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View Full Version : Insurance "recovery" firms going after farm insurance!



mgmiller
May. 2, 2011, 04:52 PM
I'm wondering if any of you other barn owners have experienced this. One of my boarders slipped on a step last December and twisted/sprained her ankle. Not sure which, she did not make a big deal of it but the next day I made sure to make the step wider and to put an anti-slip cover over it so no one else would slip. Recently she told me that her health insurance company called and was all over her about how and where she slipped and clearly wanted to find someone else to shift the expense of her one doctor visit to. She told them to f___ off. Today she showed me a letter she received from a company called "Healthcare Recoveries." Their apparent purpose is to find someone else to pay the insurance company for any outlays they make for accidents experienced by their insured. Has anyone else had any experience with this? The boarder did NOT blame us at all - it was December and icy - but the health insuror obviously wants to shift the cost to us. We have always insisted that our boarders and riders have health insurance. With this, it appears that even if your boarder is insured and in no ways holds your responsible for their injury, their health insuror may try to get you or your insurance company to pay. If this is how things are going I think it is time to retire! I'd love comments from anyone on this.

Seal Harbor
May. 2, 2011, 05:05 PM
Yes they do that. When I have gotten one I put in the comments "My stupid fault" and they stop looking for people to reclaim monies from.

2BayPonies
May. 2, 2011, 05:17 PM
I've rec'd those notices on every "incident" I've had since being back with BCBSTX. When I had surgery for DDD and they went fishing for another party to blame - I sent back the response - "it seems to be bad conformation - blame my parents"

JSwan
May. 2, 2011, 05:31 PM
Turn it over to your insurance company and let them deal with it.

Yes, that is the way things are going - and have been for a long time. Sorry.

ddashaq
May. 2, 2011, 09:13 PM
Yep, when I came off my horse last summer and got stepped on, I received three letters from my insurance company trying to get information on anyone they could get $ out of. Very irritating.

foggybok
May. 3, 2011, 01:29 PM
I've rec'd those notices on every "incident" I've had since being back with BCBSTX. When I had surgery for DDD and they went fishing for another party to blame - I sent back the response - "it seems to be bad conformation - blame my parents"

LOL, I love it!

I just got one as well, had a few injuries in the last year, one by horse and one by playing with my dog.... seems BCBS wants to sue them.... Both were 100% my fault for being stupid and clutzy.....

PRS
May. 3, 2011, 02:11 PM
I've gotten similar letters in the past. I just say it was my fault, it happened on my own property etc. I would never make someone else pay for something like that. Whether the insurance company comes after your insurance company or not depends on how your boarder answers those questions.

AnotherRound
May. 3, 2011, 02:38 PM
Right, like the time I fell down my boyfriend's stairs outdoors - there they go, all looking for the name of the property owner. they put on the letter "and don't just not respond to this, because it won't go away". Okaaay, you want to threaten me? Intimidate me? Actually that was a threat of harrassment, so I didn't respond. Kept a copy of it, got another one, and didn't respond to that either. They went away. Three years later, just recently, I got another one. I wrote back - I don't remember where I was at the time. Haven't heard back yet.

Another time, took an ambulance ride to the emergency clinic because I fell at my own house (rented) and sprained my wrist. I should have driven myself, but people thought it was broken so there you go. Got a letter "give name of your landlord." Yeah, right, gonna sue my landlord, that will really get me a nice tidy lease renewal in the spring. Ignored them, never heard from them again.

Scum bag slum dog Sleezies.

AnotherRound
May. 3, 2011, 02:39 PM
Whether they come after the other insurance company depends on how the person answers the questions, but they will write the letters in such a way that it makes you think you must have already told them it was someone elses fault.

Really sleezy.

clanter
May. 3, 2011, 06:23 PM
look up the address of their home office building and list that as the location

DiablosHalo
May. 4, 2011, 10:26 AM
look up the address of their home office building and list that as the location


:lol::lol::lol:

Macimage
May. 4, 2011, 10:37 AM
My husband has back problems.

Over the years I have received a few letters from our health insurance company wanting us to fill out more information, such as did this happen at work, was it an auto accident, etc.?

I just throw them away.

Happy Trails~
Joyce

downen
May. 4, 2011, 11:39 AM
Recently, I got a letter from my insurance co. asking where I got injured for a doctor's bill... it was for a PAP SMEAR! Not only are they sleazy, they're idiots! :lol:

starrunner
May. 4, 2011, 11:44 AM
Hahaha downen. That takes the cake!

Rhiannonjk
May. 4, 2011, 12:38 PM
look up the address of their home office building and list that as the location

all joking aside, remember that you can be prosecuted with insurance fraud if you do lie to an insurance company.

dressagetraks
May. 4, 2011, 12:39 PM
I've never received one, but I think I did give my vet a few seconds of heart failure once.

Couple of years ago, I badly injured both hands in an accident AT THE VET CLINIC. Severe rope burns - 2nd and 3rd degree - to 8 fingers and left palm. Both thumbs spared. It was 6 months before the last bandage came off - all outpatient treatment, but it hurt like nothing else in my life, and I never want to have something top it, either. The worst finger, right index, is still badly scarred, that hand is swollen still at baseline, and that one spot still hurts and I have to be careful how I angle pressure while using it. I have some other odd scars and numb spots on the fingers from this, but the right index was the worst by far.

