My mother tripped and fell on the sidewalk of a local fast food place. Her medical insurance is declining to pay her doctors bill because they said the company is responsible. The fast food place had a representative call my mom after the incident and told her they were going to send her some documents to fill out. About 2 months later, she never received the documents. This weekend, she received a bill for injuries from the medical facility stating the insurance denied it saying the company may be responsible. What next? Who should we call? Should we call the fast food place to ask for their insurance company? Please help! My mom is very worried that if she doesn't come up with the $2,000 for the bill by the end of this month it will negatively impact her credit score.
You need to stop self help and hire a lawyer. Personally, I would be after the insurance company also. We dont allow that in Texas. So, consult with a local lawyer and get some immediate relief.
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If there was a defect in the sidewalk, she may be able to get more than medical bills paid with a lawyer.
Your mom needs to at least meet with an attorney. Is her insurance refusing to pay, or are her providers refusing to bill her health insurance? If the business has med-pay, the providers would get paid close to 100% of their bill; if the providers bill her health insurance, they might be paid anywhere from 15% to 65%, depending on what type of health insurance she has. For that reason, providers often insist on billing med-pay if it is available.
She should also follow up with the business's insurance company regarding the paperwork she never received. In short, her situation isn't very difficult to fix if she is willing to make some phone calls herself and not rely on what the providers/health insurers tell her. Her health insurance should always be willing to pay, even though it will likely have a lien on any potential recovery she might obtain down the road. If there ends up being a med-pay policy available, it might (or might not) reimburse the health insurer for the bills the health insurer paid; the reimbursement would depend on the type of health insurance your mom has (i.e. Medicaid, Medicare, ERISA or non-ERISA, etc.) and the med-pay policy language.
The problem is that, unless the business was at fault for causing her fall and she has at least somewhat serious injuries, attorneys won't be interested in taking her case. Trip-and-fall cases are always difficult to prove. When you add onto that the fact Delaware juries are notoriously stingy with all personal injury cases, and trip & fall/slip & fall cases in particular, there has to be some serious injuries and medical treatment for there to be enough money at stake for an attorney to be interested in taking her case. That said, she can get a free consultation with an attorney in Georgetown to have her situation evaluated and get some guidance on how to handle the issue with the medical bills. She should take ALL papers, letters, bills, medical records, notes, etc., with her to the consultation. Good luck!
This communication is general in nature and not to be construed as legal advice or creating an attorney-client relationship. All situations are different and you should meet with and discuss your particular situation with an attorney.
The health insurer does not want to pay if there is other insurance available through the restaurant. Typically, restaurants and their landlords carry premises liability insurance coverage, which often has no-fault med-pay coverage of limited coverage (similar to homeowners' insurance) available. Your health insurer may want a statement that the med-pay coverage has been exhausted before it will cover the expenses. If the restaurant or its insurer is not cooperating, and your mother's accident took place in Delaware, then she should meet with a Delaware lawyer for assistance with this matter.
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