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  1. #1
    Join Date
    Dec. 26, 2004
    Location
    Suburbs of Cleveland, OH
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    522

    Default Anyone with legal knowledge? Regarding fall liability...

    I will try to make this short and sweet and greatly appreciate any advice you guys can give me.

    There's really not much of a story. Took a nasty spill in September (was catapulted (sp?) head over heels, landed flat on head and back - hard). I knew I had a concussion, and was sore, everything you'd expect but a day later my right arm and hand went numb so off to the ER I went for CT's and such. I sprained my back, my neck, and had a concussion. The numbness was from swelling in my cervical vertebrae. No biggie, a week and some painkillers/muscle relaxers later I was fine.

    Fast forward to today - I received a letter from what looks to be a law firm stating that I haven't responded to inquiries from my insurance company (haven't gotten any!) about my treatment on that date. That their records indicate that there could be another party at fault and they want me to fill out a form with the BO's name, insurance carrier, number, etc and if I don't, they will proceed accordingly. What does this mean? This was not BO's fault, I'd never sue someone over a spill, and I signed a release and hold harmless well before it happened. It sounds like they want me to let my insurance company go after BO or they're going to make me pay the bazillion dollar hospital bill. Can they do that?!? How should I respond to this or should I at all?



  2. #2
    Join Date
    Mar. 8, 2004
    Location
    Baltimore, MD
    Posts
    19,763

    Default

    Very common. Definitely respond and be truthful. They always look for a way to recoup their losses, they would send the same thing to you if it were your own horse.



  3. #3
    Join Date
    Dec. 13, 2005
    Location
    New England
    Posts
    1,377

    Default

    I've heard of this before. It's standard M.O. Don't get frazzled, tell them nothing or if forced say it was your own fault. I would round file the letter myself.



  4. #4
    Join Date
    Feb. 28, 2011
    Posts
    520

    Default

    Your insurance company will go after your BO's. If I get hurt I always say it happened at home. I tell people don't call an ambulance, just pick up the pieces, throw them in the trunk and drive. I have insurance to cover me not sue people (who are friends) who are not at fault.



  5. #5
    Join Date
    Jun. 18, 2011
    Posts
    1,324

    Default

    I don't know the first thing about this sort of thing but I think you should definitely respond. I doubt ignoring it will make it go away.

    That being said, I wouldn't be offering up any information on the BO to the insurance company until talking to someone that DOES know the ins and outs of these types of matters.

    Just a simple inquiry to the insurance company as to why this is necessary is where I'd start along with expressing to them that the accident was not the fault of any third party. Based on the tone of the conversation and how willing they seem to pursue it my second call would be to the BO to give a heads up, and maybe even consider contacting a lawyer after that.



  6. #6
    Join Date
    Dec. 26, 2004
    Location
    Suburbs of Cleveland, OH
    Posts
    522

    Default

    I agree - I'm not about to give them BO's info. I filled out my info on the form and under the property owner/info section wrote "This was a no fault accident and there is a signed release of liability to the property owner in place".

    I can't really say that it happened at home - I'm sure they could easily figure out that I live on an unfenced 1/3 acre in a housing development that someone would surely notice a horse living on!

    The "proceed accordingly" just has me freaked out as to what that entails!



  7. #7
    Join Date
    Sep. 13, 2002
    Location
    Pacific Northwest
    Posts
    4,978

    Default

    Standard thing now days. Happened to me when I had a bad fall during a lesson at a boarding barn. I filled it out with the info that I had at hand (wasn't asking BO for insurance info, etc. -- he was hands off, non-horsey and would have had a meltdown at even the hint of a problem...). I did not mention that I was in a lesson as I didn't want to draw my trainer into it, but I also wasn't going to lie about where and when, etc. I just noted that I was riding my own horse, no one was at fault except HIM (well, me...it is always the rider's fault, you know...I did get on!), and I have signed releases for the boarding barn. Never heard another word. My form came from my insurance company, so I wonder if you got a request and didn't notice it -- you do end up getting so much after any kind of claim, it could get lost in the pile.

    Not giving any legal advice here; just reporting my experience!



