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Need Advice - Medical insurance company possibly looking to recover costs

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  • Need Advice - Medical insurance company possibly looking to recover costs

    A few weeks ago I was had a cross country lesson with my trainer. The lesson was at a farm that is not where I board nor is it owned by my trainer. I signed a waiver and paid for schooling on the property prior to the lesson. During the lesson I fell of and was taken to the emergency room for treatment.

    In the mail today I received a letter from my medical insurance company stating that my claim is under review to see whether other parties could be responsible for my health costs. They specifically mention injuries occurring at work, on commercial property, or in a car accident. However, in the questionaire they included for me to fill out, they want details of the accident which includes a section to be completed if the injury occurred on another person's property. In this section they want the name and address of the property owner, thier insurance company information, and whether I have already filed a claim with them.

    I in no way feel the the property owner is responsible for my accident and do not want my insurance company to pursue them for recovering costs. In fact, I have never met the propery owner. Is there anything I can do here to prevent this or do I just need to fill out the form completely and honestly, sign it, and hope for the best? Any advise on this is appreciate. Thanks.

  • #2
    I had one of those several years ago...I just answered a sound "NO" to every questions that implicated someone else. For the reason for injury, I wrote something like "fell due to own fault" or some such. Don't lie...just give as little info as possible.


    • #3
      Something similar happened to me when I separated my shoulder motorcycle racing. They wanted the information about the guy that (completely unintentionally) hit me.

      I sent them back a letter saying that
      I did not know his name (though he was a friend of a friend, and I could have found out)
      It was not his fault.
      It wasn't on the street
      I had signed a release.

      I had to do it twice, but then they gave up.

      In your case I would send them a letter saying that you had signed a release, and the landowner was not at fault. Then see what happens.

      I would also let the landowner know.

      chief feeder and mucker for Music, Spy, Belle and Tiara. Someone else is now feeding and mucking for Chief and Brain (both foxhunting now).


      • #4
        Just say that you fell off your own horse as a result of your own error. I'm surprised they bothered.. I've cost my insurance company well over $20k in the past year and they haven't tried to get money out of anyone else.
        Against My Better Judgement: A blog about my new FLF OTTB
        Do not buy a Volkswagen. I did and I regret it.
        VW sucks.


        • #5
          answer and answer truthfully, otherwise you put your health insurance at risk
          That being said, when I got one of these, I clearly stated in answer to one of the questions that it was an accident and not anyone's fault.
          I warned the property owner and the horse owner that I had filled out the form so they might be contacted- they never were (and the medical costs associated with this injury were huge).
          There is something about the outside of a horse that is good for the inside of a man.(Churchill)


          • #6
            Tell them you had printed out details of the Obama Health care plan, and they blew into the ring causing your horse to spook, and you fell off. Perhaps Obama is responsible????


            • #7
              So sorry this is happening. This is why I'm so in favor of those waivers and will _ask_ to sign one even if the owner/organizer/instructor doesn't mention it. YOU may not want to sue them, but your insurance company WILL. And if you want your injuries covered, you have to cooperate. I don't think the Equine liability laws have really been tested in most states, but at least I can point to having signed something in advance that says I knew the risks.

              It's sad, but I'm very careful about volunteering information when I go to the doctor. I had a fall recently and got checked out. I did tell them I fell from a horse, it's kind of important for them to understand I fell from six feet in the air, with some momentum behind it, rather than just tripping and falling. The nurse asked if it was my own horse -- and my guard instantly went up. In this case it was, so I didn't mind saying yes, but if it hadn't been, I wouldn't have told them that. Just, "he's one of my favorites!" or something noncommittal, or changed the subject.

              I think you have to be honest and say where the accident happened. I wouldn't do any of their work for them, however, like getting the owner's insurance information. I would give the owner a head's up -- through your instructor or whoever organized the outing if you don't know them.

              I'm not sure whether sending a copy of the waiver you signed would help -- maybe reserve that for the second round, if you can't put them off of this idea by explaining that you fell from your own horse and no one else was at fault.
              ... and Patrick


              • #8
                Originally posted by amastrike View Post
                Just say that you fell off your own horse as a result of your own error. I'm surprised they bothered.. I've cost my insurance company well over $20k in the past year and they haven't tried to get money out of anyone else.
                Yep. I told my insurance company that my most recent accident was my fault, and possibly my horse's fault... and that they were welcome to try and sue my mare to recover the damages, but the property owner was in no way responsible for the accident.

                I never heard another word back and my insurance covered the ER, the Ambulance and all the usual.

