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Homeowner claim: Would you be mad?


goldberry
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Clark Howard has warned listeners to his show to use a pay phone if they ever need to call their homeowners insurance company to ask a question about their policy. Apparently he's had listeners let him know that they called from a home phone to ask a general question about "Would this be covered?" and the insurance company looked up the phone number and then proceed to cancel their policy. Sometimes people weren't even trying to make a claim!

 

I heard this years ago. I'll search to see if I can find a link.

 

ETA: Here's a link. https://books.google.com/books?id=rBMbqu0tSCkC&pg=PA155&lpg=PA155&dq=clark+howard+homeowners+insurance+canceled&source=bl&ots=Uuqfp-f1os&sig=FXIArXCd8M1p9PFqqjC8HmWJ-t4&hl=en&sa=X&ei=eBiOVYeTK4O0-QGItoCYDQ&ved=0CDQQ6AEwBQ#v=onepage&q=clark%20howard%20homeowners%20insurance%20canceled&f=false

 

I had some of the details wrong, but the general idea of being wary was correct.

 

He said he's receieved many calls from listeners that reported an incident on the property and a case was opened without their knowledge. The insurers acted as if a claim were made, even when one was never actually filed. After a couple claims, even for small amounts, insurers often cancel the policy, and a new policy from another company will be much more expensive. This is why he says to only use HOI for "catastrophes," because it isn't worth the risk of having your policy canceled.

 

I don't see how insurers are allowed to get away with this garbage. It's like the stories of health insurance companies finding excuses not to pay.

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I have to admit being stymied about many of these insurance stories.  I know we (personally) live in an abnormal world, but our farm insurance which also covers liability on our rental properties only costs us $2100/year (now - our bill is due July 1st).  That's less than $200/month and provides us $$$ if we ever have issues with our house, barn, and a handful of outbuildings as well as liability when others come on our properties - any of them.  We have a pond (about 1 acre in size) and ponies (9 currently - has been up to 28 when we were at our peak), both potentials for "extra" issues beyond fire and storms, etc.

 

Perhaps 10 years ago we had that liability claim due to our stallion kicking our pony watcher's friend (who had no permission to be in with him) and it didn't raise our rates nor cancel our policy.  We didn't even have any "proof" that she got injured here - just the word of our pony watcher and the friend.  We never paid an extra penny.  All health bills were covered.

 

I guess when I think about it this morning, I'm glad we live in our abnormal world if all those other things are going on elsewhere.

 

Well, I'm still in favor of Universal Health Care of some sort, but that's unlikely to happen here for quite some time I suspect.

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So your credit rating didn't take a hit? Perhaps it was to small an amount (in the grand scheme of things) for them to pursue and report to the credit bureaus. That's a shame, IMO. Other people had to pay more because you didn't pay your bills. Even paying a little bit helps everyone and hospitals routinely reduce bills and work out payment plans with people. Gracious, my mother paid $20 per month on a hospital bill for years. 

 

Not everyone who can't pay a hospital bill qualifies for Medicaid - it just doesn't work like that. 

 

It's not even possible to pay a bill with money you don't have, so I don't understand your last comment. In any case, paying a bill (or seeing that it gets paid through insurance or Medicaid, if applicable) doesn't mean the person is  "SOL" - it means they're acting in a responsible manner. 

 

If I had $20, I would have paid $20 toward my mortgage (which was $250/month and which we failed to pay due to lack of money plenty often), not toward a hospital bill. Credit rating... what Martha said.

 

You can pay a bill with money you don't have if you ask a friend for a temporary loan, or get a pay-day loan, or any of that nonsense. You can pay a bill today with money you need to buy groceries and diapers tomorrow and not end up not being able to eat for the rest of the month. Point being, there are various ways to pay bills with money you don't have, and you definitely would be SOL to do so, especially if you then sign up for Medicaid and Medicaid pays for unpaid hospital bills that you don't have because you paid them with money you don't have. Medicaid isn't going to pay your pay-day loan you took out to pay the hospital bill, or give you diapers.

 

Anyway, I'm done. I pointed out that instead of filing on a friend's HOI or suing your friend, there *are* other options if you don't have the money to pay your hospital bills, including the option to just not pay it and deal with the consequences of that. Of course paying your bills is the preferred option. No kidding. I explained the situation in which we chose to not pay the bill (which should have been covered by our insurance but wasn't because the hospital insisted on filing the claim wrong) in another post, but regardless, you can leave the judging for after you've walked in my shoes. I still have flashbacks/panic attacks at times about being destitute with an unmedicated bipolar spouse and a practically nonverbal autistic toddler and the bedroom (the only room with heating) dropping below 45F in the daytime in the winter.

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So, I call bull shit on the person claiming against someone's home owners policy for an accident in their home. The person was stupid or selfish or lazy enough not to get their own health insurance, and then greedy enough to go after their friend's home owners policy. 

 

 .

Others have already responded to this post better than I.  But I am in awe that in this day and age you could still think something like the bolded.  

 

 

 What happens now is each insurer will make a detailed evaluation of the exact terms of their contract, determine liability and then argue over which company pays.  Often it will be a split in liability between more than one party and more than one insurance company.  And, the insured may have agreed to cooperate with any litigation as a condition of being insured- this information will be in the fine print of your insurance agreement. 

