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

[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?

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.

I highly doubt in this situation and many involving health insurance the carrier can deny a claim because they THINK their is a tortfesor based on the comments from the injured party. That is assuming guilt right away. The health insurance carrier will pay the claim and then subrogate. If they don't pay them claim they are opening themselves up to bad faith claims. They aren't going to leave someone open to having to file bankruptcy because they have 4 years of medical bills they can't pay because they are waiting for a trial to see if the other party is guilty.

 

[matttyl]

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.

Because the government would throw so much red tape at you? Honest question.

 

[Doug B]

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.

Absolutely.

 

[dgreen]

She said that anyone presenting at a medical facility will be asked how the accident happened

Of course they ask what happened. Was this actually in doubt?

 

[Henry Ford]

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.

Here's the best part, due to your legislators being in the pocket of the insurance industry:

Even if they would be obligated to pay, if the insured is attempting to get them to pay something in the belief that they wouldn't otherwise pay it, he/she can still be guilty of fraud. Hooray! :confetti:

 

[Henry Ford]

I highly doubt in this situation and many involving health insurance the carrier can deny a claim because they THINK their is a tortfesor. That is assuming guilt right away. The health insurance carrier will pay the claim and then subrogate. If they don't pay them claim they are opening themselves up to bad faith claims. They aren't going to leave someone open to having to file bankruptcy because they have 4 years of medical bills they can't pay because they are waiting for a trial to see if the other party is guilty.

Hahahaha.

Here, read about the standard for bad faith in Connecticut.

 

[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.

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

My initial thought about this case was that they did pay (something), and she was going after the homeowner's policy for more.

 

[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.

Because the government would throw so much red tape at you? Honest question.

The Medicare Secondary Payer Act. I've given CLEs on this - it's way too complicated to discuss in the midst of something else. Basically, Medicare expects every dime they've paid out to come back to them and then expects everything that may be necessary to pay future medicals related to that condition to be set aside to pay for future care before the plaintiff gets a penny. Of course, cases get settled for less than full amounts because of trial risk - but they don't take that into account.

It's significantly more complex than that, but that's the gist.

Also, if something gets messed up, there's a provision for Medicare to recover any of the amounts that constitute a screw up directly from the plaintiff's lawyer, with no statute of limitations. That is hopefully in the midst of getting fixed.

 

[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.

My initial thought about this case was that they did pay (something), and she was going after the homeowner's policy for more.

Why?

 

[Ookie Pringle]

I highly doubt in this situation and many involving health insurance the carrier can deny a claim because they THINK their is a tortfesor. That is assuming guilt right away. The health insurance carrier will pay the claim and then subrogate. If they don't pay them claim they are opening themselves up to bad faith claims. They aren't going to leave someone open to having to file bankruptcy because they have 4 years of medical bills they can't pay because they are waiting for a trial to see if the other party is guilty.

Hahahaha.

Here, read about the standard for bad faith in Connecticut.

So what. What you are saying is because a health insurance carrier is told by an injured person that someone else is at fault they can deny that claim? That would lead to many many people having to file bankruptcy while they let the legal process proceed. The health insurance provider pays the claim and then subrogates. They can't deny because the injured person tells them someone else did it. So are you really saying her health insurance provider said "no we aren't paying your medical bills because an 8 year old caused your injuries"?

 

[Foosball God]

So bottom line is that politicians are to blame.

 

[Doug B]

Here's the best part, due to your legislators being in the pocket of the insurance industry:


Even if they would be obligated to pay, if the insured is attempting to get them to pay something in the belief that they wouldn't otherwise pay it, he/she can still be guilty of fraud. Hooray! :confetti:

Well, in this particular case, there are at least two ways the aunt could've explained her injury. Though I guess either way might have had the same result.

a) "My nephew ran to me, jumped up, hugged me, and knocked me down."

b) "My nephew ran to me and gave me a big hug. He's getting so big now, my goodness -- I couldn't hold up his weight and I lost my balance."

It seems that both accounts are accurate. I guess one could still pursue negligence with both accounts, though.

 

[Henry Ford]

I highly doubt in this situation and many involving health insurance the carrier can deny a claim because they THINK their is a tortfesor. That is assuming guilt right away. The health insurance carrier will pay the claim and then subrogate. If they don't pay them claim they are opening themselves up to bad faith claims. They aren't going to leave someone open to having to file bankruptcy because they have 4 years of medical bills they can't pay because they are waiting for a trial to see if the other party is guilty.

Hahahaha.

Here, read about the standard for bad faith in Connecticut.

So what. What you are saying is because a health insurance carrier is told by an injured person that someone else is at fault they can deny that claim? That would lead to many many people having to file bankruptcy while they let the legal process proceed. The health insurance provider pays the claim and then subrogates. They can't deny because the injured person tells them someone else did it. So are you really saying her health insurance provider said "no we aren't paying your medical bills because an 8 year old caused your injuries"?

I'm not saying that's what did happen because I don't know the facts of this case. I am saying that I know for a fact that similar denials have happened repeatedly. For instance:

"You tripped and fell on the concrete sidewalk in front of a building. We won't pay for your dislocated kneecap (until there's a judgment saying it wasn't their fault)."

"You fell during a race you were running for charity, we won't pay for your broken elbow (until there's a judgment saying it wasn't their fault.)"

