Home Injury Claim ?

[Sales71]

I got a call today from a home policy owner stating that her sister had an accident at her home. While her sister was in her backyard she fell over her garden hose and hit her nose and wrist.

She broke her nose and busted her wrist. The homeowner has $1000 medical coverage and $300,000 for liability. I told her we will pay the medical up to the $1000 limits but not sure on the liability....does her sister have to sue her to collect on the rest of the money. She also stated that her sister is visiting a plastic surgeon to fix her nose.

A very weird claim...would love feedback from other agents.

 

[Josh]

Re: Home Claim?

In all fairness, this isn't really *that* weird of a claim.

In theory she wouldn't have to sue, the sister could simply call up the carrier and state her intention to make a claim on the policy. My guess is the carrier would either offer a nominal amount to settle, or more likely, say prove it. Judging from what you said it sounds like the carrier would deny the claim anyway because tripping over a hose that someone had in their yard is more than a stretch when it comes to liability. If the walkway was icey and her sister came over and slipped and hit her head and there was a serious injury, maybe.

My two cents, the sister there is just looking to get rich off of some perceived big deal and the carrier is going to say "prove it". She's not going to be able to prove it. I'd also put good money on her not being able to find an attorney willing to take this on a contingency.

There is an adjuster on here, FullAuto I think, and he might be able to shed more light on this.

 

[djs]

Re: Home Claim?

Well, first question is does the sister live in the house? If so, then no, not even med-pay.

Does she actually have to file a lawsuit? No, just a claim. Yes, most carriers would pay this, but she may not want to do this to her sister.

Does she have medical insurance? If so, it is better to go through that and use the med-pay for deductibles/co-pays, if needed.

Why? The homeowners policy will go up significantly due to this claim. If her medical insurance will cover it, let them, it won't impact rates. Medpay doesn't impact rates.

Now, if the sister is after pain and suffering, lost wages, a big settlement, well, then go ahead and file the lawsuit!!!!!

Dan

 

[Guest]

Re: Home Claim?

I NEVER say we will pay this amount, thats up to the adjuster,

Our job is to sell the policy, its the adjusters job to interpet the policy.

If they pay the med pay, then wouldnt they pretty much be forced to start paying the liability? Pretty much like an admittance of guilt....

 

[Bob Klee]

Re: Home Claim?

Well, first question is does the sister live in the house? If so, then no, not even med-pay.

Does she actually have to file a lawsuit? No, just a claim. Yes, most carriers would pay this, but she may not want to do this to her sister.

Does she have medical insurance? If so, it is better to go through that and use the med-pay for deductibles/co-pays, if needed.

Why? The homeowners policy will go up significantly due to this claim. If her medical insurance will cover it, let them, it won't impact rates. Medpay doesn't impact rates.

Now, if the sister is after pain and suffering, lost wages, a big settlement, well, then go ahead and file the lawsuit!!!!!

Dan

What Dan said! Good job dude, you know your stuff

 

[Sales71]

Re: Home Claim?

Well, first question is does the sister live in the house? If so, then no, not even med-pay.

Does she actually have to file a lawsuit? No, just a claim. Yes, most carriers would pay this, but she may not want to do this to her sister.

Does she have medical insurance? If so, it is better to go through that and use the med-pay for deductibles/co-pays, if needed.

Why? The homeowners policy will go up significantly due to this claim. If her medical insurance will cover it, let them, it won't impact rates. Medpay doesn't impact rates.

Now, if the sister is after pain and suffering, lost wages, a big settlement, well, then go ahead and file the lawsuit!!!!!

Dan

Thank you Dan..actually the company that I do business with the homeowners Do not raise rates due to claims. The will drop the client if they have 2 claims in 3 years, but will not raise there rate.

No sure if her medical will pay all this Bill..Like auto insurance if they find out how it happend they might go after her sister home policy to collect what they paid.

 

[djs]

Re: Home Claim?

If they pay the med pay, then wouldnt they pretty much be forced to start paying the liability? Pretty much like an admittance of guilt....

Nope. Medpay is there just to prevent the issues of liability. It pays regardless of fault. I explain it as first aid coverage. Treat first, ask questions later.

Dan
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Thank you Dan..actually the company that I do business with the homeowners Do not raise rates due to claims. The will drop the client if they have 2 claims in 3 years, but will not raise there rate.

No sure if her medical will pay all this Bill..Like auto insurance if they find out how it happend they might go after her sister home policy to collect what they paid.

I have NEVER seen a health policy go after a home policy when the incident was accidental. Not to say it hasn't happened, but this is part of the reason you have health insurance, to cover accidents.

Dan

 

[LearnMedicare]

Interesting stuff. Great information.

 

[bobson]

Re: Home Claim?

Nope. Medpay is there just to prevent the issues of liability. It pays regardless of fault. I explain it as first aid coverage. Treat first, ask questions later.

Dan
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I have NEVER seen a health policy go after a home policy when the incident was accidental. Not to say it hasn't happened, but this is part of the reason you have health insurance, to cover accidents.

Dan

I've not seen it on homeowners either. Personal auto is another mess entirely. I've seen 2 claims involving autos that weren't car accidents that the health insurance company had people make med pay claims. One was a finger in the door and one was a slip stepping out of the vehicle. I'm sure there has been others through our office.

 

[djs]

A health company 'suggesting' people use their medpay on their auto is a wise move. It usually helps signficantly with deductibles, copays, etc. This is especially true when it is a quick ER visit (like a hand slammed in the door), where the full health deductible may be coming into play for the first time that year.

Unlike the auto policy, home policy medical does not cover residents of the house, which usually makes it unusable for most ER type visits. A house guest who did something totally foolish and got hurt usually doesn't think about asking to file against the hosts homeowners policy.

Dan