 

 

This is my understanding as well.  The word "fault" no longer seems to mean what it used to mean, and is entirely determined by legal definitions rather than by moral definitions.  So yes, sometimes your insurance company will rule on whose liability it is depending on many things, including the location of the accident or whose car you were driving.  I am surprised more people don't know that about driving - when you have an accident in a friend's car, the friend's insurance will be the one to pay in most states.  Is that "fair"? Probably not.  But I doubt anyone is going to try to say, "No, let me pay that $10,000 bill even though your insurance will legally pay for it."  And as a friend, I would not expect that from another friend.  That would be ridiculous.  That is what insurance is for and we are bound by the legal definitions the insurance decides.  We don't have any control over that.

 

 

 

 

If you truthfully file the claim, most insurance companies will follow up and ask for additional information. Not being truthful when they request additional information is insurance fraud.

This is very true, it has nothing to do with personal responsibility.

 

 

First, how did she break her arm?  Was her shoe untied and she tripped over her own laces or were there toys everywhere or some unsafe condition that caused her to trip?  If my friend called and asked if I had HOI, I'd supply the info.  Just because she tries to make a claim it doesn't mean it'll be approved.  My friend getting a lawyer, however, would give me pause (at least if it was an untied shoe sort of thing and not anything to do with my house).  The homeowner in this situation really escalated the issue by not providing their HOI information.

Let's assume for the sake of argument that the person really did just trip over her own feet. It is still for the insurance company to hash that out.  Most insurances do require a measure of negligence.  However, some will settle just based on the fact of the location, that it happened inside a covered area.

 

I thought from the first that the person would never have gotten a lawyer involved if the homeowner had not reacted so dramatically and refused to give the information.  But someone else said, they would be angry to even be asked, so apparently that feeling is not unheard of.  That's part of what I was trying to understand here by asking the question.

 

 

 

Just because you *can* go after a property owner -- whether directly through a personal suit, or somewhat indirectly -- through a claim against their insurance policies, does not, at all, make it ethically or morally right. 

 

As I mentioned before, maybe it is not "fair" that your policy or mine might take a hit because of something that happened through no fault of our own.  But the way insurance determines liability is not always based on "fault" in the sense that we typically use that term.  

 

Also, I find that argument amusing somewhat... when we have talked before about companies paying *no taxes* by hiring vast quantities of lawyers and accountants to use every loophole possible, it is always argued, "well, they are working within the system, they are not doing anything illegal."  You could use the same argument, just because it is possible or legal, does not make it moral or ethical.  But nobody seems to have a problem with large companies working the system like that.

 

*******

 

Anyway, thanks to everyone who responded.  I personally would think, wow, that kind of sucks, but that's what insurance is for.  I would think my friend was using legal means at her disposal to get her bills paid (which she truly could not afford), and that is the way the system works.  I would not hold it against my friend in any way really, UNLESS she tried to come after me for more money than she actually needed to pay her bills.  

 

I appreciate hearing the other responses though, since that is why I asked, to better understand the mindset behind the other point of view.  Hive comes through, as always!   ;)   Thanks again!

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This is my understanding as well.  The word "fault" no longer seems to mean what it used to mean, and is entirely determined by legal definitions rather than by moral definitions.  

 

Yes, that's true. People in CA were fit to be tied when no-fault auto insurance became the standard. They really needed the accident to be the "fault" of the person who caused the accident. The had a hard time wrapping their minds around moral, ethical, and legal fault vs insurance fault.

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If you don't have money and don't have insurance, you just basically ignore the hospital bills, and eventually it all disappears. BTDT. Never had to file for bankruptcy.

 

Also, Medicaid will cover stuff that happened in the past x days (don't remember the value of x) if you sign up for Medicaid right afterward and the bills haven't been paid yet (so, if you paid the hospital out-of-pocket with money you didn't have, you're SOL). That's what we did when C ran into a counter at La Michoacana a few years ago, needing stitches in his forehead. The grocery store's insurance was never involved in those medical bills. It didn't even occur to us to involve them.

 

I've never had homeowner's insurance though, so I don't know. If someone had been unfortunate enough to break a limb in our house, they could have sued us personally, and gotten acquainted with the saying "getting blood from a stone".

 

ETA: we're renting now.

It takes several months and mountains of truth-containing paperwork to be approved for Medicaid. We went through this two years ago to obtain Medicaid for my mother.

 

I am genuinely perplexed by the description that the process is so easy. The only back-dated coverage was nursing home room/board/care from the date of Medicaid application.

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It takes several months and mountains of truth-containing paperwork to be approved for Medicaid. We went through this two years ago to obtain Medicaid for my mother.

 

I am genuinely perplexed by the description that the process is so easy. The only back-dated coverage was nursing home room/board/care from the date of Medicaid application.

No kidding. If someone is combining the words "government" and "assistance" then there's no way in heck it is easy or quick. Expect it to be a full time job to navigate it, validate it, keep it, and maintain it.

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It takes several months and mountains of truth-containing paperwork to be approved for Medicaid. We went through this two years ago to obtain Medicaid for my mother.