"You were in a car accident with someone, we will absolutely not pay for your broken nose"

What is your basis for saying that a health insurer can't deny coverage when there's a primary insurer for the injury?

Your insurance SHOULD pay the claim and accept subrogation. That doesn't mean it HAS to.

 

[Doug B]

So bottom line is that politicians are to blame.

The system ... the whole flippin' system

 

[Henry Ford]

So bottom line is that politicians are to blame.

And insurance companies.

 

[B-Deep]

I highly doubt in this situation and many involving health insurance the carrier can deny a claim because they THINK their is a tortfesor. That is assuming guilt right away. The health insurance carrier will pay the claim and then subrogate. If they don't pay them claim they are opening themselves up to bad faith claims. They aren't going to leave someone open to having to file bankruptcy because they have 4 years of medical bills they can't pay because they are waiting for a trial to see if the other party is guilty.

Hahahaha.

Here, read about the standard for bad faith in Connecticut.

So what. What you are saying is because a health insurance carrier is told by an injured person that someone else is at fault they can deny that claim? That would lead to many many people having to file bankruptcy while they let the legal process proceed. The health insurance provider pays the claim and then subrogates. They can't deny because the injured person tells them someone else did it. So are you really saying her health insurance provider said "no we aren't paying your medical bills because an 8 year old caused your injuries"?

I'm not saying that's what did happen because I don't know the facts of this case. I am saying that I know for a fact that similar denials have happened repeatedly. For instance:

"You tripped and fell on the concrete sidewalk in front of a building. We won't pay for your dislocated kneecap (until there's a judgment saying it wasn't their fault)."

"You fell during a race you were running for charity, we won't pay for your broken elbow (until there's a judgment saying it wasn't their fault.)"

"You were in a car accident with someone, we will absolutely not pay for your broken nose"

What is your basis for saying that a health insurer can't deny coverage when there's a primary insurer for the injury?

Your insurance SHOULD pay the claim and accept subrogation. That doesn't mean it HAS to.

Can we agree that IF she went homeowners instead of medical to try and stick it on the other people's insurance she's as much of a jackass as the initial headline makes her seem?

 

[Foosball God]

So bottom line is that politicians are to blame.

And insurance companies.

But mostly the politicians, because they are allowing the insurance companies to do it.

Stinkin' politicians.

First, we kill all the politicians...

 

[James Daulton]

This thread is active as a mofo.

 

[Ookie Pringle]

I highly doubt in this situation and many involving health insurance the carrier can deny a claim because they THINK their is a tortfesor. That is assuming guilt right away. The health insurance carrier will pay the claim and then subrogate. If they don't pay them claim they are opening themselves up to bad faith claims. They aren't going to leave someone open to having to file bankruptcy because they have 4 years of medical bills they can't pay because they are waiting for a trial to see if the other party is guilty.

Hahahaha.

Here, read about the standard for bad faith in Connecticut.

So what. What you are saying is because a health insurance carrier is told by an injured person that someone else is at fault they can deny that claim? That would lead to many many people having to file bankruptcy while they let the legal process proceed. The health insurance provider pays the claim and then subrogates. They can't deny because the injured person tells them someone else did it. So are you really saying her health insurance provider said "no we aren't paying your medical bills because an 8 year old caused your injuries"?

I'm not saying that's what did happen because I don't know the facts of this case. I am saying that I know for a fact that similar denials have happened repeatedly. For instance:"You tripped and fell on the concrete sidewalk in front of a building. We won't pay for your dislocated kneecap (until there's a judgment saying it wasn't their fault)."

"You fell during a race you were running for charity, we won't pay for your broken elbow (until there's a judgment saying it wasn't their fault.)"

"You were in a car accident with someone, we will absolutely not pay for your broken nose"

What is your basis for saying that a health insurer can't deny coverage when there's a primary insurer for the injury?

Because they are obligated to pay and then subrogate when it is determined LEGALLY their is another primary insurer. For example, if someone is in an auto accident while on the job and the other party is clearly at fault and cited, then that employers work comp company pays for the claim because they can't have the injured employee racking up medical bills that go unpaid. Then when everything is resolved the work comp company will subrogate against the other party and their auto insurance company if they have one.

Do you honestly have experience seeing health insurance companies denying claims right away because the injured person told them someone else was at fault?

 

[James Daulton]

I highly doubt in this situation and many involving health insurance the carrier can deny a claim because they THINK their is a tortfesor. That is assuming guilt right away. The health insurance carrier will pay the claim and then subrogate. If they don't pay them claim they are opening themselves up to bad faith claims. They aren't going to leave someone open to having to file bankruptcy because they have 4 years of medical bills they can't pay because they are waiting for a trial to see if the other party is guilty.

Hahahaha.

Here, read about the standard for bad faith in Connecticut.

So what. What you are saying is because a health insurance carrier is told by an injured person that someone else is at fault they can deny that claim? That would lead to many many people having to file bankruptcy while they let the legal process proceed. The health insurance provider pays the claim and then subrogates. They can't deny because the injured person tells them someone else did it. So are you really saying her health insurance provider said "no we aren't paying your medical bills because an 8 year old caused your injuries"?

I'm not saying that's what did happen because I don't know the facts of this case. I am saying that I know for a fact that similar denials have happened repeatedly. For instance:"You tripped and fell on the concrete sidewalk in front of a building. We won't pay for your dislocated kneecap (until there's a judgment saying it wasn't their fault)."

