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Hmmm.. Insurance company letter

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  • Hmmm.. Insurance company letter

    I had a knee arthroscopy 6 weeks ago. I received a letter from my health insurance carrier, Anthem, stating "If another person or entity caused or may be responsible for the injury/illness treated, we have processed the claim in accordance with you contract benefits. However, we may be able to recover the expense of these services from the party causing the injury." As much as I LOVE helmet threads, I think this might give pause to allowing anyone to ride on your property or in your barn without a helmet. Your friends may not sue you, but it sure sounds like the insurance company will. I'm not a lawyer, so correct me if I'm wrong. TIA! The rest of the letter is a questionnaire asking details about when and how and if I was injured. They can't sue my dog, he's the one that did it.

  • #2
    This is why signing a release is so important. Your health insurance company can sue to recover the costs of treating you even without your consent - or more specifically, you gave your consent in advance when you accepted the policy. They'll definitely try to find someone to sue in the case of an expensive accident like a serious brain injury.
    If you are allergic to a thing, it is best not to put that thing in your mouth, particularly if the thing is cats. - Lemony Snicket


    • #3
      I once had a very severe concussion. A few weeks afterwards I got a call from my insurance wanting to know how it happened. I could truthfully answer that I had no idea, I had lost about twelve hours of time.

      I did not tell them I was pretty sure it happened while riding as that is the last thing I remembered. I did not want to give them horse riding fuel.


      • #4
        I've seen it happen - an insurance company went after the BO of a lesson barn for quite some time even though the rider had signed a release. I'm not sure how it resolved in the end.
        The big guy: Lincoln

        Southern Maryland Equestrian


        • #5
          Subrogation: happens all the time.

          I received a letter much like riderboy's and answered it as vaguely as I could. Ohio's equine liability shelter law notwithstanding, I'm not going to help a health insurer screw someone else over.


          • #6
            You better tell your dog to hide his piggy bank!
            Life doesn't have perfect footing.

            Bloggily entertain yourself with our adventures (and disasters):
            We Are Flying Solo


            • #7
              One word: Canada.


              • #8
                I have gotten numerous letters like that. I always say that the accident was my responsibility.


                • Original Poster

                  Originally posted by JER View Post
                  One word: Canada.

                  Only problem with that is summer doesn't always fall on a weekend.


                  • #10
                    JER and riderboy-
                    I have gotten one of those too and to the best of my knowledge my insurance company never went after anybody (even though someone else's horse bit me and I required surgery and lots of OT for it). I am not sure most carriers would have let that one go.
                    There is something about the outside of a horse that is good for the inside of a man.(Churchill)


                    • #11
                      ER and my insurance company wanted to know who was responsible for my crushed toe. I said I got stepped on by horse, and then when I clarified it was MY horse, well that ended the ER inquiries. But the insurance form, which came in the mail weeks later, said that I had to answer the questions ( either because it was the law or because it nullify my insurance.) it was something threatening in any case.


                      • #12
                        I was interviewed as a witness in a case where the insurance company was looking to sue someone. I was very glad to be able to say that it was the insured's own horse and that there was no other factor, that it was just an accident.

                        I shudder to think what would have happened had it been someone else's horse.
                        If you are allergic to a thing, it is best not to put that thing in your mouth, particularly if the thing is cats. - Lemony Snicket


                        • #13
                          Lawyers .....


                          • #14
                            Sadly! Welcome to the real world!
                            Some riders change their horse, they change their saddle, they change their teacher; they never change themselves.

                            Remember the horse does all the work, we just sit there and look pretty.


                            • #15
                              Originally posted by flutie1 View Post
                              Lawyers .....
                              yeah, yeah, everybody hates them until they need one
                              now, if you want to bash the medical insurance industry, I will start the discussion
                              There is something about the outside of a horse that is good for the inside of a man.(Churchill)


                              • #16
                                this is so wierd! I just got a letter in the mail from my insurance company about a riding accident i had nearly 4 YEARS AGO!! I had fallen from my young horse while schooling at home and brok my shoulder and collarbone requiring a lengthy hospital stay and rehab as it all got pieced back together. Now they are looking to find someone else to foot the bill and sent a letter asking whose horse it was, where the accident occured, and if there was anyone else involved! Four years is a long time and I felt they were just looking for any and every excuse to counter sue someone to get out of paying the bill!!


                                • #17
                                  Subrogation is practiced by all insurance companies. Like if anyone has been in a not at fault car accident? Know how you get that deductible back if you elect to get the claim paid via your carrier...yep, it's because your company was able to subrogate against the other persons carrier.

                                  Even insurance companies need to make money as they are businesses after all and not providing coverage out of the goodness of their hearts.


                                  • #18
                                    Don't blame the lawyers. They just do what the insurance companies want them to do.

                                    I'd much prefer the old New Zealand no fault insurance system. Then there is no blame and the insurance companies (which in most cases is the government) is simply insuring RISK, which is what insurance was created to do in the first place. But I don't know if New Zealand even still has no fault.
                                    "I'm a lumberjack, and I'm okay."
                                    Thread killer Extraordinaire


                                    • #19
                                      You bet your sweet bum they have agencies pouring through documets hoping to glean $$$

                                      Example 1. My daughter took jer pet rat to school, in the excitement of classroom it bit her, never has before or since but teacher had left room so who knows what was going on. Go to doctor explain it was our rat at school on show and tell day after having to explain this 5 other times to different doctors and nurses I was getting pissy as each and everyone of them had a chart and was very worried how she got this wild rat that could have rabies. For the 6th time a domestic rat born in our home cage and after 3 hours we left with meds, wraps, etc. 2 years later a get a investigator wanting to know name of school, district, teacher because they want their money back (hospital) for the rat bite cleaning, wrapping and neoporin... This went on for months until I call up HMO and said call off your dogs and they did but think about this the total for this visit according to paper work was $675 NUTS these investigators


                                      • #20
                                        Just close all the doors you can

                                        1.) It was my responsibility.
                                        2.) I was on my property at home.
                                        3.) Lightning struck, or storm started, or whatever else they can't go after money for.

                                        Love the answer "was unconscious for 12 hours"!

                                        The cost to send out a form letter is very low. Keep the response short and to the point.