Anyway, it happened at the vet clinic. I was picking up the mares after hours, by prior arrangement with them. Due to my job, couldn't get there during regular hours. They left the mares in a corral out back with a tub of water. I showed up, had a stupid loading accident. (When your horse seriously spooks, truly is panicked for a moment, and with extreme intent decides to head outta Dodge, LET GO OF THE ROPE!!!) I said a few appropriate words, caught mare, loaded mare, loaded other mare, drove the rig 45 minutes home while alternating every few seconds which hand held my ice-cold Coke, unloaded mares, and drove myself to the ER. The whole while saying, "What a stupid accident. Let go of the rope, moron."

The one thing that nobody ever asked me was where it happened. Not at the ER, not later. It truly never came up. I said correctly that it was a horse accident with a lead rope, and that it was my own stupid fault.

Months later, with me finally getting the last bandage off, I took a horse to the clinic for something. The vet noted my right hand, visibly swollen, visibly scarred, still being used gingerly. I gave him a chronicle of the injury and showed him that worst spot, and then, just in conversational coincidence, mentioned, "Actually, it happened here."

He froze for a second, and I honestly did not understand the expression of horror until a little later. Bad injury, sure, but why should where it happened scare him. "Here? You mean RIGHT HERE? At OUR CLINIC????" :eek:

I was still in full conversational mode. "Yes, here. So, what do you think about . . ." And off I went on a question on the animal we had there that day. He followed me into vet talk, but he still looked rattled.

Honestly took me until a bit later for the puzzle pieces to click. Yes, I seriously and with permanent effects injured myself at their place of business when I was there all alone with their permission. And no, I never once thought of suing them. Could have happened anywhere; just happened to happen there. It was an accident.

I think I must have taken a few years off the poor vet's life, though. :yes:

Trevelyan96
May. 4, 2011, 01:53 PM
Yep, when Rico kicked me a few years ago, resulting in my first ambulance ride ever,they letters came in. Who's horse? Mine. Who's propery? Mine.

So after around 9 months another letter comes in. Was there a trainer or other responsible adult present? No.

They really work hard at not paying for what you pay those riduculously high premiums for.

mpsbarnmanager
May. 4, 2011, 04:54 PM
A few years ago I was at the barn alone one saturday morning. I was leading my mare and her buddy out to the pasture. My back suddenly went from hurting to excruciating. I turned them loose and collapsed onto the ground. Eventually I crawled to the fence, made my way to my car (cell phone) and DH drove me to the ER for what turned out to be a back spasm. My ins company hounded me for months asking me was I at work? What was I doing? Why did it happen? Whose fault was it? It got annoying but they did finally stop. It is really stupid and I hope nothing comes of it for you!

clanter
May. 4, 2011, 06:53 PM
all joking aside, remember that you can be prosecuted with insurance fraud if you do lie to an insurance company.

would not lie, would go there and fall down

Kementari
May. 4, 2011, 07:04 PM
all joking aside, remember that you can be prosecuted with insurance fraud if you do lie to an insurance company.

:yes: And they can refuse to pay or cancel your policy if you don't return their handy dandy little forms. It's all there in the fine print when you get the policy.

If the insured maintains it was his/her own fault, the insurance co will generally leave it alone, as it would not work well for them to go to court and have their prime witness saying that. ;)

headsupheelsdown
May. 4, 2011, 08:03 PM
Hey all, I was a subrogation adjuster for almost a decade. It is not a scummy practice at all.

The form they sent you is just asking for some information. In healthcare recovery, the letter is often sent out due to a "trigger" in the file. If someone put in a code for "slip/trip/fall", "motor vehicle accident", "animal bite", "assault" etc as the cause for your injury, you might get a letter asking for further details of what happened. Where did you fall? why did you fall? Yes, they are looking to recover what was paid out on your health insurance claim if someone else was liable. Why shouldn't they? It will keep your health insurance policy costs down. If no one was at fault (you just tripped), or if you don't want someone to get a claim filed against their insurance policy, just say you weren't looking where you were going and tripped. In my case I subrogated on workers compensation claims. If one of our insured's salesmen was rear-ended and injured while on the job and we paid a WC claim, we of course went after the party responsible for the employee's injuries to reimburse the WC claim. Why not?

I find it interesting that so many people find this objectionable.

Just send back the form asking for more information with the comment "I just wasn't watching where I was going and fell"

downen
May. 4, 2011, 09:37 PM
OK, then why did I get a letter after I got my pap smear? That was it, my yearly close encounter with my gyno. And I get the letter. Discuss.

Bells
May. 4, 2011, 10:13 PM
Your vajayjay has been coded w/a trigger? Explain that to your SO!

downen
May. 4, 2011, 10:22 PM
OMG, I am so busted! :lol:

CatOnLap
May. 4, 2011, 11:41 PM
Hey all, I was a subrogation adjuster for almost a decade. It is not a scummy practice at all.

The form they sent you is just asking for some information. In healthcare recovery, the letter is often sent out due to a "trigger" in the file. If someone put in a code for "slip/trip/fall", "motor vehicle accident", "animal bite", "assault" etc as the cause for your injury, you might get a letter asking for further details of what happened. Where did you fall? why did you fall? Yes, they are looking to recover what was paid out on your health insurance claim if someone else was liable. Why shouldn't they? It will keep your health insurance policy costs down. If no one was at fault (you just tripped), or if you don't want someone to get a claim filed against their insurance policy, just say you weren't looking where you were going and tripped. In my case I subrogated on workers compensation claims. If one of our insured's salesmen was rear-ended and injured while on the job and we paid a WC claim, we of course went after the party responsible for the employee's injuries to reimburse the WC claim. Why not?

I find it interesting that so many people find this objectionable.