                OP - I'm in NC too.
                Dreaming in Color


                • #9
                  By the way, this is very normal and has been SOP for years.

                  I want to echo that this is why it is very important to sign a waiver when you're on someone else's property. It will help prevent your insurance company from suing.

                  I hate them, ugh.
                  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


                  • #10
                    North Carolina has one of these no fault releases that protect the landowner in case of accident. Will that be of use to all involved?


                    • #11
                      I got one of those letters too when I broke my ankle. I suggest calling the number on the form and tell them you fell off your own horse.

                      That is what I did and the stopped looking for someone else to pay.

                      I never stated where I was riding or anything. Simply said I fell off my own horse, end of story.

                      Jetsmom, your comment made me laugh and laugh


                      • #12
                        Pretty standard -- insurance company would love to get someone, anyone besides them to pay for it. I got the same letter when I had a bad fall. I think once your bill hits $x, they send it!

                        I was riding at the boarding barn where I kept my horse. I answered all the questions with the appropriate info (barn owner, etc.) but then I did indicate that I was riding my own horse at a barn where I pay to keep my horse and have signed a waiver and that the fall was no one else's fault beside my #$%!ing horse and my inability to defy gravity. Never heard another thing about it, and I don't think they even contacted the barn owner.


                        • #13
                          Originally posted by jetsmom View Post
                          Tell them you had printed out details of the Obama Health care plan, and they blew into the ring causing your horse to spook, and you fell off. Perhaps Obama is responsible????


                          • #14
                            Had the same thing happen to me a few years back. My bill wasn't that enormous either.

                            At the time I was with Blue Cross; they could easily have paid my bill with a small bit of their CEO's monthly salary. I cannot imagine he would have missed it, but as I don't earn anywhere near seven (or is it eight now?) figures a year, I wouldn't know. Perhaps he could have foregone that second yacht payment.
                            Full-time bargain hunter.


                            • #15
                              Fill out the form, answering the questions honestly. A failure to do so may cause the company to really take a hard look and you won't like that.

                              This happened to me when I got dumped a couple of years ago. Tri-Care sent me the form, I filled it out, and never heard another word. Nor did anyone else.

                              Mangalarga Marchador: Uma Raça, Uma Paixão


                              • #16
                                This is why the place I board at makes us carry a $1 million liability policy that includes the equestrian center and the city (because it is on city property) as additional named insured.


                                • #17
                                  Originally posted by jetsmom View Post
                                  Tell them you had printed out details of the Obama Health care plan, and they blew into the ring causing your horse to spook, and you fell off. Perhaps Obama is responsible????
                                  Love this answer To bad it can not be used

                                  I think this is pretty standard procedure in the case of an accident.

                                  I would answer truthfully the questions you can answer, put an "N/A" or "I don't have the info" is those you can not easily answer such as landowner's insurance co. Attach a statement if there is not room to write it on the form that simply says, I fell off my horse due to no one's fault and I signed a waiver with the person who owns the land. If there is a phone number you can call, you might give that a try too.


                                  • #18
                                    I get one of these letters now with virtually every trip to the doctor that requires xrays. None were really horse-related, but it sure woke me up. On the last one, under potential cause I wrote "old age"......
                                    pace, path, balance, impulsion and ??

                                    Don't panic! Ralph Leroy Hill


                                    • #19
                                      Originally posted by amastrike View Post
                                      Just say that you fell off your own horse as a result of your own error. I'm surprised they bothered.. I've cost my insurance company well over $20k in the past year and they haven't tried to get money out of anyone else.
                                      thats what I did when I shattered my wrist foxhunting a few years ago (and had surgery and 4 months of PT-not a small bill).
                                      No way in hell was I giving them the name of the landowner who's property we happened to be on. I fell off my own horse that I tacked up myself with my own stuff, had nothing to do with them.
                                      "Perhaps the final test of anybody's love of dogs is their willingness to permit them to make a camping ground of the bed" -Henry T. Merwin


                                      • #20
                                        I just got one in the mail for the concussion I suffered during the 'big blizzard of 2010'. I whacked my head on the upper part of Rico's dutch door. So now they want to know if it was work related, etc, etc.

                                        The last time, when Rico kicked me, I made the mistake of mentioning that I was getting my horse for a lesson, so they tried to hone in in my trainer. I shut them down real fast, explained that it was MY horse on MY property, and the trainer hadn't even arrived yet.

                                        I am sure Care First and my employer will all heave a sigh of relief once I become the responsibility of Mr. Trevelyan's health insurance company.
                                        Lowly Farm Hand with Delusions of Barn Biddieom.
                                        Witherun Farm