Why does my health insurance want so much info about an accident?

I hurt my shoulder snowboarding about a month ago, and ended up going to see an orthopedic surgeon, who just did some x-rays. On the statement from my insurance provider, they have a whole list of questions they want me to answer before they’ll pay for it, since it appears to be an accidental injury.

The list:
How did the accident occur?
When did it occur?
Where did it occur?
Was it a motor vehicle accident?
Did the accident occur at work?

What’s up with this? If I answer these “wrong”, are they going to deny it?

Can’t say a thing about whether or not the first three can help/hurt you…

The last two questions are clearly intended to find out if the accident was covered by another form of insurance. If you are hurt in an automobile accident, your injuries would likely be covered by your automobile insurance policy; if you were injured at work, your employer’s policy would likely cover you.

They don’t want to pay if someone else already will do so.

Your health insurance company needs to know if a third party is liable for your claims. It doesn’t necessarily mean they won’t pay your claims, but they may be able to go after a third party to recoup the costs if the third party is determined liable. This is typical of motor vehicle accidents. Answering these questions will help your insurance company determine who is ultimately responsible for your claims.

If in doubt, call your insurance company and ask them how they handle subrogation (third party liability).

Yep, the last question is definitely to see if it should be covered by worker’s compensation at your job. If so, there is a whole different set of paperwork to be filled out by your employer (and within a certain amount of time, depending on regs).

So it sounds like if it wasn’t car or work related, I don’t have to worry about telling the truth. Thanks!

I wouldn’t say that. I suspect that you could be charged with insurance fraud and/or have the claim denied if they found you were not telling the truth (even if the lie seemed irrelevant).

I think he meant it the other way around – that telling the truth wouldn’t hurt him, so there was no reason to worry about the possible negative consequences of truthfullness.

Sorry. Yes, you’re right. I misinterpreted his statement.

If you need further treatment, be prepared to answer those questions again and again.

I was injured almost three years ago in a car accident, and I’m still undergoing various therapies. I’ve had to fill out those forms three or four times now, as well as getting letters from my doctors’ billing offices that the insurance company will not pay until I call them to answer those same questions again.