"You fell during a race you were running for charity, we won't pay for your broken elbow (until there's a judgment saying it wasn't their fault.)"

"You were in a car accident with someone, we will absolutely not pay for your broken nose"

What is your basis for saying that a health insurer can't deny coverage when there's a primary insurer for the injury?

Because they are obligated to pay and then subrogate when it is determined LEGALLY their is another primary insurer. For example, if someone is in an auto accident while on the job and the other party is clearly at fault and cited, then that employers work comp company pays for the claim because they can't have the injured employee racking up medical bills that go unpaid. Then when everything is resolved the work comp company will subrogate against the other party and their auto insurance company if they have one.

Do you honestly have experience seeing health insurance companies denying claims right away because the injured person told them someone else was at fault?

My patient accounting director specifically said the insurer will pay us, then go after the home owners or whomever.

 

[Henry Ford]

I highly doubt in this situation and many involving health insurance the carrier can deny a claim because they THINK their is a tortfesor. That is assuming guilt right away. The health insurance carrier will pay the claim and then subrogate. If they don't pay them claim they are opening themselves up to bad faith claims. They aren't going to leave someone open to having to file bankruptcy because they have 4 years of medical bills they can't pay because they are waiting for a trial to see if the other party is guilty.

Hahahaha.

Here, read about the standard for bad faith in Connecticut.

So what. What you are saying is because a health insurance carrier is told by an injured person that someone else is at fault they can deny that claim? That would lead to many many people having to file bankruptcy while they let the legal process proceed. The health insurance provider pays the claim and then subrogates. They can't deny because the injured person tells them someone else did it. So are you really saying her health insurance provider said "no we aren't paying your medical bills because an 8 year old caused your injuries"?

I'm not saying that's what did happen because I don't know the facts of this case. I am saying that I know for a fact that similar denials have happened repeatedly. For instance:"You tripped and fell on the concrete sidewalk in front of a building. We won't pay for your dislocated kneecap (until there's a judgment saying it wasn't their fault)."

"You fell during a race you were running for charity, we won't pay for your broken elbow (until there's a judgment saying it wasn't their fault.)"

"You were in a car accident with someone, we will absolutely not pay for your broken nose"

What is your basis for saying that a health insurer can't deny coverage when there's a primary insurer for the injury?

Because they are obligated to pay and then subrogate when it is determined LEGALLY their is another primary insurer. For example, if someone is in an auto accident while on the job and the other party is clearly at fault and cited, then that employers work comp company pays for the claim because they can't have the injured employee racking up medical bills that go unpaid. Then when everything is resolved the work comp company will subrogate against the other party and their auto insurance company if they have one.

Do you honestly have experience seeing health insurance companies denying claims right away because the injured person told them someone else was at fault?

Yeah, I understand you're saying they are obligated to do that, I'm asking what the basis is for your saying that thing that is often wrong.

And yes, I have experience with health insurance companies denying payment because of classification of the injury as a tort.

 

[Henry Ford]

I highly doubt in this situation and many involving health insurance the carrier can deny a claim because they THINK their is a tortfesor. That is assuming guilt right away. The health insurance carrier will pay the claim and then subrogate. If they don't pay them claim they are opening themselves up to bad faith claims. They aren't going to leave someone open to having to file bankruptcy because they have 4 years of medical bills they can't pay because they are waiting for a trial to see if the other party is guilty.

Hahahaha.

Here, read about the standard for bad faith in Connecticut.

So what. What you are saying is because a health insurance carrier is told by an injured person that someone else is at fault they can deny that claim? That would lead to many many people having to file bankruptcy while they let the legal process proceed. The health insurance provider pays the claim and then subrogates. They can't deny because the injured person tells them someone else did it. So are you really saying her health insurance provider said "no we aren't paying your medical bills because an 8 year old caused your injuries"?

I'm not saying that's what did happen because I don't know the facts of this case. I am saying that I know for a fact that similar denials have happened repeatedly. For instance:"You tripped and fell on the concrete sidewalk in front of a building. We won't pay for your dislocated kneecap (until there's a judgment saying it wasn't their fault)."

"You fell during a race you were running for charity, we won't pay for your broken elbow (until there's a judgment saying it wasn't their fault.)"

"You were in a car accident with someone, we will absolutely not pay for your broken nose"

What is your basis for saying that a health insurer can't deny coverage when there's a primary insurer for the injury?

Because they are obligated to pay and then subrogate when it is determined LEGALLY their is another primary insurer. For example, if someone is in an auto accident while on the job and the other party is clearly at fault and cited, then that employers work comp company pays for the claim because they can't have the injured employee racking up medical bills that go unpaid. Then when everything is resolved the work comp company will subrogate against the other party and their auto insurance company if they have one.

Do you honestly have experience seeing health insurance companies denying claims right away because the injured person told them someone else was at fault?

My patient accounting director specifically said the insurer will pay us, then go after the home owners or whomever.

That is not always the case.

 

[Ookie Pringle]

I highly doubt in this situation and many involving health insurance the carrier can deny a claim because they THINK their is a tortfesor. That is assuming guilt right away. The health insurance carrier will pay the claim and then subrogate. If they don't pay them claim they are opening themselves up to bad faith claims. They aren't going to leave someone open to having to file bankruptcy because they have 4 years of medical bills they can't pay because they are waiting for a trial to see if the other party is guilty.

