Pennsylvania  |  Personal Injury

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10/02/09, 8:12 pm

Legal Question


Good Evening - I was recently injured while on vacation in the condo I was staying in. I broke and sprained my ankle while evacuating the building at 11:00 pm due to a fire alarm. The condo's liability company has provided to me the opportunity for payments, to cover my out of pocket expense (up to $5,000) under a Medical Payment Provisions rider on their liability policy. Per their letter they write, "...while we are willing to reimburse you for your out of pocket expenses, it is not admission of liability and any payments made to you...are done so with the understanding that those payments will be included in any settlement we may reach."

I don't anticipate a settlement of any sort, because I believe this situation to be truly an accident, through no fault of the condo owner.

I received a letter from my medical insurer today stating that based on some "codes" coming through their system, they believe my injury and claims may be subject to subrogation.

I guess my questions are:

#1 If I accept money from the liability insurer for my out of pocket, based on their rider to the policy, is that money subject to the subrogation?

#2 If I don't plan any sort of legal action against the condo, and only want to collect the out of pocket, do I need to inform my medical carrier?

Their form mentions if “the injury was someone else’s fault, or just on someone else's property”; So do I just give them the information and let them do their own investigation?

I don't feel my insurance company should be entitled to any money on the liability policy because, again, it was purely an accident. If so, I don't even want to collect the out of pocket expenses if I have to just turn them over to the insurance company. I'm hoping because they admit no liability and are just providing the "up to $5,000" separately, it won't be subject to the subrogation.

Any guidance would be appreciated. Thank you very much.


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