 

I am genuinely perplexed by the description that the process is so easy. The only back-dated coverage was nursing home room/board/care from the date of Medicaid application.

Hmm, we're on Medicaid and it was quite simple. Fill out application, give copies of pay stubs, driver's license and social security cards and wait 2 weeks to get the approval letter. We had an issue once with them losing paperwork but since I had photocopied it with the date stamped on it from the office they made everything retroactive from that date. So its not always hard to get it.

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Hmm, we're on Medicaid and it was quite simple. Fill out application, give copies of pay stubs, driver's license and social security cards and wait 2 weeks to get the approval letter. We had an issue once with them losing paperwork but since I had photocopied it with the date stamped on it from the office they made everything retroactive from that date. So its not always hard to get it.

Each state varies, as I should have recalled. We had to provide five years of tax and financial information. No gaps or omissions allowed. Had my mother made any "gifts", the entire application would have failed. My father was using a top-ranked, for our major metro area at least, eldercare attorney. We had done our homework before selecting him, and his fees were worth it, because of how much money in the long run he saved my father. It took either seven or eight months in our case. My father was refunded that many months' of his payments to the nursing home.

 

Are you, by chance, speaking of the Medicaid program for children? (called CHIP here in Texas) That logically could have greatly different application requirements.

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I think for the elderly, they can go back 5 years to be sure the patient didn't sign the house or expensive possessions over to relatives to just look poor when they file. Going back 5 years may prevent someone getting close to needing extensive medical care and giving possessions away right beforehand as a slick way to try to keep the gov't requiring the house or other expensive possessions be used for medical bills instead of just Medicaid paying for it all. That's probably why it is a more extensive process for an eldery person vs. a young family.

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Each state varies, as I should have recalled. We had to provide five years of tax and financial information. No gaps or omissions allowed. Had my mother made any "gifts", the entire application would have failed. My father was using a top-ranked, for our major metro area at least, eldercare attorney. We had done our homework before selecting him, and his fees were worth it, because of how much money in the long run he saved my father. It took either seven or eight months in our case. My father was refunded that many months' of his payments to the nursing home.

 

Are you, by chance, speaking of the Medicaid program for children? (called CHIP here in Texas) That logically could have greatly different application requirements.

5 years of tax and financial info?!?! That is a crazy amount of info to gather. No not CHIP. Dh and I have Medicaid too.

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I think for the elderly, they can go back 5 years to be sure the patient didn't sign the house or expensive possessions over to relatives to just look poor when they file. Going back 5 years may prevent someone getting close to needing extensive medical care and giving possessions away right beforehand as a slick way to try to keep the gov't requiring the house or other expensive possessions be used for medical bills instead of just Medicaid paying for it all. That's probably why it is a more extensive process for an eldery person vs. a young family.

 

This is what I was thinking.

 

The deep level of scrutiny is why I would have expected Medicaid to be denied if coverage were sought immediately following an expensive medical procedure or hospitalization as a means of paying for it.  "Sits funny" with me.      

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5 years of tax and financial info?!?! That is a crazy amount of info to gather. No not CHIP. Dh and I have Medicaid too.

 

It WAS a crazy ride.  DH and I assisted my father (who lives with us) throughout the process.  Bank statements.  Life insurance policies.  Tax filings.  Property taxes.  Investments.  The whole shebang.  My Dad is hoping that he won't have to go through this for himself someday.  (He is 93, and pretty tired by now!)

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Are you, by chance, speaking of the Medicaid program for children? (called CHIP here in Texas) That logically could have greatly different application requirements.

 

CHIP is not Medicaid for children. When I was pregnant with B, I was on CHIP, because I'm not a citizen. The moment he was born, he was covered by Medicaid though, and NOT by CHIP, which was a hassle that took several months for the hospital to understand, but eventually they did figure it out. I'm not entirely sure what the differences are between CHIP and Medicaid, as CHIP does cover children and pregnant people, but so does Medicaid. IIRC, CHIP is for children and pregnant people who somehow don't qualify for Medicaid. I'm glad to be able to not worry about the difference now though.

 

CHIP sucks. CHIP meant I had to use an OB 60 miles from where we lived, even though there were two decent size cities in between where we lived and where the OB was. Which then also meant that I had to give birth in a hospital 60 miles from where we lived. Which then meant that when B was born and he was turning blue when they tried to feed him (according to the hospital staff - I never witnessed that), they called the pediatric hospital 3.5 hours driving from where we live to transport him there (saying he might be in the hospital for several weeks). It took a lot of arguing to convince them to take him to a pediatric hospital that was 1.5 hours from where we live instead (both hospitals were about the same distance from the hospital I gave birth in, but they had an agreement that they'd transport to the one in the wrong direction from us). On the bright side, the pediatric hospital fed him and he didn't turn blue... B turned out to be a perfectly healthy newborn after all.

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It WAS a crazy ride. DH and I assisted my father (who lives with us) throughout the process. Bank statements. Life insurance policies. Tax filings. Property taxes. Investments. The whole shebang. My Dad is hoping that he won't have to go through this for himself someday. (He is 93, and pretty tired by now!)

