Do I have to tell my health insurance company who injured me?

by Jane
(Dallas, TX, USA)

I was playing racquetball and got hit in the face with my opponent's racquet. I went to the ER immediately. My health insurance is now asking me for details about the incident. Am I legally obligated to tell them who hit me? I'm insured through a huge company by United Healthcare. If I ignore them can they cancel my coverage? Thanks.

Visitor Question:
Disclaimer: Information provided in our response is NOT formal legal advice. It is generic legal information based on the very limited information provided. Under no circumstances should the information in our response, or anywhere else on this site be relied upon when deciding the proper course of a legal matter. Our response does NOT create an attorney-client relationship. Always get a formal case review from a licensed attorney in your area.

ANSWER for "Do I have to tell my health insurance company who injured me?":

Jane (Dallas, TX, USA):

It's fair to say all insurance company policies, whether property or medical, require the insured to cooperate with the investigation and processing of their claim. United Healthcare is no different. Those insured who decide not to cooperate with the investigation and processing of their injury claim may be rightfully denied coverage

It's not a matter of being legal or illegal. Those terms apply to criminal events.

You would be best served by cooperating with your insurance company. From the facts you present, it appears you are concerned United Healthcare may "subrogate" against your opponent. To subrogate means they may pursue your opponent for reimbursement for the monies they paid out on your behalf. While that is a possibility, it is remote.

In most cases of accidental injury by a third party, especially in matters of sporting injuries, health insurance companies rarely, if ever pursue the party who accident inflicted the injury.

United Healthcare had to document the events leading to the injury, the injury, and the "damages" sustained by their insured. With first party insurers, damages normally include payment of medical and/or chiropractic bills, and out of pocket expenses for medications. You and your opponent shouldn't be concerned about being transparent with matters related to your injury. Cooperate and move on. This will be over before you know it.

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,

Judge Calisi

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