Hahahaha.

Here, read about the standard for bad faith in Connecticut.

So what. What you are saying is because a health insurance carrier is told by an injured person that someone else is at fault they can deny that claim? That would lead to many many people having to file bankruptcy while they let the legal process proceed. The health insurance provider pays the claim and then subrogates. They can't deny because the injured person tells them someone else did it. So are you really saying her health insurance provider said "no we aren't paying your medical bills because an 8 year old caused your injuries"?

I'm not saying that's what did happen because I don't know the facts of this case. I am saying that I know for a fact that similar denials have happened repeatedly. For instance:"You tripped and fell on the concrete sidewalk in front of a building. We won't pay for your dislocated kneecap (until there's a judgment saying it wasn't their fault)."

"You fell during a race you were running for charity, we won't pay for your broken elbow (until there's a judgment saying it wasn't their fault.)"

"You were in a car accident with someone, we will absolutely not pay for your broken nose"

What is your basis for saying that a health insurer can't deny coverage when there's a primary insurer for the injury?

Because they are obligated to pay and then subrogate when it is determined LEGALLY their is another primary insurer. For example, if someone is in an auto accident while on the job and the other party is clearly at fault and cited, then that employers work comp company pays for the claim because they can't have the injured employee racking up medical bills that go unpaid. Then when everything is resolved the work comp company will subrogate against the other party and their auto insurance company if they have one.

Do you honestly have experience seeing health insurance companies denying claims right away because the injured person told them someone else was at fault?

My patient accounting director specifically said the insurer will pay us, then go after the home owners or whomever.

Exactly. I don't know that states laws for health insurance. I work closely in the commercial insurance and work comp field.

 

[SWC]

if this was her insurance company making her do this the way she is a pile of crapper hitting the social media fan dont you think she would have said i did not have a choice it was my insurance company making me do it blah blah blah by now i do so i think she and her brilliant attorneys thought they could make a buck and now instead of winning and getting paid the clients name is mud and the attorneys are the guys that get you turned in to the worlds joke great marketing slogan if you ask me but hey keep defending them i guess bromigos take that to the bank

 

[Henry Ford]

I highly doubt in this situation and many involving health insurance the carrier can deny a claim because they THINK their is a tortfesor. That is assuming guilt right away. The health insurance carrier will pay the claim and then subrogate. If they don't pay them claim they are opening themselves up to bad faith claims. They aren't going to leave someone open to having to file bankruptcy because they have 4 years of medical bills they can't pay because they are waiting for a trial to see if the other party is guilty.

Hahahaha.

Here, read about the standard for bad faith in Connecticut.

So what. What you are saying is because a health insurance carrier is told by an injured person that someone else is at fault they can deny that claim? That would lead to many many people having to file bankruptcy while they let the legal process proceed. The health insurance provider pays the claim and then subrogates. They can't deny because the injured person tells them someone else did it. So are you really saying her health insurance provider said "no we aren't paying your medical bills because an 8 year old caused your injuries"?

I'm not saying that's what did happen because I don't know the facts of this case. I am saying that I know for a fact that similar denials have happened repeatedly. For instance:

"You tripped and fell on the concrete sidewalk in front of a building. We won't pay for your dislocated kneecap (until there's a judgment saying it wasn't their fault)."

"You fell during a race you were running for charity, we won't pay for your broken elbow (until there's a judgment saying it wasn't their fault.)"

"You were in a car accident with someone, we will absolutely not pay for your broken nose"

What is your basis for saying that a health insurer can't deny coverage when there's a primary insurer for the injury?

Your insurance SHOULD pay the claim and accept subrogation. That doesn't mean it HAS to.

Can we agree that IF she went homeowners instead of medical to try and stick it on the other people's insurance she's as much of a jackass as the initial headline makes her seem?

No, but it makes it more likely.

 

[B-Deep]

to the bank

 

[Ookie Pringle]

I highly doubt in this situation and many involving health insurance the carrier can deny a claim because they THINK their is a tortfesor. That is assuming guilt right away. The health insurance carrier will pay the claim and then subrogate. If they don't pay them claim they are opening themselves up to bad faith claims. They aren't going to leave someone open to having to file bankruptcy because they have 4 years of medical bills they can't pay because they are waiting for a trial to see if the other party is guilty.

Hahahaha.

Here, read about the standard for bad faith in Connecticut.

So what. What you are saying is because a health insurance carrier is told by an injured person that someone else is at fault they can deny that claim? That would lead to many many people having to file bankruptcy while they let the legal process proceed. The health insurance provider pays the claim and then subrogates. They can't deny because the injured person tells them someone else did it. So are you really saying her health insurance provider said "no we aren't paying your medical bills because an 8 year old caused your injuries"?

I'm not saying that's what did happen because I don't know the facts of this case. I am saying that I know for a fact that similar denials have happened repeatedly. For instance:"You tripped and fell on the concrete sidewalk in front of a building. We won't pay for your dislocated kneecap (until there's a judgment saying it wasn't their fault)."

"You fell during a race you were running for charity, we won't pay for your broken elbow (until there's a judgment saying it wasn't their fault.)"

"You were in a car accident with someone, we will absolutely not pay for your broken nose"

What is your basis for saying that a health insurer can't deny coverage when there's a primary insurer for the injury?

