Can my health insurance company refuse to pay for my son's broken arm because it happened at the neighbors?

Question

My son broke his arm playing at the neighbor's house. Can my insurance company refuse to pay for the medical expenses? We got a letter stating that they wanted us to use the neighbor's homeowners insurance and possibly sue them. I DO NOT want to do this and ruin our relationship with the neighbors. Can insurance companies refuse to pay if you refuse to make a stink about it with the neighbors?

Answer 1

If your neighbors Home Owners Insurance is not paying the claim, or you are not going to file a claim with the, you should call your medical insurance company and ask them what you should do. I work for an insurance company in PA and we would still pay the claims unless someone told us that there another party liable, but the laws can  vary from state to state.

Answer 2

Absolutely!

Answer 3

Your insurance company can probably pay for your son's medical expenses and then go after your neighbor's insurance company in a process called subrogation. (Auto insurance companies do this daily -- I would be surprised if a healthcare company couldn't do the same.) This would keep you from having to sue your neighbors, and would distance both you and your neighbor from the situation. You might suggest this route to your insurance carrier.

Answer 4

Unfortunately you already told them it happened there.  So, yes they can make you try to get their homeowners to pay first.  If someone else is liable for the medical payments then the insurance company won't want to pay naturally.  You can pay out of pocket and you won't have to worry about it.  Next time you know how to answer the questions on the form.

Answer 5

No, they can't refuse to pay out.  BUT, when they do, there's a clause in your policy, that you automatically give THEM the right to go after the homeowner, for reimbursement of up to the amount they paid out.  Generally, they'll also try to get your deductible and copay out of it, also.  

So it's not YOU making the stink, but you can bet they will.

Answer 6

They should'nt.

Answer 7

Take the letter to your neighbors and show it to them.

A homeowners policy has two coverages that could apply (Medical Payments and Liability Coverage).

Tell your neighbors you will need to file against the Medical Payments coverage on their homeowners policy- it may help to show them the letter from the health insurance co.  Medical Payments coverage pays when someone is injured on your property -regardless of fault.  Most homeowners policies provide Medical Payments coverage with a limit of $5000 (five thousand).

Homeowners coverage also has liability coverage. That pays when your negligence causes an injury to someone. Tell your neighbor - you do not believe they were negligent and do not want to pursue a claim against this - that you have no intention of suing them.

Once the homeowners medical payments coverage pays -the adjuster can send you a letter stating that the coverage limit is exhausted and no other coverage applies to the loss. Usually once you give that to the health insurance they will pick up the rest of the medical bills.

This way, you can still keep the relationship in tact with the neighbors and your health insurance will pay.

Answer 8

Yes because it did happen at the neighbor's.

They have to have public liability insurance by law.

Your company rightfully will not pay a bill they don't owe, just like you wouldn't.

Answer 9

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