  8. #8
    Join Date
    Dec. 26, 2004
    Location
    Suburbs of Cleveland, OH
    Posts
    522

    Default

    There's no way they're getting near the BO in all of this - there's no way they could find out who/where it even is. I don't want to tell her and freak her out. I just think it's complete BS if my insurance company is going to try to come after ME because they don't feel like paying a bill that I pay them to cover.

    And how sad is this? Like the world isn't sue happy enough, now the health insurance company is going to try to prompt lawsuits in case it hadn't occurred to the injured party to do so?!?

    I should suggest they sue my son's school for allowing him to shove that bead up his nose a few months ago...



  9. #9
    Join Date
    Oct. 11, 2007
    Location
    Andover, MA
    Posts
    5,558

    Default

    I'd be a bit worried that this has been escalated to a legal firm when you've heard nothing from your insurance company so far.

    Every ER visit I've made in the past few years (there have been 4) has been followed by a polite letter and form from my health insurance company asking me to indicate if anyone else could be considered at fault. In all cases, I've filled out the form making it clear that the ER visit was my own damn fault, and have not heard anything more. Pretty funny to fill out the form in two cases saying that I went to the ER because my cat bit me!
    You have to have experiences to gain experience.

    Proudly owned by Mythic Feronia, 1998 Morgan mare; G-dspeed Trump & Minnie; welcome 2014 Morgan filly MtnTop FlyWithMeJosephine



  10. #10
    Join Date
    Apr. 6, 2005
    Location
    Frozen tundra
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    1,447

    Default

    That happened to me too. The insurance company had an attorney contact me to get information and I didn't give them any. I just kept repeating "I fell off and it was no one's fault." They went away.



  11. #11
    Join Date
    Dec. 26, 2004
    Location
    Suburbs of Cleveland, OH
    Posts
    522

    Default

    Horsepoor - That is completely possible. I got so many explanation of benefits from every different service that was performed that day, I may have just glossed over something! Thanks for setting my mind at ease, I hope I don't hear from them again after I send this form back!



  12. #12
    Join Date
    Feb. 2, 2003
    Location
    Iowa, USA
    Posts
    2,397

    Default

    In past threads that talk about legal issues, I never really thought it was a problem to offer the "if it were me, I'd...." kind of answer. But after reading this thread I've learned how reckless it is to offer (or take) legal advice on this board.



  13. #13
    Join Date
    Apr. 30, 2008
    Posts
    82

    Default

    khorsem,

    They will call you or try to contact you again. The initial letter/form is a formality when there is an injury.
    I've been through this more than once. The best way to resolve this is to pick up the phone and call to speak with a person.

    Legally speaking (but I'm no lawyer), it's not in anyone's best interest to be deceptive. Tell the truth.

    I was riding my horse and got hurt. Total flurry of calls/letters from subrogation. Interesting conversation really and for a moment I thought they wanted to interrogate my gelding.

    Anyway, be straight, answer clearly (with as few words as possible). Put yourself as the responsible party.

    Of course, if you are hesitant, there is no harm in seeking legal advice.

    Good luck. This too shall end.



  14. #14
    Join Date
    Dec. 26, 2004
    Location
    Suburbs of Cleveland, OH
    Posts
    522

    Default

    Thanks for that - I was really just looking for anyone familiar with this type of thing as I've never come across it before. I could be wrong, but I don't think it's illegal to share experiences and opinions- no one is claiming to have any official capacity. And I'm certainly not going to make any legal decisions based on what anyone here has said.



  15. #15
    Join Date
    Oct. 26, 2003
    Posts
    1,897

    Default

    The brake lines on my truck went out when I was pulling my horse trailer and it slammed into the back of a guy parked at a stop sign. Fortunately, no one was hurt but my truck and his car had some damage. A rep from my insurance company called and asked if there was ANY way the guy I hit was at fault. I told her he was minding his own business when I ran into him. She asked again, "Was there anything he did that contributed to the accident?" I told her that other than being there, no, and frankly I was very happy that I didn't kill or seriously injure him or his passenger. She finally let it go after that.