Just send back the form asking for more information with the comment "I just wasn't watching where I was going and fell"


:lol:

it appears your point of view is a decidely minority opinion. And possibly the result of insurance company propaganda and brainwashing. Perhaps you believe also that the insurance company is there for the benefit of the insured? :winkgrin:

The questions are asked and answered in the original accident/injury reports. Why is there a need for the insurance company to repeat the question again, bothering the insured unecessarily? Anyone (outside the company) would infer the company was fishing for information so they could blame, I mean subrogate their expenses, to another person. :rolleyes:

Kementari
May. 5, 2011, 01:11 AM
:lol:

it appears your point of view is a decidely minority opinion. And possibly the result of insurance company propaganda and brainwashing. Perhaps you believe also that the insurance company is there for the benefit of the insured? :winkgrin:

The questions are asked and answered in the original accident/injury reports. Why is there a need for the insurance company to repeat the question again, bothering the insured unecessarily? Anyone (outside the company) would infer the company was fishing for information so they could blame, I mean subrogate their expenses, to another person. :rolleyes:

In all my horsey dr visits, I have never had the doctor ask me whose property I was on when it happened, whose horse I was riding, or whether or not I felt I was at fault. While those things may or may not come up in the conversation with medical professionals, they are most definitely NOT a standard part of the original injury report. Thus, the insurance company requests a follow-up report from their insured.

Insurance companies exist to make money. One way they do that is through your premiums, and another way they do that is through not paying out for incidents that are/should be covered by someone else. This is not rocket science.

Ever lived in a state that didn't require no-fault auto insurance? You'll find your insurance rates MUCH cheaper (having just done a quote for required insurance here in OR, in fact, I can tell you not-required insurance in NH cost HALF what it will here) as it's easier for your insurance company to go after the other driver if they feel that person bears responsibility. If you're interested in paying twice as much for health insurance, perhaps you can find a company that's willing to not go after another party who bears responsibility for your injury. (Though I would point out that even with no-fault auto insurance, in the case of blatant failing on the part of the other party, your insurance will still go after them - and win.)

If this bothers you so much, then don't do business with insurance companies.

Leprechaun
May. 5, 2011, 09:24 AM
They will do ANYTHING!

We were away for a long weekend. Our house/farm sitter (over 21) had a friend over who was under 21. Our house sitter went to bed at 10 pm as she had to be at the barn at 5 am. Her friend apparently decided to open up the wet bar and go for it. Her boyfriend called after midnight and she decided to go meet him. Wrapped her car around a tree (unhurt, thank God!) a mile down the road and was arrested.

Months later, out of the clear blue, we receive all of these scary letters from her insurance company that they are going to go after US! We weren't even there and she was not our paid housesitter. In the end, it didn't amount to much but was a real eye-opener about just how far these insurance companies will go.

Disgusting!

Trevelyan96
May. 5, 2011, 12:37 PM
I think I was fine with them asking about who's horse and who's property. It was when they followed up 9 months later to ask if there was a trainer or other 'responsible' adult present, giving the impression that the trainer might be responsible, that infuriated me.

I just had x-rays to check my hip after falling of Rico. You can bet that I will tell them that I was at home, alone, when it happened.

nls
May. 5, 2011, 02:48 PM
my husband was injured by a horse at our farm, our horse, our property. We received 7 different letters over the course of several weeks after his health insurance company had received the bills, (from United Healthcare) asking for specific details about the accident, the nature of our farm, who owned the horse, where did it occur.... It was eye-opening to realize the posibility of getting sued by "ourselves!" It has made me very diligent with having everyone who is involved with horses here sign their releases and makes me glad that I keep us well covered with insurance. It might be your best friend who gets injured and would never, ever dream of suing you, but their insurance company would in a heartbeat! I think back to places I boarded and trained at over the years that I know did not have commercial insurance policies. I don't see how they could do that these days.

sar2008
May. 5, 2011, 02:55 PM
Recently, I got a letter from my insurance co. asking where I got injured for a doctor's bill... it was for a PAP SMEAR! Not only are they sleazy, they're idiots! :lol:

:lol::lol::lol::lol::lol::lol::lol:

Thats hilarious!

Wayside
May. 5, 2011, 04:34 PM
Recently, I got a letter from my insurance co. asking where I got injured for a doctor's bill... it was for a PAP SMEAR! Not only are they sleazy, they're idiots! :lol:

Yeah, I got a similiar letter asking if my surgery was the result of an injury at work or some such. I'm a stay-at-home mom and I'd just gotten my tubes tied :lol:

danceronice
May. 5, 2011, 08:00 PM
I agree with headsupheelsdown. I'd rather they make someone else's company pay them and have the responsible party's premium go up instead of mine. I just pay them to pay my doctor. As long as they do, I don't care where they go to recoup their losses if it's not me. (Though IIRC, I never got one of those when I broke my finger--I wonder if it's because I have a high deductible so there wasn't much for them to recoup anyway--investigating would probably cost more.) If it IS in fact someone else's responsibility, that's why THEY have insurance--why should yours pay?

One sent regarding a pap smear--that's where I bet you're seeing computers at work.

JanM
May. 5, 2011, 09:43 PM
A long time ago a lady I worked with needed her bladder tacked back in place, and her doctor sent the preapproval request for the surgery and the name of it started with a 'v'. A while later she received the approval for her vasectomy from the insurance company, I guess the first letter confused them (and she had a copy of the doctor's request so it was the insurance company's mistake). When she called the insurance company about this we were all listening to her side of the conversation, and the gasp from the customer rep was hysterical.

