I had a slip and fall accident at a well-known franchised restaurant and injured my knee. I was immediately treated and I am currently in the process of getting an MRI. The ortho surgeon suspects I will need ortho surgery. I have not hired an attorney. I decided that I just wanted to be reimbursed for my own expenses, such as co-pays, mileage, lost wages, etc. I am employed so all expenses other than co-pays have been covered by my employer group insurance. My question is, once I am released from the ortho doctor's care and I settle with the liability insurance company, what happens if a year later my knee starts having issues again, will my group insurance cover future treatment? I have not mentioned that I fell at a restaurant during any of my doctor visits, I've only said that I fell. Am I obligated to tell my insurance carrier?
7 Answers from Attorneys
If you settle your case, and sign a release, then you will be forever barred from pursuing the restaurent for any injuries, regardless of what happens in the future. But your own health insurance should cover any future medical treatment, depending on the policy. Your own insurance may want to get reimbursed, under the reimbursement provision of the policy, if you recover from the liability carrier. As to the obligation to tell your own insurance carrier, that is dependant on a number of factors.
I agree with most of Mr, Morrell's answer. I disagree, though, with his statement that "your own health insurance should cover any future medical treatment, depending on the policy." You might need treatment years from now, and by then you might not have your current insurance. If the Supreme Court strikes down the health care reforms which it is considering this week, any insurance you get in the future will view your knee injury as a pre-existing condition and will probably deny coverage on that basis.
It is important for your settlement agreement to take this possibility into account. That means you need better information about your prognosis. It also means you need a lawyer to protect your interests.
If you have an injury serious enough to require surgery, and it was caused by the negligence of someone else... WHY would you do that person any favors? Don't you think people should be responsible for their actions? It doesn't do any good to you or to society when you let people like that off the hook. They will be laughing at you behind your back, even while they stick it to you even further, mark my words!
You might think that being "reasonable" will get you fair treatment from the insurance company, but all it really does is mark you as a sucker who can be taken advantage of. They will look at your out-of-pocket claims, and then offer you a dime on the dollar. As for lost wages, they'll deny that entirely. If you don't like it, they'll say "too bad," and by that time it will be too late to get a lawyer. Why? Because you need to build the case properly from the beginning. No lawyer wants to get in on a case after a do-it-yourself claimant has mucked it up.
Not only that, but your health insurance carrier has a right to be reimbursed from your settlement--regardless of how much you settled for! So if you just settle for co-pays, you may have to turn all that money over to your health carrier to cover the bills that you never collected on. It's crazy to take that risk just to hand a windfall to a negligent person.
Listen, friend, you have rights to a lot more than you're asking for. Don't sell yourself short! Nobody will thank you for it. You're only hurting yourself, and helping a big insurance company that doesn't need it. Do yourself a favor and give me a call BEFORE you pull the trigger: (877) LION-FOR-LAW (546-6367)
I completely agree with Mr. Hoffman and Mr. Stone-Molloy. You are putting your health and your future ability to do things at risk by handling this case yourself. Stop it. Hire an attorney and take care of this thing in the right way.
My law firm handles slip and fall / trip and fall cases all over the state of California. You can read about these cases at http://www.slip-and-fall.net. If you want to discuss your case, you may call me for a free consultation at 800-816-1529 x. 1.
Just following-up to make sure you're getting the help you need. Feel free to call anytime: (877) LION-FOR-LAW (546-6367) or email [email protected]
I've been posting (sometimes cutting and pasting as I really couldn’t say what I said better myself) my biased opinions and comments here and there on the Internet and Avvo for a while now (since Al Gore invented online attorney forums, I believe), and every time I see a post about a person doing battle all by his or her non-lawyer self against an insurance company, I keep thinking the post might as well read something like, “my no-insurance second cousin on my father’s side needs to get that brain tumor removed from the base of his skull. It's now the size of a golf ball and is causing him to shake something fierce. He's up to six cans of Coors Light a day to stop the shakes. So, what I need to know is whether I should go in with my cordless Makita or the corded Dewalt...”
No one who has suffered personal injury should handle personal injury cases. No one but a neurosurgeon should do brain surgery, even if one’s second cousin is a schmuck.
A good personal injury attorney should not only understand the law applying to the claim/lawsuit but fully understand the medical damages associated with the injury. Trauma can affect many body parts, vary in severity, vary in long term complications and sequelae. To better one’s chances for a full and fair recovery, one must have an attorney who knows what to ask for from the defendant – compensation for all bodily harms and future medical care that will be needed.
We personal injury lawyers offer free consultations. We handle cases on a contingent basis. We actually love the game, the battling, the negotiations, the tactics, etc. An injured person should just worry about getting better.
Fortunately, most of us personal injury types offer free consultations and take such cases on contingency, so there is nothing to fear in calling us.
Paul J. Molinaro, M.D., J.D.
Attorney at Law, Physician, Broker
Fransen & Molinaro, LLP
980 Montecito Drive, Suite 206
Corona, CA 92879
www.fransenandmolinaro.com / www.888MDJDLAW.com
"When you need a lawyer, call the Doctor... Call Paul J. Molinaro, M.D., J.D... Call (888)MDJDLAW."
* This post and all others I make on Internet are for informational purposes only. None of the information or materials I post are legal advice. Nothing I post as comments, answers, or other communications should be taken as legal advice for any individual case or situation. This information is not intended to create, and receipt or viewing of this information does not constitute, an attorney-client relationship. While I try to be accurate, I do not guarantee accuracy.
** Fransen & Molinaro, LLP practices in the areas of personal injury, medical malpractice, and real estate law.