  16. #16
    Join Date
    Apr. 30, 2008
    Posts
    82

    Default

    Quote Originally Posted by khorsem View Post
    Thanks for that - I was really just looking for anyone familiar with this type of thing as I've never come across it before. I could be wrong, but I don't think it's illegal to share experiences and opinions- no one is claiming to have any official capacity. And I'm certainly not going to make any legal decisions based on what anyone here has said.
    It's pretty unnerving to get that letter. No harm in asking about others experience.
    Sorry you are having to go through this. Unfortunately, it's becoming more common.



  17. #17
    Join Date
    Dec. 19, 2008
    Location
    Where The Snow Flies
    Posts
    2,381

    Default

    I work for the insurance company (a rather large national one) and what you received is called an accident letter. DO NOT SAY IT WAS A "NO-FAULT" ACCIDENT. In insurance terms, no-fault means there should be a no-fault carrier for third party liability. No-fault is like your car insurance. Your car insurance will pay for your bodily injuries in the event of a car accident - not your health insurance. This letter is usually automatically generated based on an accident indicator diagnosis code on a claim your doctor sent in. Any claims that may have a third-party liability (such as no-fault, accident/injury that you're suing for and workers comp) go through subrogation and subro is usually done through a subrogation attorney - which is why you received the letter from the law office. Fill out the letter and just say, you had an accidental fall while riding a horse. There should be questions on the letter about your attorney if you have one, the property owner's information, etc... Fill out the information honestly but give the minimum necessary. If it's a yes/no question - just say yes or no. Do not elaborate. You don't have to.



  18. #18
    Join Date
    Nov. 6, 2011
    Location
    Northern Virginia
    Posts
    207

    Default

    It is called subrogation. Just another way of insurance companies shifting the blame.



  19. #19
    Join Date
    Dec. 26, 2004
    Location
    Suburbs of Cleveland, OH
    Posts
    522

    Default

    Quote Originally Posted by Snowflake View Post
    I work for the insurance company (a rather large national one) and what you received is called an accident letter. DO NOT SAY IT WAS A "NO-FAULT" ACCIDENT. In insurance terms, no-fault means there should be a no-fault carrier for third party liability. No-fault is like your car insurance. Your car insurance will pay for your bodily injuries in the event of a car accident - not your health insurance. This letter is usually automatically generated based on an accident indicator diagnosis code on a claim your doctor sent in. Any claims that may have a third-party liability (such as no-fault, accident/injury that you're suing for and workers comp) go through subrogation and subro is usually done through a subrogation attorney - which is why you received the letter from the law office. Fill out the letter and just say, you had an accidental fall while riding a horse. There should be questions on the letter about your attorney if you have one, the property owner's information, etc... Fill out the information honestly but give the minimum necessary. If it's a yes/no question - just say yes or no. Do not elaborate. You don't have to.
    Thank you. I'm confused by this - shouldn't my health insurance pay for bodily injuries in any case because that's what I pay for coverage for? How is "no fault" implicating a third party? (not being a smart @ss - just curious!)



  20. #20
    Join Date
    Dec. 19, 2008
    Location
    Where The Snow Flies
    Posts
    2,381

    Default

    Quote Originally Posted by CruisingforGold View Post
    It is called subrogation. Just another way of insurance companies shifting the blame.
    Hey now.... It's not "shifting the blame" it's called coordinating benefits. Be glad the insurance companies subrogate. It's a cost savings measure that does keep premiums down. There is a hierarchy to claims payments when it comes to this and this is defined by law. They need to make sure that any third party liability is address before they pay.

    In my state, our medicaid program does not subrogate, which makes me INSANE! So, a medicaid member can get into a car accident, exhaust their no-fault coverage and sue the car insurance company. The car insurance company can give them a settlement to cover them for their medical bills. In a subrogation situation, this money would go to paying outstanding medical bills first and then if it's exhausted, the health insurance kicks in. Last year, I worked on a medicaid case where the woman received a $100,000 settlement from a no-fault case and because medicaid doesn't subrogate, the woman kept every penny while medicaid covered all of her bills. And, because in our state, we don't consider legal settlements income and don't do asset checks anymore, she got to go to the bank with that and keep her state-funded healthcare. My tax dollars hard at work supporting her. And her "injury" - a torn ACL for which she had surgery and fully recovered.



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