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Why can't your insurance company call you instead ? That would be faster and easier than sending a letter.
It's a delay and hassle tactic. They will add wickets you have to jump through in order to get bill from your provider paid. The hope is you will give up and they don't pay.
They are also fishing for a reason to deny the claim. There may be language in your policy saying you aren't covered for accidents that happen during hazardous (hang gliding, SCUBA diving, etc.) activities or if you are on illegal drugs.
Without knowing more, I don't see how we can answer this.
It may be that they're looking for someone else's insurance to cover you - for example, if you were injured on someone's private property and there was a known hazard.
Or if medical malpractice might be involved, for example.
My insurance company UMR gave me a phone number which I called and found out they are looking into making someone else pay for the hospital bill.
Hopefully you didn't go yacking to coworkers about what happened and one of them dropped a dime to the boss. Your employer may have directed UMR to research your claims for outside liability.
This happen in a restaurant parking lot where I fell on ice.
Well then they may want to see if the restaurant has liability insurance to cover the cost of your injury since the restaurant is responsible for ice removal.
Just like in your other example where if someone else hit you while you were crossing the street, your insurance would want to try to get coverage from that person’s auto insurance before paying out.
Well then they may want to see if the restaurant has liability insurance to cover the cost of your injury since the restaurant is responsible for ice removal.
Just like in your other example where if someone else hit you while you were crossing the street, your insurance would want to try to get coverage from that person’s auto insurance before paying out.
Seems simple enough doesn't it? The insurance company wants the responsible party to pay.
I'm surprised at the amount of paranoia about insurance companies, "tricking people and trying to steal their money". Right before one gets into an accident or needs surgery, they don't send someone out to sneak into a person's house and change all the coverage reflected in their policy papers.
People need to read the information about their membership to find out what their benefits are, and not be so surprised when they actually need it.
If I'm informed, no one appears to be 'trying to trick' me.
They are checking for Third Party Liability. Auto accident, workers comp injury, etc. If third party liability exists the insurance company subrogates and gets any money that was paid out on your injury from the other insurance carrier ( work comp, auto ins, homeowners etc)
Also some Plans do have specific exclusions for hazardous hobbies or specific kinds of accidents like all terrain vehicles.
Fill the form out or your claim won't get paid. Don't lie either because the insurance carrier also gets the medical records from the provider.
They are looking to see if someone else is responsible. I was asked once what type of accident caused my medical issue so they could find out if it was something like a car accident.
This exactly. This is not a new practice. They want to make sure they should be the one's paying the claim. If your injury was at work it would go through our employer as a work comp claim. If it was due to an auto accident then they want to know if someone else caused the accident as your insurance carrier would then subrogate (get reimbursed) by the other drivers auto insurance company.
Since you fell on ice your insurance company might tell you to submit your bills through the restaurant owners liability insurance or they might for after them for reimbursement.
I've received these quite a few times after certain kinds of injuries. It's part of normal underwriting, where they're looking to see if someone else is responsible.
Take for example you went in for neck pain, but it started when someone hit you in your car from behind and gave you whiplash. Your primary coverage should be through the party that hit you (or their insurer), not your medical insurance. That's why your insurer asks.
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