Broke my ankle in a bounce house...
I broke my ankle at a kids birthday party in a bounce house. I signed a waiver which covered me and my child. I am not claiming negligence or looking to sue.
However, my question is, since I signed a waiver, can my own personal medical insurance refuse to pay for my care, since I assumed liability for the activity? This hasn't happened yet but they are asking me a lot of questions about the circumstances of the accident and I am concerned that things might go in that direction.
Must they pay if there is no other liable party? If you sign a waiver like I did, does that give my personal medical insurance the right to refuse treatment? Is there anything else I should know in this situation? Thank you.
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ANSWER for "Broke my ankle in a bounce house...":
Anonymous (Dallas, TX):
While the coverage in medical insurance policies varies, in most cases it is relatively simple. If you are injured, or become ill, your medical insurance will pay for the medical treatment set out in your policy.
Signing a waiver of liability protects the owner of the Bounce House. The waiver can not result in diminishing or voiding the coverage you purchased from your insurance company.
The only reason your insurance company could possibly refuse to pay for the medical treatment allowed under your policy is if your were to file a fraudulent claim, or in some cases, if you intentionally injured yourself. From the facts you present, there is no evidence of either.
Under the 1996 Health Insurance Portability and Accountability Act (HIPAA), a group medical health insurance plan cannot exclude coverage for acts of negligence or self-inflicted injuries. An individual health insurance plan can only exclude coverage for self-inflicted injuries if the plan excludes pre-existing conditions and the insured had a history of mental illness when enrolling in the plan.
Tell your insurance company the truth. Asking questions about the incident and resulting injuries is standard. Those questions are normally asked of anyone injured who has filed a medical claim.
The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from an attorney licensed in your state. Find a local attorney to give you a free case review here, or call (888) 647-2490.
Best of luck,
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