SportNCurls
May. 5, 2011, 10:07 PM
I stepped on a rusty nail, my own farm and the health insurance company refused to pay until I filled it out..... twice.. my own property, my own rusty nail climbing through and old corn barn fishing out a chicken...

geesh it was one office visit, one tetanus shot and a round of antibiotics..

maybe I could have sued the hen? wait no she was mine too :)

headsupheelsdown
May. 5, 2011, 11:50 PM
:lol:

it appears your point of view is a decidely minority opinion. And possibly the result of insurance company propaganda and brainwashing. Perhaps you believe also that the insurance company is there for the benefit of the insured? :winkgrin:

The questions are asked and answered in the original accident/injury reports. Why is there a need for the insurance company to repeat the question again, bothering the insured unecessarily? Anyone (outside the company) would infer the company was fishing for information so they could blame, I mean subrogate their expenses, to another person. :rolleyes:

OK, so you would be thrilled if someone ran a red light and totalled your car and your insurance company didn't go after what they paid for your claim from the responsible party but just raised your premium? :winkgrin:

In fact, that is exactly what happens in a "no-fault" state. No fault is assessed in accidents, each person's own insurance pays their own vehicle's damages (for the most part... sometimes exceptions are made in some states for parked, unoccupied vehicles being struck), even if someone is clearly at fault. No recovery is allowed. And as a poster above said, the premiums you have to pay in those states are considerably higher.

You can be that generous, but for me I am glad the recovery people exist.

headsupheelsdown
May. 6, 2011, 12:15 AM
They will do ANYTHING!

We were away for a long weekend. Our house/farm sitter (over 21) had a friend over who was under 21. Our house sitter went to bed at 10 pm as she had to be at the barn at 5 am. Her friend apparently decided to open up the wet bar and go for it. Her boyfriend called after midnight and she decided to go meet him. Wrapped her car around a tree (unhurt, thank God!) a mile down the road and was arrested.

Months later, out of the clear blue, we receive all of these scary letters from her insurance company that they are going to go after US! We weren't even there and she was not our paid housesitter. In the end, it didn't amount to much but was a real eye-opener about just how far these insurance companies will go.

Disgusting!

Wow! This could have gone very, very badly for you if someone had gotten hurt or killed. Choose your housesitters more carefully in the future (a bonded professional housesitter?), yikes! Glad it was OK and no one got hurt! Sorry that the housesitter violated your trust like that!

Guilherme
May. 6, 2011, 08:56 AM
Subrogation is a tort doctrine that is hundreds of years old. It's based on the principle that if I pay for something for you as a result of your being injured then I have the right to "step into your shoes" and may seek indemnity from the person that injured you, if such a person exists.

This right exists by contract with an insurance company. I can't see how it's "disgusting" or morally or ethically corrupt or somehow dishonest. It's based upon the very simple principle that the responsibility for a loss should rest primarily upon the person causing. Why is this so disturbing?

I clerked for an insurance defense firm that also did a large amount of subrogation work. I would file several dozen cases per week (as would the two other clearks). I also would file several dozen motions for default judgement each week as the people sued failed to respond. I don't know how much was ever collected.

When I got thrown at a competition and ran up a significant hospital bill I got a "subrogation" letter and form from Tri-Care. I read it, filled it out, and noted that the loss resulted from my error and that no third parties were involved. That's the last I heard.

The company, in the policy, assumes the risk of loss from my acts, errors, or omissions. It does not assume these risks for the actions of others; nor should it.

G.

Calamber
May. 6, 2011, 09:44 AM
Subrogation is a tort doctrine that is hundreds of years old. It's based on the principle that if I pay for something for you as a result of your being injured then I have the right to "step into your shoes" and may seek indemnity from the person that injured you, if such a person exists.

This right exists by contract with an insurance company. I can't see how it's "disgusting" or morally or ethically corrupt or somehow dishonest. It's based upon the very simple principle that the responsibility for a loss should rest primarily upon the person causing. Why is this so disturbing?

I clerked for an insurance defense firm that also did a large amount of subrogation work. I would file several dozen cases per week (as would the two other clearks). I also would file several dozen motions for default judgement each week as the people sued failed to respond. I don't know how much was ever collected.

When I got thrown at a competition and ran up a significant hospital bill I got a "subrogation" letter and form from Tri-Care. I read it, filled it out, and noted that the loss resulted from my error and that no third parties were involved. That's the last I heard.

The company, in the policy, assumes the risk of loss from my acts, errors, or omissions. It does not assume these risks for the actions of others; nor should it.

G.

I am pretty sure that the intention was "honorable" in the beginning however, the insurance giants are some of the richest sleezeballs in the entire world. Only second and maybe co-companions of the hedge fund and derivatives inspired thieves of the merchant banking industry. I have had two very serious battles with USAA as a company that I have done business with for 35 years and probably have given (as in legal theft) (not invested) them over $50,000 in "premiums" (good word for having a premium amount of money stolen from you). I do not receive as much as even $700 back on that "investment" per year and had to do vicious battle with them the two times I needed for them to step up and pay small claims that mattered over the years. What do you call that? I call it grand theft, period and scumbag dirtballs who could not give a rat's ass about the average person in this country. Did it ever occur to the insurance company defenders that we did not need them a couple of decades ago to the extent we do now and why that would be?

headsupheelsdown
May. 6, 2011, 09:51 AM
I am pretty sure that the intention was "honorable" in the beginning however, the insurance giants are some of the richest sleezeballs in the entire world. Only second and maybe co-companions of the hedge fund and derivatives inspired thieves of the merchant banking industry. I have had two very serious battles with USAA as a company that I have done business with for 35 years and probably have given (not invested) them over $50,000 for premiums. I do not receive as much as even $700 back on that investment and had to do vicious battle with the the two times I needed them to step up and pay claims that mattered over the years. What do you call that? I call it grand theft, period and scumbag dirtballs who could not give a rat's ass about the average person in this country.

