Welcome to DU! The truly grassroots left-of-center political community where regular people, not algorithms, drive the discussions and set the standards. Join the community: Create a free account Support DU (and get rid of ads!): Become a Star Member All Forums Issue Forums Culture Forums Alliance Forums Region Forums Support Forums Help & Search

ColinC

(8,227 posts)
Wed Sep 21, 2022, 03:22 PM Sep 2022

Question about health insurance coverage

For anybody who might have the proper knowledge: Thanks in advance!

If you are injured on your property and your health insurance contacts you after paying for the majority of your treatment to get your property insurance to pay -and pressure you to file a property insurance claim, are you obligated to respond accordingly and how legal are their actions?

5 replies = new reply since forum marked as read
Highlight: NoneDon't highlight anything 5 newestHighlight 5 most recent replies
Question about health insurance coverage (Original Post) ColinC Sep 2022 OP
Homeowners' insurance generally doesn't cover injuries to the owner FBaggins Sep 2022 #1
No. We still have not contacted them yet directly. Just got the letter. ColinC Sep 2022 #2
If the loss occurred while you were insured... FBaggins Sep 2022 #3
I've never heard of homeowners Progressive dog Sep 2022 #4
This is called subrogation of benefits. It is probably required by your health plan yellowdogintexas Sep 2022 #5

FBaggins

(26,695 posts)
1. Homeowners' insurance generally doesn't cover injuries to the owner
Wed Sep 21, 2022, 03:35 PM
Sep 2022

Did they say what sort of claim they think you should file?

ColinC

(8,227 posts)
2. No. We still have not contacted them yet directly. Just got the letter.
Wed Sep 21, 2022, 03:46 PM
Sep 2022

Thing is we are no longer covered by home owners insurance (although we were when the accident happened). I assume you cannot do a retroactive claim.

FBaggins

(26,695 posts)
3. If the loss occurred while you were insured...
Wed Sep 21, 2022, 03:49 PM
Sep 2022

... then you could file a claim IF there was something covered by that insurance.

I'm just wondering what they think should be covered.

yellowdogintexas

(22,114 posts)
5. This is called subrogation of benefits. It is probably required by your health plan
Wed Sep 21, 2022, 07:38 PM
Sep 2022

and/or state insurance law to confirm if reimbursement by the homeowners' plan is available.

The health plan will want an official denial from the homeowners policy, or a description of what if any benefits there are. If your homeowners doesn't have any coverage, then that is the end of it.

If your homeowners plan has for example a lump sum benefit of $10,000 then the health plan can require that money to be used up before it can begin to process.

This is what happens with auto insurance liability or anything else that involves a lump sum. When I processed medical claims, we would research any accident or injury claim to find out if any insurance of this sort was available. If I recall correctly, we would advise the hospital to submit their claim to the liability company and refund any overpayment back to us.

The lumpsum liability benefit is supposed to pay out first but the carrier pretty much does not know about it at the beginning, and the hospital, doctors, etc certainly don't know.

Have your homeowner's plan communicate with the health plan; they will duke it out and any overpayments will be refunded to the health plan. If there is a benefit, it is most likely going to be applied to the largest bill first which is usually a facility. Hospitals are accustomed to this.

Latest Discussions»The DU Lounge»Question about health ins...