Should I Go Through My Insurance Company After Being Injured in a Fall?

Written by James Hirby and Fact Checked by The Law Dictionary Staff  

After you've been injured in a fall, you're likely to face a host of bills. For starters, you'll have to cover the cost of your medical expenses. Depending upon the severity of your injury, it's entirely possible that you'll face medical bills of $20,000 or more. After all, the average "in and out" U.S. emergency room visitor pays $1,000 for the services that he or she receives. A typical overnight hospital stay can cost between $5,000 and $15,000. Even simple procedures like setting a broken arm or stitching up severe lacerations can cost thousands of dollars.

If your fall was particularly serious, you could face recurring outlays like follow-up hospital visits, physical therapy sessions and home medical supplies. To make matters worse, you'll almost certainly receive multiple prescriptions for painkillers, blood thinners and other medications. If you need to refill these prescriptions multiple times, you could incur significant out-of-pocket expenses.

If you have medical insurance, you'll need to file a claim and recoup these expenses. Depending upon the quality of your insurance policy, you may be entitled to receive free follow-up visits and prescription drugs. Although you'll probably have to pay for a portion of your hospital bills out of your own pocket, it's likely that your insurer will cover the bulk of your expenses. Depending upon the size of your deductible, you could face out-of-pocket charges of as much as $12,000 or as little as $500. Some gold-plated health plans eschew deductibles altogether.

It's possible that your health insurance provider will dispute some of the costs that you claim. For instance, it may require you to obtain a generic form of a certain prescription or visit a particular doctor for your follow-up visits. If you don't follow these restrictions, you could be forced to pay for these products and services out of your own pocket. However, the bulk of your care should be covered.

If you fell on your own property, your homeowner's insurance company probably won't pick up any of the medical costs associated with your injury. However, it may cover any property repairs or upgrades that must be made in its wake.

If you fell on someone else's property, the situation could become more complicated. Technically, you have the right to file an injury-related claim with the property's insurance carrier. However, this may cause your health insurance provider to withhold payments on your medical bills until the dispute has been settled. If you can't afford to wait, you may wish to avoid taking this route.

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