While I actually tend to agree with you, insurance companies have a LOT of practices I disagree with.... subrogation/recovery is not one of them.

In fact, 95% of the time, the insurance company simply "coattails" on the claim or suit the injured party actually brings against the repsonsible party. Pretty much very rarely does an insurance carrier pursue subrogation on it's own (in injury cases). 95% of the time, if there is a third party liable for an injury... the injured party themselves brings an action/claim/lawsuit against the responsible party and all the insurance carrier does is attach to that. What usually happens when there is a third party responsible for the injury... is we get that "what happened?" letter back with the injured party's attorney info and the information that they are already pursuing. We then send out lien letters to all involved.

amastrike
May. 6, 2011, 01:19 PM
Reading this thread ("how were you injured?" for a pap) makes me wonder why I haven't gotten one of these yet. In a week and a half I'm having my 4th surgery in 18 months, all due to trauma. You'd think they'd try to go after someone.

Guilherme
May. 6, 2011, 01:38 PM
I am pretty sure that the intention was "honorable" in the beginning however, the insurance giants are some of the richest sleezeballs in the entire world. Only second and maybe co-companions of the hedge fund and derivatives inspired thieves of the merchant banking industry. I have had two very serious battles with USAA as a company that I have done business with for 35 years and probably have given (as in legal theft) (not invested) them over $50,000 in "premiums" (good word for having a premium amount of money stolen from you). I do not receive as much as even $700 back on that "investment" per year and had to do vicious battle with them the two times I needed for them to step up and pay small claims that mattered over the years. What do you call that? I call it grand theft, period and scumbag dirtballs who could not give a rat's ass about the average person in this country. Did it ever occur to the insurance company defenders that we did not need them a couple of decades ago to the extent we do now and why that would be?

Me thinks I detect the stench of "sour grapes."

I've been insured by USAA for 40 plus years. I've never had an issue with them (with auto claims, homeowner claims, hurricane related claims, etc.). Indeed their ratings with independant evauators has always been first-rate. I don't know, nor do I care to know, the details of your problem. But if you have a problem and the company is at fault then sue them. If not then quit bellyaching.

All insurance relationships are governed by the contract. The company must do what the contract says, but may never exceed that responsibility. That's because premium and reserve levels are driven by the contact. If they do things in excess of contractual requirements they are hazarding all other insureds in that particular grouping. This is something that is poorly understood by the general populace.

Just to prove how ignorant the populace is I saw a life insurance company ad where they claim "they put people in front of policies." If this is true (and I don't believe for a minute that it is) they they will be shut down by regulators within months as they will be insolvent within months (no matter how much money they have in reserve). The policy,and nothing else, governs the relationship.

G.

downen
May. 6, 2011, 05:57 PM
My sister and BIL are actuarials. Actuarials make sure insurance companies make out like bandits, and are paid well for it (mid six figures, I believe, depending on what level they achieve). My sister summed it up perfectly: "There is no benevolence there."

Guilherme
May. 6, 2011, 06:31 PM
My sister and BIL are actuarials. Actuarials make sure insurance companies make out like bandits, and are paid well for it (mid six figures, I believe, depending on what level they achieve). My sister summed it up perfectly: "There is no benevolence there."

Nor should there be.

G.

KayBee
May. 8, 2011, 12:03 PM
With this, it appears that even if your boarder is insured and in no ways holds your responsible for their injury, their health insuror may try to get you or your insurance company to pay.

Yep. Blue Cross wouldn't pay an ER bill until they contacted me and I (irate) told the rep that it was no one's fault but mine. Woman got defensive and said "they had to make sure no one else was responsible."

Seriously, for a... $600 (?) ER bill you're going to:

Pursue me to get details?
Have to deal with hospital calling to see why bill isn't paid?
Pay a lawyer to sue... whomever?

Where's the cost/benefit?

Not to mention a really crappy way to behave. It is INSURANCE, isn't it.

And with Blue Cross, I was paying for the insurance myself. They made way the hell more off me than they ever paid out on my behalf. (And I know that's the point, to share risk. But still...)

Am waiting to see what happens with my new insurance company re: latest ER visit. :o

(Note, in neither case was I seriously injured. First was a minor concussion -- so minor it may not have been one at all. The second was whacking the hell out of my ITB (http://www.google.com/imgres?imgurl=http://4.bp.blogspot.com/_A9hfyWmI4j0/SKIng3H45CI/AAAAAAAAAYg/U40wbKd7kW0/s400/Iliotibial%2BBand.jpg&imgrefurl=http://duchossois.blogspot.com/2008/08/tuesdaywith-cherries-on-top.html&h=400&w=298&sz=16&tbnid=p_-nwkW6KIhsDM:&tbnh=124&tbnw=92&prev=/search%3Fq%3DITB%2Bband%2B-syndrome%26tbm%3Disch%26tbo%3Du&zoom=1&q=ITB+band+-syndrome&hl=en&usg=__YP5KAbzQyhDEoMWpYWlu0PaGUio=&sa=X&ei=9r3GTbWYEdSdgQeXjunKBA&ved=0CCIQ9QEwBA). Still feeling it today, 3 weeks later...) Hit hardest where it passes close to the point of the pelvis (or more properly, the iliac crest...)

