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Respected Contributor
Posts: 2,910
Registered: ‎05-08-2017

Re: homeowners insurance question


@stevieb wrote:

@Ms tyrion2 wrote:

@stevieb wrote:

Because insurance is a legalized racket and their primary goal is to not pay out on a claim. If they can get the other party's insurance to pay, so much the better.


 

 

Wrong.

Each state determines a lot of this. As others before said, there is a prescribed order of coverage. Medical payments coverage is paid regardless of fault. It's often a fairly small amount. $5000 Is common. Once that coverage is exhausted, health insurance kicks in. 

 

I don't see any attempt to avoid payment. The different carriers are just handling the claims in proper order as prescribed by the state.


No, Not "wrong". You have your opinion and others have theirs... Perhaps you're limiting your discussion to this case, which makes sense, as this is the instance under discussion here. I'm basing my opinion on the larger experience, whereby companies will both craft a policy and then glean it when claims are made to avoid paying, citing exclusions that the average customer would have no understanding of when they took out the policy... In too many cases, customers thought they were covered but are denied based on the 'fine print' that they likely didn't even know existed and that their agent probably didn't highlight for them... 


 

 

 

How long did you work in the insurance industry?

You are free to have an opinion, but facts are more important here.

 

I spent over 40 years in the claims area of insurance. Let me let you in on a little secret..

Insurance companies (HO and auto) do everything possible to FIND coverage. Regulations and Bad Faith laws are so severe that an insurance company does everything possible to cover a first party claim rather than deny it. 

 

There is very little "fine print" in an auto or HO insurance policy these days. States also regulate that.  

 

Health insurance is a different animal when it comes to denials of coverage and not the subject of this thread.

 

There seems to be some confusion about liability claims and medical payments coverage here . To prevail in a liability action one must prove negligence on  the homeowner's or driver's part. Medical payments coverage in an auto or HO policy pays for injuries sustained by a passenger in your car or person on your property without there being any negligence on the policyholder's part.

 

Order of payment between medical payments coverage and health insurance is prescribed by the state or by policy language. Health insurance is almost always secondary when there is other insurance.

 

 

Respected Contributor
Posts: 3,227
Registered: ‎04-04-2015

Re: homeowners insurance question


@Ms tyrion2 wrote:

@stevieb wrote:

@Ms tyrion2 wrote:

@stevieb wrote:

Because insurance is a legalized racket and their primary goal is to not pay out on a claim. If they can get the other party's insurance to pay, so much the better.


 

 

Wrong.

Each state determines a lot of this. As others before said, there is a prescribed order of coverage. Medical payments coverage is paid regardless of fault. It's often a fairly small amount. $5000 Is common. Once that coverage is exhausted, health insurance kicks in. 

 

I don't see any attempt to avoid payment. The different carriers are just handling the claims in proper order as prescribed by the state.


No, Not "wrong". You have your opinion and others have theirs... Perhaps you're limiting your discussion to this case, which makes sense, as this is the instance under discussion here. I'm basing my opinion on the larger experience, whereby companies will both craft a policy and then glean it when claims are made to avoid paying, citing exclusions that the average customer would have no understanding of when they took out the policy... In too many cases, customers thought they were covered but are denied based on the 'fine print' that they likely didn't even know existed and that their agent probably didn't highlight for them... 


 

 

 

How long did you work in the insurance industry?

You are free to have an opinion, but facts are more important here.

 

I spent over 40 years in the claims area of insurance. Let me let you in on a little secret..

Insurance companies (HO and auto) do everything possible to FIND coverage. Regulations and Bad Faith laws are so severe that an insurance company does everything possible to cover a first party claim rather than deny it. 

 

There is very little "fine print" in an auto or HO insurance policy these days. States also regulate that.  

 

Health insurance is a different animal when it comes to denials of coverage and not the subject of this thread.

 

There seems to be some confusion about liability claims and medical payments coverage here . To prevail in a liability action one must prove negligence on  the homeowner's or driver's part. Medical payments coverage in an auto or HO policy pays for injuries sustained by a passenger in your car or person on your property without there being any negligence on the policyholder's part.

 

Order of payment between medical payments coverage and health insurance is prescribed by the state or by policy language. Health insurance is almost always secondary when there is other insurance.

 

 


I would think you would have to establish some sort of liability.  Otherwise, you'd have people literally falling daily in stores in order to collect on their "back injuries" etc.

 

I can't believe that if a guest in your home suddenly has a stroke, for example, that you suddenly become responsible for all resultant medical bills.  That just makes no sense.