Because they are obligated to pay and then subrogate when it is determined LEGALLY their is another primary insurer. For example, if someone is in an auto accident while on the job and the other party is clearly at fault and cited, then that employers work comp company pays for the claim because they can't have the injured employee racking up medical bills that go unpaid. Then when everything is resolved the work comp company will subrogate against the other party and their auto insurance company if they have one.

Do you honestly have experience seeing health insurance companies denying claims right away because the injured person told them someone else was at fault?

Yeah, I understand you're saying they are obligated to do that, I'm asking what the basis is for your saying that thing that is often wrong.And yes, I have experience with health insurance companies denying payment because of classification of the injury as a tort.

In the situations they do deny what is the timeline that is happening with that claim? What do those people do to pay the providers if they don't have the money while they wait for the legal process to play out?

 

[Henry Ford]

I highly doubt in this situation and many involving health insurance the carrier can deny a claim because they THINK their is a tortfesor. That is assuming guilt right away. The health insurance carrier will pay the claim and then subrogate. If they don't pay them claim they are opening themselves up to bad faith claims. They aren't going to leave someone open to having to file bankruptcy because they have 4 years of medical bills they can't pay because they are waiting for a trial to see if the other party is guilty.

Hahahaha.

Here, read about the standard for bad faith in Connecticut.

So what. What you are saying is because a health insurance carrier is told by an injured person that someone else is at fault they can deny that claim? That would lead to many many people having to file bankruptcy while they let the legal process proceed. The health insurance provider pays the claim and then subrogates. They can't deny because the injured person tells them someone else did it. So are you really saying her health insurance provider said "no we aren't paying your medical bills because an 8 year old caused your injuries"?

I'm not saying that's what did happen because I don't know the facts of this case. I am saying that I know for a fact that similar denials have happened repeatedly. For instance:"You tripped and fell on the concrete sidewalk in front of a building. We won't pay for your dislocated kneecap (until there's a judgment saying it wasn't their fault)."

"You fell during a race you were running for charity, we won't pay for your broken elbow (until there's a judgment saying it wasn't their fault.)"

"You were in a car accident with someone, we will absolutely not pay for your broken nose"

What is your basis for saying that a health insurer can't deny coverage when there's a primary insurer for the injury?

Because they are obligated to pay and then subrogate when it is determined LEGALLY their is another primary insurer. For example, if someone is in an auto accident while on the job and the other party is clearly at fault and cited, then that employers work comp company pays for the claim because they can't have the injured employee racking up medical bills that go unpaid. Then when everything is resolved the work comp company will subrogate against the other party and their auto insurance company if they have one.

Do you honestly have experience seeing health insurance companies denying claims right away because the injured person told them someone else was at fault?

My patient accounting director specifically said the insurer will pay us, then go after the home owners or whomever.

Exactly. I don't know that states laws for health insurance. I work closely in the commercial insurance and work comp field.

Precisely. It is a state issue and often has to do with what the state allows in their contracts of insurance. Connecticut is virtually controlled by the insurance industry. That's why Aetna and Cigna are both headquartered there.

 

[Henry Ford]

I highly doubt in this situation and many involving health insurance the carrier can deny a claim because they THINK their is a tortfesor. That is assuming guilt right away. The health insurance carrier will pay the claim and then subrogate. If they don't pay them claim they are opening themselves up to bad faith claims. They aren't going to leave someone open to having to file bankruptcy because they have 4 years of medical bills they can't pay because they are waiting for a trial to see if the other party is guilty.

Hahahaha.

Here, read about the standard for bad faith in Connecticut.

So what. What you are saying is because a health insurance carrier is told by an injured person that someone else is at fault they can deny that claim? That would lead to many many people having to file bankruptcy while they let the legal process proceed. The health insurance provider pays the claim and then subrogates. They can't deny because the injured person tells them someone else did it. So are you really saying her health insurance provider said "no we aren't paying your medical bills because an 8 year old caused your injuries"?

I'm not saying that's what did happen because I don't know the facts of this case. I am saying that I know for a fact that similar denials have happened repeatedly. For instance:"You tripped and fell on the concrete sidewalk in front of a building. We won't pay for your dislocated kneecap (until there's a judgment saying it wasn't their fault)."

"You fell during a race you were running for charity, we won't pay for your broken elbow (until there's a judgment saying it wasn't their fault.)"

"You were in a car accident with someone, we will absolutely not pay for your broken nose"

What is your basis for saying that a health insurer can't deny coverage when there's a primary insurer for the injury?

Because they are obligated to pay and then subrogate when it is determined LEGALLY their is another primary insurer. For example, if someone is in an auto accident while on the job and the other party is clearly at fault and cited, then that employers work comp company pays for the claim because they can't have the injured employee racking up medical bills that go unpaid. Then when everything is resolved the work comp company will subrogate against the other party and their auto insurance company if they have one.

Do you honestly have experience seeing health insurance companies denying claims right away because the injured person told them someone else was at fault?

Yeah, I understand you're saying they are obligated to do that, I'm asking what the basis is for your saying that thing that is often wrong.And yes, I have experience with health insurance companies denying payment because of classification of the injury as a tort.

In the situations they do deny what is the timeline that is happening with that claim? What do those people do to pay the providers if they don't have the money while they wait for the legal process to play out?

Often, the providers simply place a lien on recovery. It's imperative that a lawyer get involved and convince them to do that.