Ow. Got some percocet out of the deal, though. Wheee...

Briggsie
May. 13, 2011, 10:58 PM
Yes, I have experienced this...I was the boarder though. I had a horrible riding accident on my trainers farm. She was there to witness. Problem is, it happened in her indoor. EMTs took me from the indoor. Well, the glory is this: the road marija lived on was actually not documented....only her mailbox is. Therefore...after the insurance came after her...I told them the accident happened on the road near the mailbox, which is owned by the county. The other catch: another of marija's clients is a lawyer. she told me that I am only required to report the true facts if I financial gain on my behalf is involved. there was none of that, so I was legally within my right to ignore the paperwork. They bully people into filling out the information and spilling the beans so they can go after the farm owners insurance...because people think they are legally obligated to. You are not legally obligated to...I never filled out a damn thing.

Briggsie
May. 13, 2011, 11:07 PM
In all my horsey dr visits, I have never had the doctor ask me whose property I was on when it happened, whose horse I was riding, or whether or not I felt I was at fault. While those things may or may not come up in the conversation with medical professionals, they are most definitely NOT a standard part of the original injury report. Thus, the insurance company requests a follow-up report from their insured.

Insurance companies exist to make money. One way they do that is through your premiums, and another way they do that is through not paying out for incidents that are/should be covered by someone else. This is not rocket science.

Ever lived in a state that didn't require no-fault auto insurance? You'll find your insurance rates MUCH cheaper (having just done a quote for required insurance here in OR, in fact, I can tell you not-required insurance in NH cost HALF what it will here) as it's easier for your insurance company to go after the other driver if they feel that person bears responsibility. If you're interested in paying twice as much for health insurance, perhaps you can find a company that's willing to not go after another party who bears responsibility for your injury. (Though I would point out that even with no-fault auto insurance, in the case of blatant failing on the part of the other party, your insurance will still go after them - and win.)

If this bothers you so much, then don't do business with insurance companies.

Of course you weren't asked by the doctors...because they are not the ones who care. the insurance bullies come knocking later...they are the one's who go on the witch hunt.

Wayside
May. 14, 2011, 12:48 AM
This is timely. I just got ANOTHER letter from my insurance company. Since I told them after the last one that no, my tubal was not work related, they now want to know if there is anyone else that could be at fault. For me having my tubes tied. :rolleyes:

Previous insurance company wasn't this bad. I can't remember them ever asking for the details of how I was injured, even when I was actually injured.

IronwoodFarm
May. 14, 2011, 07:45 AM
Thanks Guilherme for the sensible posts.

Our current insurance system depends on cost shifting....insurance is balkanized enough so that there may be coverage under multiple policies. Carriers are always trying to have someone else be the primary insurer if that is possible.

If we don't like a health care insurance system that shifts fault to various P&C coverages, then maybe a nationalized no-fault health care coverage is worth having. Reforming the current system, which is state regulated, is just not going to happen.

IMO, the odds for having a national health care systen for everyone (not just Medicare) looks bleak. So we just have to live with the system we got.

spotmenow
May. 14, 2011, 09:06 AM
Happened to us. A boarder was dismounting from her own horse and fell backward because she got her foot caught in the stirrup. No lesson going on, horse was standing quietly, it was just an...accident. Her health insurance company wanted to come after us but luckily she refused to give them any information and finally told them to stop harassing her or she'd file a complaint against them. Disgusting.

EponaRoan
May. 14, 2011, 04:52 PM
This is timely. I just got ANOTHER letter from my insurance company. Since I told them after the last one that no, my tubal was not work related, they now want to know if there is anyone else that could be at fault. For me having my tubes tied. :rolleyes:

Oh, you could have SUCH fun with this! :lol::lol:

Sounds like there's either a problem with coding and/or their computer program picking up the code as something else.

clanter
May. 14, 2011, 05:02 PM
This is timely. I just got ANOTHER letter from my insurance company. Since I told them after the last one that no, my tubal was not work related, they now want to know if there is anyone else that could be at fault. For me having my tubes tied. :rolleyes:

Previous insurance company wasn't this bad. I can't remember them ever asking for the details of how I was injured, even when I was actually injured.

here send this in hinidi they may understand then since English does not appear to work

क्या नहीं समझते? मैं अपनी ट्यूब बंधा था.

in fact write them a whole letter in hinidi

http://www.stars21.com/translator/english_to_hindi.html

SilvyFilly
May. 14, 2011, 05:57 PM
This is timely. I just got ANOTHER letter from my insurance company. Since I told them after the last one that no, my tubal was not work related, they now want to know if there is anyone else that could be at fault. For me having my tubes tied. :rolleyes:

Previous insurance company wasn't this bad. I can't remember them ever asking for the details of how I was injured, even when I was actually injured.

I would write back to them and say that your husband/SO is to blame for this operation and see what they say. It's technically the truth. :)

CatOnLap
May. 15, 2011, 12:48 PM
Blame Planned Parenthood and send the address of your nearest branch on the form...

PS- no one can be an "actuarial". Its an adjective used to describe a noun.
You can however, be an "Actuary"- which is a professional qualification requiring about 8-10 years of practice and exams AFTER you do a Bachelors of Commerce or the like, in Actuarial mathematics. My dad, rest his soul, was a professor of Actuarial Science.