I jinx myself saying how easy Medicaid was for us the other day. Today I got 3 letters from social services. One telling me dh is losing coverage because he makes too much for a family of 2(umm we are a family of 6) one saying my kids all still have coverage because our income is less than the income limit for a family of 6(I thought they just said we were a family of 2) and I lost coverage because I'm neither pregnant nor do I have any children under my care(umm I have 4 that your other letter just told me still have coverage!)

 

I called to get it figured out and it was very obvious my caseworker has off work tomorrow and was trying to get me off the phone to start her long weekend. She said she'll figure it out and call me Monday. Note to self, never talk about how easy anything is ever again.

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Homeowner was shocked that "such a good friend would even consider filing a claim on homeowner's insurance".  She could not believe friend would ask that question and that their friendship was clearly over.

 

Then of course she got REALLY mad when friend got a lawyer.  But honestly I wasn't surprised friend got a lawyer when homeowner told me how she responded to the phone call.  She told the person, "I'm not giving you my homeowner info and this conversation is over."

I don't blame the homeowner.  Geez, get your own health insurance. 

 

How is it the homeowner is responsible for this fall?   Unless the homeowner created a nuisance, the homeowner isn't responsible in any way for an accident.

 

Remember "accidents"?  That's what used to happen before the world went crazy.

 

When I was a child, the boy next door hit me in the eye with a rock from a slingshot.  He didn't know I was behind an obstacle.  I spent days in the hospital and they didn't know if I would lose my sight. 

 

It was a freaking ACCIDENT.  Not at any time did my parents threaten his parents. 

 

I will tell you I never once let my kids have slingshots or be around them at all though. 

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So now I'm confused.  Does this mean that the times that my children bumped their head while jumping up and down in the kitchen and hitting a cupboard door that was left open and needing stitches, or sliding across the kitchen floor and crashing into the radiator and needing stitches, or jumping off the bed and missing and hitting their head and needing stitches, etc., etc., should have been covered by our homeowners insurance instead of our health insurance?  Does this work for when it happens in your own home as well?

What's wrong with your kids!  They should have SUED you for those dangerous nuisances like furniture and cabinets that you keep in your house.  How reckless of you. 

 

(kidding)

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I am in agreement with the comments here..  I would have no problem with a friend filing a claim with my homeowners insurance for an accident that occurred in my home. I would be upset if they tried to defraud me or claim the injury was worse than it was.  But just to get medical bills, etc. covered, that seems perfectly normal to me.

 

I was really surprised this person took offense right at the beginning.  Just made me curious if anyone else would have felt that way. 

But it is an accident, unless the homeowner left a dangerous situation in her home and did not warn guest.

 

How is homeowner remotely responsible for an accident that happened at her house but just as easily could have happened at the victim's house or walking down the street?    Kind of makes me want to never have anyone over ever. 

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If you were hurt in a car accident in a friend's car, wouldn't you expect their insurance to cover your medical expenses? Filing a claim against insurance does not equal personally suing a friend. Homeowner's insurance may not be the appropriate coverage for this accident. We don't know the facts or the applicable state law. But if it is, using the appropriate insurance shouldn't be seen as being some evil suit-happy gold digger.

 

IME (as an attorney), people are always "oh I'd never!" until it happens to them. ;)

That's entirely different in a car.  You are not in control of your own actions in the friend's car.  If she hits someone or someone hits the car, that is a car insurance matter.

At home, you are entirely responsible to act appropriately on your own, and once in awhile, accidents still happen. 

 

I'm flummoxed that it seems some people believe that it is the location's fault if you have an accident and fall, absent any evidence of negligence. 

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Others have already responded to this post better than I.  But I am in awe that in this day and age you could still think something like the bolded.  

 

 

 

This is my understanding as well.  The word "fault" no longer seems to mean what it used to mean, and is entirely determined by legal definitions rather than by moral definitions.  So yes, sometimes your insurance company will rule on whose liability it is depending on many things, including the location of the accident or whose car you were driving.  I am surprised more people don't know that about driving - when you have an accident in a friend's car, the friend's insurance will be the one to pay in most states.  Is that "fair"? Probably not.  But I doubt anyone is going to try to say, "No, let me pay that $10,000 bill even though your insurance will legally pay for it."  And as a friend, I would not expect that from another friend.  That would be ridiculous.  That is what insurance is for and we are bound by the legal definitions the insurance decides.  We don't have any control over that.

 

 

 

 

This is very true, it has nothing to do with personal responsibility.

 

 

Let's assume for the sake of argument that the person really did just trip over her own feet. It is still for the insurance company to hash that out.  Most insurances do require a measure of negligence.  However, some will settle just based on the fact of the location, that it happened inside a covered area.

 

I thought from the first that the person would never have gotten a lawyer involved if the homeowner had not reacted so dramatically and refused to give the information.  But someone else said, they would be angry to even be asked, so apparently that feeling is not unheard of.  That's part of what I was trying to understand here by asking the question.

 

 

 

As I mentioned before, maybe it is not "fair" that your policy or mine might take a hit because of something that happened through no fault of our own.  But the way insurance determines liability is not always based on "fault" in the sense that we typically use that term.  