I will say, I've had a lot of success just calling and talking to the insurance company's general counsel. Usually assurance that I'm pursuing the claim and intend to collect, along with making it clear that if he doesn't pay my client will have much larger bills down the line and I expect them to pay for it if we lose helps things along. But I usually have a history with whatever guy covers my area for a given company - when I started out it was a lot harder.

 

[SWC]

i just read an article by marketwatch that said her own health insurance paid her bills but not all of them so i bet her only unpaid bills were copays and deductibles and maybe some bs fakeout medicine if she tried to do that basically all of the stuff about subrogation and whatever just appears to be wrong and she just thought she could make a buck and her attorneys and her went to far down the road of we will try this watch out pay us or else and got their keesters handed to them by the jury of normal people take that to the bank

 

[Henry Ford]

i just read an article by marketwatch that said her own health insurance paid her bills but not all of them so i bet her only unpaid bills were copays and deductibles and maybe some bs fakeout medicine if she tried to do that basically all of the stuff about subrogation and whatever just appears to be wrong and she just thought she could make a buck and her attorneys and her went to far down the road of we will try this watch out pay us or else and got their keesters handed to them by the jury of normal people take that to the bank

Why do you bet that? Isn't it as likely that they paid the emergency treatment, saw the UB codes and refused to pay for later treatment?

 

[Doug B]

Connecticut is virtually controlled by the insurance industry. That's why Aetna and Cigna are both headquartered there.

:strokesbeardthoughtfully:

 

[matttyl]

My initial thought about this case was that they did pay (something), and she was going after the homeowner's policy for more.

Why?

That was just my initial gut reaction. Here in VA the medical insurance always pays. You get in a car accident you get the medical part paid by your insurance and you go after the at fault party for what you can. You can double dip all day.

 

[SWC]

i just read an article by marketwatch that said her own health insurance paid her bills but not all of them so i bet her only unpaid bills were copays and deductibles and maybe some bs fakeout medicine if she tried to do that basically all of the stuff about subrogation and whatever just appears to be wrong and she just thought she could make a buck and her attorneys and her went to far down the road of we will try this watch out pay us or else and got their keesters handed to them by the jury of normal people take that to the bank

Why do you bet that? Isn't it as likely that they paid the emergency treatment, saw the UB codes and refused to pay for later treatment?

if her attorneys are taking to the press to defend her and there own reputations dont you think they would have said that brohan or if the health insurer was not paying bills that they should have dont you think they would have sued them to bromigo i think the thing is that you want to fill in a lot of blanks with a lot of legal technicalities but what we are not hearing is anyone actually saying that those types of technicalities actually happened so when you eliminate everything else the most simple thing is normally what happened and that is that an attorney and a woman thought they could make a buck and got what they had coming from a jury or normal bluecollars take that to the bank

 

[Ditkaless Wonders]

So bottom line is that politicians are to blame.

And insurance companies.

But mostly the politicians, because they are allowing the insurance companies to do it.

Stinkin' politicians.

First, we kill all the politicians...

That's all I am asking, then the insurance companies followed by bankers, and then the lawyers. Hell, we will be needed in all the murder cases on the first three. You don't want to get rid of us too fast.

 

[Henry Ford]

Connecticut is virtually controlled by the insurance industry. That's why Aetna and Cigna are both headquartered there.

:strokesbeardthoughtfully:

It's like trying to sue a credit card company in South Dakota.

 

[SWC]

ps if it ends up that it was some bo code or something that i do not really undertsand then i am a dope and you win again and i will say that again to your internet face if it happens but for now i am going with her and and her attorney stinking the bag so there you have it take that ot the bank

 

[matttyl]

Precisely. It is a state issue and often has to do with what the state allows in their contracts of insurance. Connecticut is virtually controlled by the insurance industry. That's why Aetna and Cigna are both headquartered there.

Very, very true.

 

[Ditkaless Wonders]

I highly doubt in this situation and many involving health insurance the carrier can deny a claim because they THINK their is a tortfesor. That is assuming guilt right away. The health insurance carrier will pay the claim and then subrogate. If they don't pay them claim they are opening themselves up to bad faith claims. They aren't going to leave someone open to having to file bankruptcy because they have 4 years of medical bills they can't pay because they are waiting for a trial to see if the other party is guilty.

Hahahaha.

Here, read about the standard for bad faith in Connecticut.

So what. What you are saying is because a health insurance carrier is told by an injured person that someone else is at fault they can deny that claim? That would lead to many many people having to file bankruptcy while they let the legal process proceed. The health insurance provider pays the claim and then subrogates. They can't deny because the injured person tells them someone else did it. So are you really saying her health insurance provider said "no we aren't paying your medical bills because an 8 year old caused your injuries"?

I'm not saying that's what did happen because I don't know the facts of this case. I am saying that I know for a fact that similar denials have happened repeatedly. For instance:"You tripped and fell on the concrete sidewalk in front of a building. We won't pay for your dislocated kneecap (until there's a judgment saying it wasn't their fault)."

"You fell during a race you were running for charity, we won't pay for your broken elbow (until there's a judgment saying it wasn't their fault.)"

"You were in a car accident with someone, we will absolutely not pay for your broken nose"

What is your basis for saying that a health insurer can't deny coverage when there's a primary insurer for the injury?