Crooked Horse
May. 15, 2011, 01:09 PM
This is timely. I just got ANOTHER letter from my insurance company. Since I told them after the last one that no, my tubal was not work related, they now want to know if there is anyone else that could be at fault. For me having my tubes tied. :rolleyes:



I would write back to them and say that your husband/SO is to blame for this operation and see what they say. It's technically the truth. :)

No, blame the kids...;)

I had one of those letters once after a horse injury requiring 38+ stitches to my face :eek:

I let the insurance company know that it was my horse and my fault. And, oh-by-the-way, that the BO was an attorney and they could rest assured that all of the proper releases were in order. I never heard from them again.

Wayside
May. 15, 2011, 03:08 PM
Maybe I'll write back and tell them my insurance company is to blame for insisting I use the bc pills from their pharmacy which gave me all sorts of weird side effects. :lol: In all seriousness, I took bc pills for years without side effects until Cigna decided they would only cover bc pills from their own mail-order pharmacy.

For horse related stuff, I think they asked a few questions a few years ago when I got kicked by one of my own horses. My then two year old hadn't really been trailered since before she was weaned, and she nailed me when I stepped into the trailer. They wanted to know if it was my own horse (it was) and whose property I was on. I told them it happened in my horse trailer, which was my property, so therefore, yes, it happened on my property.

SonnysMom
May. 15, 2011, 09:34 PM
Yes, there are a few insurance companies that are too aggressive about denying things or pursuing additional information. Just like any group of companies or people there are always a few that a slime.
However there is a number of individuals that game the system. Person A has an accident and sues the landowner or other car driver or whoever was at fault. Part of the settlement was for medical bills. Person A didn't pay the medical bills, his insurance company did but the Person A keeps the money (less 1/3 for his lawyer) anyway. In many cases all the health insurance company wants to do is put a lien against any settlements that the Person A gets that includes payment for medical bills.
Why shouldn't they? Person A should not be able to have his health insurance pay the medical bills and get "reimbursed" for medical claims that Person A did not actually pay. This is double dipping.
The entity that paid the medical bills should get reimbursed for the medical bills especially when the at fault party has paid out to cover those bills.
I have been paying medical claims for over 20 years and have dealt with numerous insurance companies and insurance plans. I have never seen where a health insurance company sued the responsible party on their own. I have seen where they have required money from a plaintiff that sued the responsible party on their own and got a settlement.

For the person commenting about the $600 bill and wanting to recoup such a small amount where do you draw that line? $1,000, $10,000, $100,000? Just because the bill is $600 now what happens if 6 months or a year from now you develop complications and need major surgery? Those $600 claims add up.

Subrogation is not evil. Yes, insurance companies make a lot of money but they are a for profit company. At this point it is the system that we have in place. I think Blue Cross/Blue Shields are not for profit but they still need to have certain reserves by law.

Yes, we went decades without needing insurance but that was before MRI, cat scans, expensive chemo, radiation, expensive life altering drugs, Taj Mahal hospitals with 42 inch flat screen TV's in the birthing suite, all private room hospitals. When I first started paying claims I would get an occasional bill with a room fee for a ward and I don't mean intensive care. I haven't seen a bill for a ward in probably 17 years. Many hospital have gone to all private rooms. Somebody is paying for that. Private rooms and semi-private rooms means more staffing. It is easier for a nurse to cover 6 people in one ward versus 6 private rooms or 3 semi-private rooms. It means more floor space.

The advances in technology have dictated the need for insurance. American's also want insurance to cover everything. Original health insurance was hospitalization only and excluded maternity. Office visits and well care was not covered. Way back when you used to be able to barter with your doctor for your care. Here Doc, I can't afford to pay you for the office visit but have two chickens. Doc has dinner for his family for a few nights because he is a doctor not a farmer.

ACP
May. 16, 2011, 12:33 AM
My friend, who is a nurse and works at a hospital which provides their employee's insurance, was bucked off her own horse, and had an ER visit and some follow-up exams, a bit of PT. The hospital where she worked was also the hospital where she went to the ER. The insurance co. didn't pay.

They were waiting for her to sue the owner of the horse.

camohn
May. 16, 2011, 02:50 AM
My story is with auto insurance though. I was driving my vehicle when it caught fire. I got out and called 911 from my cell phone and the nice elderly man whose lawn I was sitting stranded on drove me home where I called the insurance company. The first 3 questions were 1) have you filed for bankruptcy recently? 2) have you been laid off from your job recently? 3) are you behind on your car payments or other bills? I told the man on the other end:I know you probably have a list of questions you have to ask but let me stop you right there as I see where this is going and you have not yet asked me what *happend* in regards to the fire. It is a cold and miserable day with near freezing rain and I was several miles from home. I was driving the vehicle at the time it caught fire....so no....I did not torch the truck for the insurance money so I could be stranded on the road in the freezing rain.

Guilherme
May. 16, 2011, 08:21 AM
My friend, who is a nurse and works at a hospital which provides their employee's insurance, was bucked off her own horse, and had an ER visit and some follow-up exams, a bit of PT. The hospital where she worked was also the hospital where she went to the ER. The insurance co. didn't pay.

They were waiting for her to sue the owner of the horse.

Stories like this should be approached carefully.

Subrogation means the party that pays gets to look to someone else to pay them. Note that no right of subrogation arises until payment is made.

You policy governs who does what, when. EVERY policy I have (and every exemplar I've ever seen) says that they will pay on my behalf. NONE require that I initiate a civil suit as a result of a mishap. If I do sue I have a duty to notify the company and, if I receive payment for something they paid for, I have to reimburse them. If they sue I have a duty to cooperate with them in pursuing payment.