 

Also, I find that argument amusing somewhat... when we have talked before about companies paying *no taxes* by hiring vast quantities of lawyers and accountants to use every loophole possible, it is always argued, "well, they are working within the system, they are not doing anything illegal."  You could use the same argument, just because it is possible or legal, does not make it moral or ethical.  But nobody seems to have a problem with large companies working the system like that.

 

*******

 

Anyway, thanks to everyone who responded.  I personally would think, wow, that kind of sucks, but that's what insurance is for.  I would think my friend was using legal means at her disposal to get her bills paid (which she truly could not afford), and that is the way the system works.  I would not hold it against my friend in any way really, UNLESS she tried to come after me for more money than she actually needed to pay her bills.  

 

I appreciate hearing the other responses though, since that is why I asked, to better understand the mindset behind the other point of view.  Hive comes through, as always!   ;)   Thanks again!

We need to eliminate insurance companies and their billion dollar profits. 

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That's entirely different in a car.  You are not in control of your own actions in the friend's car.  If she hits someone or someone hits the car, that is a car insurance matter.

At home, you are entirely responsible to act appropriately on your own, and once in awhile, accidents still happen. 

 

I'm flummoxed that it seems some people believe that it is the location's fault if you have an accident and fall, absent any evidence of negligence. 

 

If you read the thread though, you will see it is not "some people" who think that, it has to do with the insurance company.  Even if the person had health insurance, their health insurance could and probably would still go after the homeowner insurance.  It's a lot less personal than it seems on the surface.  

 

Regarding the car comment, though, this was referring to the situation where you let someone else drive *your* car.  If that person gets into an accident, even though she was driving, it will be *your* insurance that pays in most states.  It was given as an example of how the definition of fault and responsibility are different in the insurance world, whether we agree with them or not. 

 

 

 And yes, I agree with you other comment...I think pretty much all insurance companies are evil. :glare: Sometimes I am glad they are there though. 

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That's entirely different in a car. You are not in control of your own actions in the friend's car. If she hits someone or someone hits the car, that is a car insurance matter.

At home, you are entirely responsible to act appropriately on your own, and once in awhile, accidents still happen.

 

I'm flummoxed that it seems some people believe that it is the location's fault if you have an accident and fall, absent any evidence of negligence.

It's not "some people." It's liability law. Deciding which type of insurance covers damage is an established field of law. It isn't just something crazy people on this thread made up for funsies.

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It's not "some people." It's liability law. Deciding which type of insurance covers damage is an established field of law. It isn't just something crazy people on this thread made up for funsies.

Oh, crazy people did make it up (and legislated it) but I understand it is the current convoluted state of liability law. 

 

It is still not right though.  Accidents do happen. 

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It's not "some people." It's liability law. Deciding which type of insurance covers damage is an established field of law. It isn't just something crazy people on this thread made up for funsies.

 

Did we ever see any details on the accident?  Just curious as some have been arguing the homeowner was definitely wrong but for all we know they were negligent.

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…...

I'm flummoxed that it seems some people believe that it is the location's fault if you have an accident and fall, absent any evidence of negligence. 

 

It often has nothing to do with fault. IME, most homeowner's policies include a provision for $1000 per person per event for medical payments with no regard to fault. It's known as a good neighbor clause. More than that, the injured party would have to prove liability on the part of the homeowner. 

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Are some people just skimming the thread?  They are still acting like the lady with the broken arm had any control over the issue.  I got bit by a black widow years ago at my aunt's house.  At the ER, they asked me what happened...  I told them, having no idea what would happen next.  2 weeks later I get a call from my health insurance company asking for ALL of my aunt's information so they could see if her homeowner's insurance would cover it.  I couldn't them say "nope, didn't happen there" as it was in writing in my medical file.  I wasn't willing to commit fraud.  I called my aunt immediately and apologized.  Thankfully they didn't find them at fault....

Anyway - point being, I have fantastic medical coverage, but it didn't matter....

 

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It takes several months and mountains of truth-containing paperwork to be approved for Medicaid. We went through this two years ago to obtain Medicaid for my mother.

 

I am genuinely perplexed by the description that the process is so easy. The only back-dated coverage was nursing home room/board/care from the date of Medicaid application.

 

 

No kidding. If someone is combining the words "government" and "assistance" then there's no way in heck it is easy or quick. Expect it to be a full time job to navigate it, validate it, keep it, and maintain it.

 

 

Hmm, we're on Medicaid and it was quite simple. Fill out application, give copies of pay stubs, driver's license and social security cards and wait 2 weeks to get the approval letter. We had an issue once with them losing paperwork but since I had photocopied it with the date stamped on it from the office they made everything retroactive from that date. So its not always hard to get it.

 

 

Each state varies, as I should have recalled. We had to provide five years of tax and financial information. No gaps or omissions allowed. Had my mother made any "gifts", the entire application would have failed. My father was using a top-ranked, for our major metro area at least, eldercare attorney. We had done our homework before selecting him, and his fees were worth it, because of how much money in the long run he saved my father. It took either seven or eight months in our case. My father was refunded that many months' of his payments to the nursing home.