Honored Contributor
Posts: 37,053
Registered: ‎03-09-2010

Re: homeowners insurance question

@Isobel Archer

 

there is a difference between having  a stroke and having an accident.

**********************************************
"I would prefer even to to fail with honor than win by cheating." - Sophocles
Respected Contributor
Posts: 3,227
Registered: ‎04-04-2015

Re: homeowners insurance question


@sunshine45 wrote:

@Isobel Archer

 

there is a difference between having  a stroke and having an accident.


Don't people with strokes ever fall?  And wouldn't that be an accident?

 

What if someone is dehydrated and gets dizzy and falls?  Or is on medication that makes them dizzy causing them to fall?

 

I think you get my point.  So are you saying that in those cases, I would now be responsible for all their resulting medical bills - since they fell at my house?

Respected Contributor
Posts: 2,910
Registered: ‎05-08-2017

Re: homeowners insurance question

[ Edited ]

@Isobel Archer wrote:

@Ms tyrion2 wrote:

@stevieb wrote:

@Ms tyrion2 wrote:

@stevieb wrote:

Because insurance is a legalized racket and their primary goal is to not pay out on a claim. If they can get the other party's insurance to pay, so much the better.


 

 

Wrong.

Each state determines a lot of this. As others before said, there is a prescribed order of coverage. Medical payments coverage is paid regardless of fault. It's often a fairly small amount. $5000 Is common. Once that coverage is exhausted, health insurance kicks in. 

 

I don't see any attempt to avoid payment. The different carriers are just handling the claims in proper order as prescribed by the state.


No, Not "wrong". You have your opinion and others have theirs... Perhaps you're limiting your discussion to this case, which makes sense, as this is the instance under discussion here. I'm basing my opinion on the larger experience, whereby companies will both craft a policy and then glean it when claims are made to avoid paying, citing exclusions that the average customer would have no understanding of when they took out the policy... In too many cases, customers thought they were covered but are denied based on the 'fine print' that they likely didn't even know existed and that their agent probably didn't highlight for them... 


 

 

 

How long did you work in the insurance industry?

You are free to have an opinion, but facts are more important here.

 

I spent over 40 years in the claims area of insurance. Let me let you in on a little secret..

Insurance companies (HO and auto) do everything possible to FIND coverage. Regulations and Bad Faith laws are so severe that an insurance company does everything possible to cover a first party claim rather than deny it. 

 

There is very little "fine print" in an auto or HO insurance policy these days. States also regulate that.  

 

Health insurance is a different animal when it comes to denials of coverage and not the subject of this thread.

 

There seems to be some confusion about liability claims and medical payments coverage here . To prevail in a liability action one must prove negligence on  the homeowner's or driver's part. Medical payments coverage in an auto or HO policy pays for injuries sustained by a passenger in your car or person on your property without there being any negligence on the policyholder's part.

 

Order of payment between medical payments coverage and health insurance is prescribed by the state or by policy language. Health insurance is almost always secondary when there is other insurance.

 

 


I would think you would have to establish some sort of liability.  Otherwise, you'd have people literally falling daily in stores in order to collect on their "back injuries" etc.

 

I can't believe that if a guest in your home suddenly has a stroke, for example, that you suddenly become responsible for all resultant medical bills.  That just makes no sense.


 

Personal homeowner's policies are not the same thing as business policies. Your question about falling in a store is not relevant to this conversation.

 

Again, please read my post regarding liability claims as opposed to medical payments claims. 

 

If someone had a stroke and fell in your home, your medical payments coverage would apply. You are not "responsible" for their injuries. Medical payments coverage is not paid based on fault

Honored Contributor
Posts: 37,053
Registered: ‎03-09-2010

Re: homeowners insurance question

[ Edited ]

@Isobel Archer wrote:

@sunshine45 wrote:

@Isobel Archer

 

there is a difference between having  a stroke and having an accident.


Don't people with strokes ever fall?  And wouldn't that be an accident?

 

What if someone is dehydrated and gets dizzy and falls?  Or is on medication that makes them dizzy causing them to fall?

 

I think you get my point.  So are you saying that in those cases, I would now be responsible for all their resulting medical bills - since they fell at my house?


 

 

you are dehydrated, get dizzy, and fall in your friends home.

you go to the doctor and tell them what happened.

they ask you all the details.

you tell them honestly.

if they they or the insurance company think it may be covered under a homeowners policy then they will tell you.

in the meantime, your health insurance will cover you.

if another insurance company becomes an interested party, the insurance companies will figure it out.