There's an old insurance adgage that goes, "The Big Print Giveth and the Small Print Taketh Away." It's about true. The Big Print in a medical policy generally says something like "We will pay all sums on behalf of the insured for treatments that are medically indicated..."

So to get the company to pay the insured must first pay or incur a debt for medical treatment. In the OPs story the treatment was provided by the victims employer, seemingly at no cost to her. If this is true then the company has no duty to pay anything.

We also don't know about deductables and co-pays.

My wife works part time for a university level family practice clinic. We both benefit from a level of "professional courtesy" that flows from her work there (both with them and with some other MDs). This benefits us, and our insurance carrier. Many medical facilities render care to their own under an "insurance only" billing system. This benefits the employee/victim and employer/professional. It doesn't help the carrier very much and they don't like it. Sadly for them they don't have to like it; they do have to honor their policy.

Again, long, outrageous tales of insurance woes should be carefully evaluated before massive outrage is displayed.

G.

mvp
May. 16, 2011, 10:45 AM
In fact, 95% of the time, the insurance company simply "coattails" on the claim or suit the injured party actually brings against the repsonsible party. Pretty much very rarely does an insurance carrier pursue subrogation on it's own (in injury cases).

Really? So insurance co.s are not first in line in creating lawsuits? I would have assumed they were as few of us has the money to launch those. I suppose attorneys working on spec help. But subrogation is the insurance company's way of doing the same thing: making someone else-- anyone else-- pay. Have I got that right?


Yes, I have experienced this...I was the boarder though. I had a horrible riding accident on my trainers farm. She was there to witness. Problem is, it happened in her indoor. EMTs took me from the indoor. Well, the glory is this: the road marija lived on was actually not documented....only her mailbox is. Therefore...after the insurance came after her...I told them the accident happened on the road near the mailbox, which is owned by the county. The other catch: another of marija's clients is a lawyer. she told me that I am only required to report the true facts if I financial gain on my behalf is involved. there was none of that, so I was legally within my right to ignore the paperwork. They bully people into filling out the information and spilling the beans so they can go after the farm owners insurance...because people think they are legally obligated to. You are not legally obligated to...I never filled out a damn thing.

Again, just making sure I understand what you say. So if I won't financially benefit, nor will my insurance co, then I'm not obligated to reveal information? But how does the insurance company know up front whether or not there is someone besides me and my property involved? So they get to ask once but not multiple times?

As to the offense/defense discussion. Yes, everyone understands that insurance is pooled risk and also a bet. Insured is betting they will have a bill larger than their premium. Insurance co is betting they won't. They hire actuaries to create policies that make sure the company wins more than it loses. To me, it looks a bit like the casino business.

But insurance companies also invest the money they aren't using at present to pay out on legitimate claims. So profit comes in two forms-- the original bet and the interest generated on the invested money.

Both, it seems clear to those paying in, seem to create on a very strange business relationship. You pay an insurance co for a service up front. When you file a claim, however, you meet an essential conflict of interest that means they'll try to limit what they pay back out to you as best they can. At least that's the nugget of what I hate about insurance. I'm paying for the privilege of being mistreated.

headsupheelsdown
May. 25, 2011, 07:14 PM
[QUOTE=mvp;5609062]Really? So insurance co.s are not first in line in creating lawsuits? I would have assumed they were as few of us has the money to launch those. I suppose attorneys working on spec help. But subrogation is the insurance company's way of doing the same thing: making someone else-- anyone else-- pay. Have I got that right?QUOTE]

No, the insurance company cannot subrogate unless they have actually paid the claim. They are looking for reimbursement, not to avoid paying the claim and making someone else pay.
And the attorneys working for the injured party are usually working on contingency basis, which means that except for expenses, the attorney only makes money if the lawsuit results in a settlement. Often, there is no lawsuit actually filed and the attorney simply acts as a negotiator between the injured party and the reponsible party and the insurance company. As a poster above stated, usually the atty gets 1/3, the injured party get 1/3 and all the lienholders (those that paid the medical bills) gets 1/3 of the settlement. If it is a large settlement, lienholders might get paid in full, the atty gets his 33-40% and the injured party gets the rest. It just depends on how it is all negotiated.

Don't forget as well, it doesn't have to be an injury claim. If your car is rear-ended and you choose not to go through the reposible party's insurance carrier because you have better car rental coverage on your own, or your company gives you a better value, or just better customer service, a subrogation adjuster will get pursue that claim payment for reimbursement as well. Or if you suffer a theft of jewelry or cash, a subrogation adjuster will work with the criminal matter in the courts and get those items returned or ask the judge to award restitution.

headsupheelsdown
May. 25, 2011, 07:21 PM
Again, just making sure I understand what you say. So if I won't financially benefit, nor will my insurance co, then I'm not obligated to reveal information? But how does the insurance company know up front whether or not there is someone besides me and my property involved? So they get to ask once but not multiple times?

Per your policy, you must cooperate in any investigations, and that includes answering their questions and filling out and returning the forms. The policy is a contract that you sign with the insurance carrier and you must uphold your part of it. Not doing so could result in problems with your coverage.

Obviously, those posters that have gotten multiple forms, or forms for information as a result of a pap smear, well, their insurance carriers have some sort of glitch in their system. Very frustrating.

BobMartins
May. 31, 2011, 06:25 AM
Hey I guess the insurent company of yours is trying to make out mess out of your problem rather then solving it out, as once a person insures himself its the sole and whole responsibility of the insurance company to tackle the matter and pay for the damages caused off-course with proper and information....