 

Are you, by chance, speaking of the Medicaid program for children? (called CHIP here in Texas) That logically could have greatly different application requirements.

 

 

It varies state to state and if you have any assets it really makes it complicated.

 

DD8 (my great niece who I am the legal guardian of) is considered her own household so she qualifies for state insurance and a small amount of cash.  But since she lives with us,and I am her guardian, they require us to submit all of our assets for consideration also.  Even though she is one of 5 of us, they consider 25% of our income as her household, and base her payments accordingly.  To raise my special needs neice (DD8) the state gives her $220 per month to live on.  :0(  If we weren't capable of paying the rest, I have no idea how anyone could provide for her on that amount.

 

Tax records for our household

All of our retirement pensions, 401k, and investments (multiple companies over 25 years of employment and multiple states...even though we can't access the money, they still want to know how much is there)

Property values, taxes and insurance  ETA proof of our value and monthly payment requirements ie loan statements

Car values for all 5 of our cars (they use Kelly Blue Book and add in all the features for every car) and insurance premiums

All of our investments are considered one-by-one so they have to have full accounting of each buy sell of investments

Record, with of start/end dates of our jobs (including our teenagers), 3 months of pay stubs (dh and I are paid weekly so that alone was 24 pages of documents)

Unemployment data including asking for proof that dh was no longer on unemployment after he got a new job (we had no way to prove this, so they had to call the employment division themselves, while I waited to get verification???) 

When we closed our business, we had to prove that we not only closed it but were no longer operating it.  ??? We asked them how we were supposed to do this, write them a letter a letter ourselves, saying we had closed it?  We had to find someone to verify that we had indeed closed it, and were no longer operating it.

ETA: Bank statements from all of our banks showing how much money is in each acount.  We have 4 credit unions we use for various reasons (better loan rates, one has a kiosk at my sons college etc), so I have to show bank statements from each to show how much cash we have on hand at that time.

 

Our stack of documents for each year, is over an inch thick! I plan at least half a day to get documents together, and a half day to go to the office and reapply.  I can't fax or mail the documents because they have lost them in the past and trying to figure out what they were missing from an inch of documents is a horror I don't want to go through again.

 

 

If we didn't have investments or retirement funds.... If we only had monthly paychecks and hadn't had a business, it wouldn't have been a big deal. 3 paycheck stubs, a Kelly Blue Book of the cars, mortgage amount/rental agreement, and we would be out the door. Some employers even post online, so some people don't even have to provide those documents. But for those of us who have a few assets.....it can be a nightmare! 

We are not wealthy at all. Upper lower class at best. One home, 4 cars (teenage drivers) a couple of investments, and retirement funds from previous employers. Dh and I used to pick up second jobs at various times. One of my retirement pensions has $300 dollars in it, but I still have to provide current values and documentation for it.

 

That is just to get medical coverage and $220 a month.  You should see what I have to do to get her special needs day care approved every year.  Another inch (not exaggerating) of documents by multiple medical providers, test results, IEPS, neuropsych evals and personal letters from teachers and doctors.

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It often has nothing to do with fault. IME, most homeowner's policies include a provision for $1000 per person per event for medical payments with no regard to fault. It's known as a good neighbor clause. More than that, the injured party would have to prove liability on the part of the homeowner. 

Yes, but the deductible is much higher than that  - at least mine is.  It would be all out of pocket anyway, and there would be a claim on the home, with a corresponding CLUE report so your rates would go up.  Everyone who has been in the real estate biz in any capacity understands that you never, ever make claims on the home insurance absent disaster- level incidents like Katrina. 

 

I would rather the person just take care of it himself, or at least talk to me about getting me to pay for HIS accident.  And I'd be pissed for his failure to have insurance because it negatively affected me. 

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It varies state to state and if you have any assets it really makes it complicated.

 

DD8 (my great niece who I am the legal guardian of) is considered her own household so she qualifies for state insurance and a small amount of cash.  But since she lives with us,and I am her guardian, they require us to submit all of our assets for consideration also.  Even though she is one of 5 of us, they consider 25% of our income as her household, and base her payments accordingly.  To raise my special needs neice (DD8) the state gives her $220 per month to live on.  :0(  If we weren't capable of paying the rest, I have no idea how anyone could provide for her on that amount.

 

Tax records for our household

All of our retirement pensions, 401k, and investments (multiple companies over 25 years of employment and multiple states...even though we can't access the money, they still want to know how much is there)

Property values, taxes and insurance 

Car values for all 5 of our cars (they use Kelly Blue Book and add in all the features for every car) and insurance premiums

All of our investments are considered one-by-one so they have to have full accounting of each buy sell of investments

Record, with of start/end dates of our jobs (including our teenagers), 3 months of pay stubs (dh and I are paid weekly so that alone was 24 pages of documents)

Unemployment data including asking for proof that dh was no longer on unemployment after he got a new job (we had no way to prove this, so they had to call the employment division themselves, while I waited to get verification???) 

When we closed our business, we had to prove that we not only closed it but were no longer operating it.  ??? We asked them how we were supposed to do this, write them a letter a letter ourselves, saying we had closed it?  We had to find someone to verify that we had indeed closed it, and were no longer operating it.

