. In many cases, the potential tortfeasor is considered the "primary insurance policy." And yes, if her nephew hurt her, and was negligent, that absolutely can give them a reason to not pay. What did you say earlier that I didn't respond to? I thought I'd caught all those.

 

[B-Deep]

so HF, now that the case was lost her insurance has to pay it i assume?

If this was about the health insurance not paying, and if the health insurer doesn't require her to appeal, then they should.She may actually be an unrepentant scumbag who is doing this of her own accord. That's still on the table.

I find it hard to believe her health insurance company didn't pay her medical bills.

Why?

i am not doubting you, but tr

through my friends and me and my family i have experienced hundreds of cases where this oculd have happend

any accident that happens on property anyone else owns could be a potential law suit, yet most of us have never heard of somehting like this

that is what makes it all seem odd

you'd think almost every accident would be investigated and the courts would be even more cluttered than they are

 

[matttyl]

so HF, now that the case was lost her insurance has to pay it i assume?

If this was about the health insurance not paying, and if the health insurer doesn't require her to appeal, then they should.She may actually be an unrepentant scumbag who is doing this of her own accord. That's still on the table.

I find it hard to believe her health insurance company didn't pay her medical bills.

Why?

Because I'd think the lawyer would have said "this case is about getting her medical insurance carrier to pay" rather than specifically calling out the homeowners.

 

[Doug B]

No, any account that intentionally attempts to get an insurance company to pay a claim that they're not legally obligated to pay is insurance fraud.

The bolded is not a bright line, is it? Or else no one would ever have to go to court about it.

Besides ... how would the aunt know what specific circumstances would change liability? What if, in her mind's eye, she really DID sincerely feel like "we hugged, and I lost my balance" and that's how she reported it? C'mon, there's nuance here.

 

[matttyl]

Are you contemplating going down the road of defending the morality of insurance fraud in a thread about impugning the moral compass of others, specifically lawyers?

Not me.

But seriously ... the system (law, insurance, subrogation, the whole thing) is incorrect and contempt-worthy if you have to have people make choices between insurance fraud and suing relatives (even if they are proxies for other parties).

It shouldn't work the way it works. That's all.

Almost like health care should be a basic right, and profit motives should be taken out of the equation of who gets health care entirely.

Makes me question where she came up with the $127k.....

And if she was in fact charged $127k for two wrist surgeries, how the providers landed on that number.....

 

[Henry Ford]

From her attorneys' website:

"From the start, this was a case was about one thing: getting medical bills paid by homeowner's insurance. Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third. Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner's insurance company could not be identified as the defendant."

"Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn't want to do this anymore than anyone else would." But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough."

Her injuries were so horrible she couldn't hold a tray of food at a party for god's sake.

And lol at their client's been though enough. Their stupid client was the one who kept the whole thing going. And there's no way her medical bills were $127k for two wrist surgeries. The fact that the jury took so little time to sweep away the case speaks volumes about the case's reasonableness.

She was offered a dollar for her medical bills. She had no choice but to sue the homeowners insurance, and since you can't name them as a defendant.

But, everyone always knew you were hardly on top of your intellect game so why expect anything different today.

By who? I doubt she was offered $1 from her medical insurance carrier. They likely paid those medical bills just like it would have paid for any other medical claim. She likely went after the homeowner's policy, and from them was offered the $1. I very much doubt that she was only offered $1 in total from all insurance companies for all of her bills.

The statement from the lawyer is very clear - the case was about getting medical bills paid by the homeowners policy. Why should they pay? Why didn't her health insurance carrier pay them?

By the defendant. In an Offer of Compromise on April 1, 2014. It's in the docket.

Her health insurance wouldn't pay if there's a tortfeasor (in this case, the 8 year old) who should be legally obligated to pay them. With a judgment against her, she's likely going to get them paid now if that's why the suit was brought.

The defendant was the child, correct? The statement said that she was offered $1 "by the insurance company." My question is what insurance company?

Homeowners.

Ok. And how much did her medical insurance carrier pay? And where does the $127k come from? Above you assumed that she needed to have $40k in each couch cushion for each surgery. You're assuming that her health insurance carrier didn't pay anything. Do we know that's the case?

I have no idea whether her medical insurance paid anything and is subrogating, paid nothing, or if she has no insurance.

No, above I assumed $20K per surgery. ($40K for the two she's already had, another $20 for the one she still has to have.) Which is based on my experience of what a wrist break diagnosis and surgery costs, with aftercare, adjusted upwards about 30% for the fact that she's in New York City instead of ####heel, Louisiana.

$127K is almost certainly a demand based on medical bills, lost work, and general damages.

 

[Henry Ford]

so HF, now that the case was lost her insurance has to pay it i assume?

If this was about the health insurance not paying, and if the health insurer doesn't require her to appeal, then they should.She may actually be an unrepentant scumbag who is doing this of her own accord. That's still on the table.

I find it hard to believe her health insurance company didn't pay her medical bills.

Why?

Because I'd think the lawyer would have said "this case is about getting her medical insurance carrier to pay" rather than specifically calling out the homeowners.

If, indeed, the medical insurance company is paying his bill, he most certainly would not say that.