 

an accident where someone falls down in your home is different from a medical incident.

**********************************************
"I would prefer even to to fail with honor than win by cheating." - Sophocles
Honored Contributor
Posts: 61,518
Registered: ‎03-10-2010

Re: homeowners insurance question


@Ms tyrion2 wrote:

@stevieb wrote:

@Ms tyrion2 wrote:

@stevieb wrote:

Because insurance is a legalized racket and their primary goal is to not pay out on a claim. If they can get the other party's insurance to pay, so much the better.


 

 

Wrong.

Each state determines a lot of this. As others before said, there is a prescribed order of coverage. Medical payments coverage is paid regardless of fault. It's often a fairly small amount. $5000 Is common. Once that coverage is exhausted, health insurance kicks in. 

 

I don't see any attempt to avoid payment. The different carriers are just handling the claims in proper order as prescribed by the state.


No, Not "wrong". You have your opinion and others have theirs... Perhaps you're limiting your discussion to this case, which makes sense, as this is the instance under discussion here. I'm basing my opinion on the larger experience, whereby companies will both craft a policy and then glean it when claims are made to avoid paying, citing exclusions that the average customer would have no understanding of when they took out the policy... In too many cases, customers thought they were covered but are denied based on the 'fine print' that they likely didn't even know existed and that their agent probably didn't highlight for them... 


 

 

 

How long did you work in the insurance industry?

You are free to have an opinion, but facts are more important here.

 

I spent over 40 years in the claims area of insurance. Let me let you in on a little secret..

Insurance companies (HO and auto) do everything possible to FIND coverage. Regulations and Bad Faith laws are so severe that an insurance company does everything possible to cover a first party claim rather than deny it. 

 

There is very little "fine print" in an auto or HO insurance policy these days. States also regulate that.  

 

Health insurance is a different animal when it comes to denials of coverage and not the subject of this thread.

 

There seems to be some confusion about liability claims and medical payments coverage here . To prevail in a liability action one must prove negligence on  the homeowner's or driver's part. Medical payments coverage in an auto or HO policy pays for injuries sustained by a passenger in your car or person on your property without there being any negligence on the policyholder's part.

 

Order of payment between medical payments coverage and health insurance is prescribed by the state or by policy language. Health insurance is almost always secondary when there is other insurance.

 

 


Homeowner insurance clains aren't limited to slip and fall claims and medpay claims, which generally are more fairly managed... There are lots of reasons a homeowner might need to access their homeowner's policy and regardless of how long you might have worked in the industry, there are countless claims being denied for a variety of reasons... The bad faith provisions were made necessary for this very reason and while they've addressed some abuses, there are questions as to whether or not they went far enough...


In my pantry with my cupcakes...
Respected Contributor
Posts: 3,227
Registered: ‎04-04-2015

Re: homeowners insurance question

Still trying to understand this.

 

So if someone has balance issues and falls - is that a medical issue or an accident?

Respected Contributor
Posts: 2,680
Registered: ‎03-28-2010

Re: homeowners insurance question


@Abrowneyegirl wrote:

Can anyone explain this?:

We have a small group of women that get together at each others home to socialize everyother month.

One of the women tripped and fell at another woman's home.  No fault of the homeowner- guest literally tripped on her own feet and could not catch herself.  Down she went and broke her wrist, it is a bad break required surgery.

The homeowner has too pay the medical bills through her homeowners insurance.

Why wouldn't it come under the "victim's" medical insurance?  It was an accident, no one's fault.

She did not sue the homeowner as they are friends.

But at the hospital she said it happened at someone's house so the medical claim was moved from her medical to the homeowner's insurance?????


A very good friend of mine got hit by a car while crossing a street to get a Yoo-hoo drink during her lunch.  She's a nurse.  She wasn't driving, she was walking.  She was very seriously injured, almost killed her.  It didn't go through medical, it went through car insurances. 

Honored Contributor
Posts: 37,053
Registered: ‎03-09-2010

Re: homeowners insurance question


@Isobel Archer wrote:

Still trying to understand this.

 

So if someone has balance issues and falls - is that a medical issue or an accident?


 

 

if balance issues are in their medical records then it should obviously go through their medical insurance.

 

if there is any question as to why or how the incident, the insurance companies would figure it out and request additional information AND communicate with each other and the doctor involved......and both the patient AND the homeowner (if necessary.)

 

 

**********************************************
"I would prefer even to to fail with honor than win by cheating." - Sophocles