 

Our stack of documents for each year, is over an inch thick! I plan at least half a day to get documents together, and a half day to go to the office and reapply.  I can't fax or mail the documents because they have lost them in the past and trying to figure out what they were missing from an inch of documents is a horror I don't want to go through again.

 

 

If we didn't have investments or retirement funds.... If we only had monthly paychecks and hadn't had a business, it wouldn't have been a big deal. 3 paycheck stubs, a Kelly Blue Book of the cars, rental agreement, and we would be out the door. Some employers even post online, so some people don't even have to provide those documents. But for those of us who have a few assets.....it can be a nightmare! 

We are not wealthy at all. Upper lower class at best. One home, 4 cars (teenage drivers) a couple of investments, and retirement funds from previous employers. Dh and I used to pick up second jobs at various times. One of my retirement pensions has $300 dollars in it, but I still have to provide current values and documentation for it.

 

That is just to get medical coverage and $220 a month.  You should see what I have to do to get her special needs day care approved every year.  Another inch (not exaggerating) of documents by multiple medical providers, test results, IEPS, neuropsych evals and personal letters from teachers and doctors.

Good Lord.  What a mess. 

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How would that work? Who would pay for accidents that cause damage to people, vehicles, homes, etc.?

Pay for it yourself as was done pre-insurance days. Who paid for them before insurance companies raking in our money and keeping billions of dollars in profits?   Prices would magically go down, and you'd have loads more income to cover it.  You might need to make bartering arrangements or pay on time, but it could be done. 

 

About health stuff, with their insanely ridiculous, no-basis-in-reality costs, I just don't know.

 

I did pay out of pocket for one surgery.  I paid a few thousand direct.   It would have cost me about $35,000-40,000 to use insurance system. 

This would benefit everyone if we could widely implement it.  But no, let's just keep paying 40% of our income in taxes (when you include everything that is taxed) and wonder why we don't have any money.

 

My friend talked me into going to the emergency room due to a sign she thought was troubling.  Doc came and could not find a hernia that I had to direct him to, I showed him, and he said it was fine and released me (which I knew). 

 

I got a multiple bills for almost $2000 beginning in two days.  How is that rational? 

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Are some people just skimming the thread?  They are still acting like the lady with the broken arm had any control over the issue.  I got bit by a black widow years ago at my aunt's house.  At the ER, they asked me what happened...  I told them, having no idea what would happen next.  2 weeks later I get a call from my health insurance company asking for ALL of my aunt's information so they could see if her homeowner's insurance would cover it.  I couldn't them say "nope, didn't happen there" as it was in writing in my medical file.  I wasn't willing to commit fraud.  I called my aunt immediately and apologized.  Thankfully they didn't find them at fault....

Anyway - point being, I have fantastic medical coverage, but it didn't matter....

That's crazy.  I've never had anyone ask where something happened.    Just what happened.    I guess I would have said, "Well, I was walking and tripped over a (whatever)"  It would never occur to me to say, "I was at my Aunt Joan's house and walked across her living room and tripped over (whatever)"?

 

Is this pretty recent?    I wonder if it is a newer thing. 

 

That is just insane.  This is why you have medical insurance...to cover things that happen to your body. 

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That's crazy.  I've never had anyone ask where something happened.    Just what happened.    I guess I would have said, "Well, I was walking and tripped over a (whatever)"  It would never occur to me to say, "I was at my Aunt Joan's house and walked across her living room and tripped over (whatever)"?

 

Is this pretty recent?    I wonder if it is a newer thing. 

 

That is just insane.  This is why you have medical insurance...to cover things that happen to your body. 

I have seen it becoming more common, for the past 5 years at least.  The doctors sometimes ask, but definately an urgent car or ER will ask/document where it happened and how it happened.  Then any type of injury that could have come from a trip/fall especially seems to get a red flag, and we also get a letter from the insurance company wanting us to tell them again what happened and to attest to it.  They say that if you don't attest to the location of the injury, they will not pay the claim.  We got a letter from a company when dd broke her toe asking the circumstances and location of the injury.  The PT for my back injury gets flagged once a year for a letter asking me about it.  When dd had a slight sprain after doing a mud run, it triggered a letter.  etc.    I get a letter from our insurance company, inquiring about someone in the houses injury at least once a year.   

 

Maybe it is a state by state thing, but we have had 5 different insurance policies so I know it isn't just one company that does the letters.  Aetna, Cigna, United Health Care (two different policies) and BCBS have all required the letters be filled out and sent in.

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That's crazy.  I've never had anyone ask where something happened.    Just what happened.    I guess I would have said, "Well, I was walking and tripped over a (whatever)"  It would never occur to me to say, "I was at my Aunt Joan's house and walked across her living room and tripped over (whatever)"?

 

Is this pretty recent?    I wonder if it is a newer thing. 

 

I've also never been asked, but it's been a few years since I showed up with an injury. I do remember being asked if it happened at work, because I guess workers' comp could kick in. But that was the extent of it.

