A few months ago I hurt my knee while doing yard work at my home and my doc sent me to physical therapy. I’m better now.
In the past month, I have received two letters from my health insurance company asking me to give them detailed info on how the injury occurred so they “can determine if the injury was the fault of someone else who is responsible for payment of the claim”. In bold print, the letters say “this claim has already been paid”.
I despise this company and want nothing to do with them except paying my premiums as required. I have just tossed both letters in the trash without replying. My question is: am I legally required to fill out this form? Nowhere on the form does it indicate this, it’s just a stern “request” for the information.
I admit I’m just being a stubborn bastard for refusing to fill out the form, but I just despise insurance companies and their tactics, and since there isn’t anyone else they can go after, am I okay with just ignoring them?
You could tell them you fell down on the concrete doorstep of their corporate insurance office building as you were entering
I don’t know if they can require that you fill out the forms. It is conceivable that the fine print in your policy says that you must. Meanwhile, if you filled it out to say that you were in your own yard and that it wasn’t a misbehaving tool or anything like that, and you were doing normal yard work, it doesn’t seem like they could go after anyone else, nor that they could complain that your answer wasn’t what they were looking for.
I despite insurance companies too. If you don’t want to cooperate, I’d check the terms of your policy carefully for any stated obligation on your part that seems applicable.
My father aged 82, recently recounted an interesting insurance story about a doctor visit. He is a long-time cardiac patient, doing well lately after a couple of heart attacks years ago. This visit involved a routine diagnostic stress test. When questioned about his present condition, Dad replied he’s been feeling fine for the most part, lately. The doctor corrected him and said, “no, you’re feeling short of breath.” Turns out the insurance won’t pay for these tests any more unless the patient is complaining about a potentially related issue. So the doctor is being forced to falsify claim documents in order to properly treat his patient, if they expect any insurance coverage.
An obvious place you could have hurt your knee would be at work. If so workers compensation insurance would have the responsibility to cover the claim. Another possibility would be a car accident where another driver was at fault. If so his insurance would have to cover the claim… This is what they want to find out–if someone has responsibility to pay for the claim. If so they will get reimbursement.
Ok, thanks, yeah I get that. But it’s none of the above. This insurance company has behaved like a dick, and I’m just not inclined to do anything to help them. Just wondering if they can cancel my policy if I don’t return the form.
From what you’ve posted, probably not. IMO, it may not be worth the risk though. Check the box that says “no one else responsible” and be done with it. They probably won’t stop asking. If it makes you feel any better, you’re not really helping them, they would much prefer having someone to go after for subrogation.
Twice I received letters from a third party company for my daughter, she’s covered under CHIP requesting information about how she got her concussion. I ignored the first one, but they sent another. I wasn’t comfortable with it so I called the insurance company and the third party was legit. I would absolutely check it out though before you send any information.
I injured my shoulder at the gym in 2005. Every time I get any kind of treatment, physical therapy, scan or anything involving that shoulder, even if I just mention it during a routine doctor’s appointment, I get a letter from the insurance company, or an investigative company they’ve hired, asking me if there is anyone they can go after for money. At this point it’s a little ridiculous, but I just click “no” and send it back again.
I had a double case of frozen shoulder in 2010 and had to go to physical therapy for them. I also got a form letter in the mail from my insurance company asking if my shoulder issue was due to a work or car accident. I ignored the first letter but when I got a second one, I wrote on on it “It’s just frozen shoulder - it’s not the result of any accident” and returned it.
Ok. Well, I threw the first two letters away, but if they send a third, I guess I’ll send the stupid thing in. As much as it feels good to flip them the bird, it’s not worth the (probably remote) risk of having my policy cancelled. Thanks everyone.
I will only add that there must be enough $$ involved with collecting from other insurance companies to justify a department at your insurance company that sends out those letters and try to collect from someone else. By cooperating with them, in cases where someone else really is liable, it helps your own insurance company, which may help them control costs. Not saying you would ever see a dime of that, but not helping them at all certainly wont help your premium.
Earlier this year I had a ganglion cyst treated. Some time after that I got a letter from a third party asking for the same kind of information requested of the OP. I did some checking and learned that this third party company is indeed contracted by my insurance company to investigate claims, and my insurance company requested that I follow through.
There was an option to give the info over the phone, so I called and it was all automatic. Every question was about where “the injury” occurred, etc, clearly seeking to establish that someone else was at fault and let my insurance company off the hook. After answering “not applicable” to ten or twelve questions, the computer voice finally asked if the treatment was due to an injury.
Stupid, and overall kind of a shady thing for an insurance company to do, IMO.
I got one a month ago after starting to see a chiropractor late last summer. Mostly same info asked for. They hadn’t cut any checks yet so I had to answer it. They provided a claim # to enter at a website. Took about 2 minutes to say no one else was at fault and no one else was on the hook to pay.