Because they are obligated to pay and then subrogate when it is determined LEGALLY their is another primary insurer. For example, if someone is in an auto accident while on the job and the other party is clearly at fault and cited, then that employers work comp company pays for the claim because they can't have the injured employee racking up medical bills that go unpaid. Then when everything is resolved the work comp company will subrogate against the other party and their auto insurance company if they have one.

Do you honestly have experience seeing health insurance companies denying claims right away because the injured person told them someone else was at fault?

My patient accounting director specifically said the insurer will pay us, then go after the home owners or whomever.

Exactly. I don't know that states laws for health insurance. I work closely in the commercial insurance and work comp field.

Precisely. It is a state issue and often has to do with what the state allows in their contracts of insurance. Connecticut is virtually controlled by the insurance industry. That's why Aetna and Cigna are both headquartered there.

What about the Hartford insurance company? I always presumed they were from Hartford Connecticut.

 

[matttyl]

i just read an article by marketwatch that said her own health insurance paid her bills but not all of them so i bet her only unpaid bills were copays and deductibles and maybe some bs fakeout medicine if she tried to do that basically all of the stuff about subrogation and whatever just appears to be wrong and she just thought she could make a buck and her attorneys and her went to far down the road of we will try this watch out pay us or else and got their keesters handed to them by the jury of normal people take that to the bank

Why do you bet that? Isn't it as likely that they paid the emergency treatment, saw the UB codes and refused to pay for later treatment?

Again, then the lawyer's statement would have been that the case was about getting the medical insurance company to pay - not the homeowner's.

 

[Ookie Pringle]

I highly doubt in this situation and many involving health insurance the carrier can deny a claim because they THINK their is a tortfesor. That is assuming guilt right away. The health insurance carrier will pay the claim and then subrogate. If they don't pay them claim they are opening themselves up to bad faith claims. They aren't going to leave someone open to having to file bankruptcy because they have 4 years of medical bills they can't pay because they are waiting for a trial to see if the other party is guilty.

Hahahaha.

Here, read about the standard for bad faith in Connecticut.

So what. What you are saying is because a health insurance carrier is told by an injured person that someone else is at fault they can deny that claim? That would lead to many many people having to file bankruptcy while they let the legal process proceed. The health insurance provider pays the claim and then subrogates. They can't deny because the injured person tells them someone else did it. So are you really saying her health insurance provider said "no we aren't paying your medical bills because an 8 year old caused your injuries"?

I'm not saying that's what did happen because I don't know the facts of this case. I am saying that I know for a fact that similar denials have happened repeatedly. For instance:"You tripped and fell on the concrete sidewalk in front of a building. We won't pay for your dislocated kneecap (until there's a judgment saying it wasn't their fault)."

"You fell during a race you were running for charity, we won't pay for your broken elbow (until there's a judgment saying it wasn't their fault.)"

"You were in a car accident with someone, we will absolutely not pay for your broken nose"

What is your basis for saying that a health insurer can't deny coverage when there's a primary insurer for the injury?

Because they are obligated to pay and then subrogate when it is determined LEGALLY their is another primary insurer. For example, if someone is in an auto accident while on the job and the other party is clearly at fault and cited, then that employers work comp company pays for the claim because they can't have the injured employee racking up medical bills that go unpaid. Then when everything is resolved the work comp company will subrogate against the other party and their auto insurance company if they have one.

Do you honestly have experience seeing health insurance companies denying claims right away because the injured person told them someone else was at fault?

My patient accounting director specifically said the insurer will pay us, then go after the home owners or whomever.

Exactly. I don't know that states laws for health insurance. I work closely in the commercial insurance and work comp field.

Precisely. It is a state issue and often has to do with what the state allows in their contracts of insurance. Connecticut is virtually controlled by the insurance industry. That's why Aetna and Cigna are both headquartered there.

Yes it is a state issue and I highly doubt they denied the claim initially because she said an 8 year old jumped into her arms as you claim they did.

 

[Henry Ford]

i just read an article by marketwatch that said her own health insurance paid her bills but not all of them so i bet her only unpaid bills were copays and deductibles and maybe some bs fakeout medicine if she tried to do that basically all of the stuff about subrogation and whatever just appears to be wrong and she just thought she could make a buck and her attorneys and her went to far down the road of we will try this watch out pay us or else and got their keesters handed to them by the jury of normal people take that to the bank

Why do you bet that? Isn't it as likely that they paid the emergency treatment, saw the UB codes and refused to pay for later treatment?

if her attorneys are taking to the press to defend her and there own reputations dont you think they would have said that brohan or if the health insurer was not paying bills that they should have dont you think they would have sued them to bromigo i think the thing is that you want to fill in a lot of blanks with a lot of legal technicalities but what we are not hearing is anyone actually saying that those types of technicalities actually happened so when you eliminate everything else the most simple thing is normally what happened and that is that an attorney and a woman thought they could make a buck and got what they had coming from a jury or normal bluecollars take that to the bank

I didn't bring up the health insurance company not paying. I explained why that can be the case when it was brought up on page 5 or so.

And Ockham's razor doesn't apply to insurance contracts.

 

[Henry Ford]

I highly doubt in this situation and many involving health insurance the carrier can deny a claim because they THINK their is a tortfesor. That is assuming guilt right away. The health insurance carrier will pay the claim and then subrogate. If they don't pay them claim they are opening themselves up to bad faith claims. They aren't going to leave someone open to having to file bankruptcy because they have 4 years of medical bills they can't pay because they are waiting for a trial to see if the other party is guilty.