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I have seen it becoming more common, for the past 5 years at least.  The doctors sometimes ask, but definately an urgent car or ER will ask/document where it happened and how it happened.  Then any type of injury that could have come from a trip/fall especially seems to get a red flag, and we also get a letter from the insurance company wanting us to tell them again what happened and to attest to it.  They say that if you don't attest to the location of the injury, they will not pay the claim.  We got a letter from a company when dd broke her toe asking the circumstances and location of the injury.  The PT for my back injury gets flagged once a year for a letter asking me about it.  When dd had a slight sprain after doing a mud run, it triggered a letter.  etc.    I get a letter from our insurance company, inquiring about someone in the houses injury at least once a year.   

 

Maybe it is a state by state thing, but we have had 5 different insurance policies so I know it isn't just one company that does the letters.  Aetna, Cigna, United Health Care (two different policies) and BCBS have all required the letters be filled out and sent in.

Really?

 

I can't imagine being asked where it happened and taking that as any more than inquiring whether it happened outside, in the yard, in the barn...whatever.

It would never occur to me to mention that I was in my "Aunt's yard" or anywhere other than a very general mention. 

 

But then I have never tried to recover for an injury like that where fault could be shifted to someone else to pay (thank the Lord).   I had no idea.  It just seems crazy to me. 

 

I live in a different century where people had common sense.  People don't want to hurt others or be hurt in my world so all exercise due care.  I guess that is no longer considered to be true.   

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Our insurance company always asks how an injury occurred, even if it was not workman's comp related. We receive a form asking many details about the injury, where, when, how, etc. Sometimes it is embarrassing to fill out the form. Once I fractured a finger from swatting the dog. She devoured a baby bird right in front of me, so I delivered a pop to her hindquarters. Ouch!

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Our insurance company always asks how an injury occurred, even if it was not workman's comp related. We receive a form asking many details about the injury, where, when, how, etc. Sometimes it is embarrassing to fill out the form. Once I fractured a finger from swatting the dog. She devoured a baby bird right in front of me, so I delivered a pop to her hindquarters. Ouch!

Yikes.  And you had to fill out forms related to that?  Not just "Ouch, hit something the wrong way and my finger fractured". 

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Yikes. And you had to fill out forms related to that? Not just "Ouch, hit something the wrong way and my finger fractured".

I have wondered whether insurance companies operate on heightened alert for domestic and/or child abuse. I really do not know why the in-depth inquries, but know that claims will not be paid without answers.

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I have wondered whether insurance companies operate on heightened alert for domestic and/or child abuse. I really do not know why the in-depth inquries, but know that claims will not be paid without answers.

Do you not have an HSA?  Here, if it is doctor, dentist, or eyesight related, we just pay for it with the HSA card.  No inquiries are made.  Of course, this is our own money taken out of the paycheck.  Insurance is really crappy today with claims.  In some small way, an HSA might be better. 

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Do you not have an HSA? Here, if it is doctor, dentist, or eyesight related, we just pay for it with the HSA card. No inquiries are made. Of course, this is our own money taken out of the paycheck. Insurance is really crappy today with claims. In some small way, an HSA might be better.

 

We do. It does not bypass insurance, it is simply pretax dollars available for paying approved medical expenses. We wipe out ours annually. I would never ise it without insurance first paying its portion of a medical event.

 

Thanks for mentioning HSA. I think we are talking about the same thing.

 

P.S.  We do not have vision insurance, and our dental insurance is unrelated to our medical insurance.  (I never have had dental and medical rolled into the same program, in fact.)

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Do you not have an HSA?  Here, if it is doctor, dentist, or eyesight related, we just pay for it with the HSA card.  No inquiries are made.  Of course, this is our own money taken out of the paycheck.  Insurance is really crappy today with claims.  In some small way, an HSA might be better. 

 

We have an HSA card but that doesn't mean there are not claims made to the insurance company. Since we have insurance, there are deals in place with practitioners and we aren't paying 100% of the cost. Our HSA usually doesn't come into play until after all claims have been submitted and paid by insurance. Then, we pay what is leftover.

 

We are always asked how an injury happened. Our explanations don't usually end with, "Hit my finger wrong on something." The doctor would normally ask what we hit it on and maybe some other follow up questions. It's really not difficult for people to let the truth out of where something happened when getting medical treatment for an injury. I don't find it odd at all.

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Given that you're given one filing with a huge premium jump and then they cancel for the second usually, they'd not be allowed back on my property. They're jacking up my insurance rate because they didn't get insurance on themselves, and that's not cool. As for those insurance questions about the accident? You just say it happened and no one was negligent. They might call and ask, and you say the same thing. You're not lying because no one is at fault for stupid accidents. I've filled out dozens of those forms as I have an ankle that dislocates suddenly and I don't believe a homeowner should pay for someone else's medical problems.

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I have had two kids in the ER with injuries over the last few months. One was a serious broken bone (billed over $5000 to insurance I think) that did happen at a neighbor's home. Ds told story repeatedly of it happening at another home. No one ever asked for more details. I never even considered the insurance company might go after the neighbor's homeowners. The other accident involved at trip to the Children's hospital ER, consult with plastic surgeon and seven stitches in dd's face :( haven't seen that bill yet. I did happen on our property but no one asked.

 

I was not even aware this was an issue. Glad to know.

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