Hahahaha.

Here, read about the standard for bad faith in Connecticut.

So what. What you are saying is because a health insurance carrier is told by an injured person that someone else is at fault they can deny that claim? That would lead to many many people having to file bankruptcy while they let the legal process proceed. The health insurance provider pays the claim and then subrogates. They can't deny because the injured person tells them someone else did it. So are you really saying her health insurance provider said "no we aren't paying your medical bills because an 8 year old caused your injuries"?

I'm not saying that's what did happen because I don't know the facts of this case. I am saying that I know for a fact that similar denials have happened repeatedly. For instance:"You tripped and fell on the concrete sidewalk in front of a building. We won't pay for your dislocated kneecap (until there's a judgment saying it wasn't their fault)."

"You fell during a race you were running for charity, we won't pay for your broken elbow (until there's a judgment saying it wasn't their fault.)"

"You were in a car accident with someone, we will absolutely not pay for your broken nose"

What is your basis for saying that a health insurer can't deny coverage when there's a primary insurer for the injury?

Because they are obligated to pay and then subrogate when it is determined LEGALLY their is another primary insurer. For example, if someone is in an auto accident while on the job and the other party is clearly at fault and cited, then that employers work comp company pays for the claim because they can't have the injured employee racking up medical bills that go unpaid. Then when everything is resolved the work comp company will subrogate against the other party and their auto insurance company if they have one.

Do you honestly have experience seeing health insurance companies denying claims right away because the injured person told them someone else was at fault?

My patient accounting director specifically said the insurer will pay us, then go after the home owners or whomever.

Exactly. I don't know that states laws for health insurance. I work closely in the commercial insurance and work comp field.

Precisely. It is a state issue and often has to do with what the state allows in their contracts of insurance. Connecticut is virtually controlled by the insurance industry. That's why Aetna and Cigna are both headquartered there.

What about the Hartford insurance company? I always presumed they were from Hartford Connecticut.

Them too.

 

[Henry Ford]

Yes it is a state issue and I highly doubt they denied the claim initially because she said an 8 year old jumped into her arms as you claim they did.

Again, I am not claiming that happened. I'm saying I wouldn't be surprised by it, and the suggestion that it doesn't happen or that it can't happen is ludicrous.

 

[B-Deep]

i just read an article by marketwatch that said her own health insurance paid her bills but not all of them so i bet her only unpaid bills were copays and deductibles and maybe some bs fakeout medicine if she tried to do that basically all of the stuff about subrogation and whatever just appears to be wrong and she just thought she could make a buck and her attorneys and her went to far down the road of we will try this watch out pay us or else and got their keesters handed to them by the jury of normal people take that to the bank

Why do you bet that? Isn't it as likely that they paid the emergency treatment, saw the UB codes and refused to pay for later treatment?

if her attorneys are taking to the press to defend her and there own reputations dont you think they would have said that brohan or if the health insurer was not paying bills that they should have dont you think they would have sued them to bromigo i think the thing is that you want to fill in a lot of blanks with a lot of legal technicalities but what we are not hearing is anyone actually saying that those types of technicalities actually happened so when you eliminate everything else the most simple thing is normally what happened and that is that an attorney and a woman thought they could make a buck and got what they had coming from a jury or normal bluecollars take that to the bank

to the bank

 

[Henry Ford]

i just read an article by marketwatch that said her own health insurance paid her bills but not all of them so i bet her only unpaid bills were copays and deductibles and maybe some bs fakeout medicine if she tried to do that basically all of the stuff about subrogation and whatever just appears to be wrong and she just thought she could make a buck and her attorneys and her went to far down the road of we will try this watch out pay us or else and got their keesters handed to them by the jury of normal people take that to the bank

Why do you bet that? Isn't it as likely that they paid the emergency treatment, saw the UB codes and refused to pay for later treatment?

Again, then the lawyer's statement would have been that the case was about getting the medical insurance company to pay - not the homeowner's.

But the case wasn't about the medical insurance company paying. They sued the homeowner's insurance company.

 

[Ditkaless Wonders]

What would happen if Ru Paul, in full on drag regalia, in her home, aggressively and full frontally hugged me causing me to wish to change my gender. Could I sue Ru Paul's homeowner's insurance to cover the associated costs, including psychological assessments and support, surgery, aftercare, new wardrobe?

BTW, are there any other person's named Ru(e) in the world other than Ru Paul and the little chick from the hunger games that gets offed?

 

[NCCommish]

Serious question: if this woman were a stranger who the kid jumped at to hug (for whatever reason - mistaken identity, thought it was cute when meeting a new person, whatever) and knocked down, would your opinion change?

Is he still 8? Does he still not have the mental capacity to consider long term outcomes of his actions?

 

[Henry Ford]

Serious question: if this woman were a stranger who the kid jumped at to hug (for whatever reason - mistaken identity, thought it was cute when meeting a new person, whatever) and knocked down, would your opinion change?

Is he still 8? Does he still not have the mental capacity to consider long term outcomes of his actions?

Is that the case with 8-year-olds? Do we not hold them responsible for any of their actions as a result?

Just asking for a friend.

 

[Henry Ford]

I mean, I know it seems crazy. But I feel like I've heard of instances where kids 8 and younger are still responsible for their actions in some ways.