What should I tell my health insurance company?

by Sam
(Bellmore, NY, USA)

I was robbed and attacked in the city and I suffered a broken hand. I had to get surgery on my hand. The bill came out to $30,000. Will my insurance company pay for it if they know I was attacked? Should I tell my health insurance company I just slipped in the rain, or should I say I was attacked?

I'm not asking for anything extra, I just don't want to have to pay for the surgery. Thank You.

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 "What should I tell my health insurance company?":

Sam (Bellmore, NY, USA):

Tell your insurance company the truth. Not only is it morally correct, but it is legally correct as well. Many people don't realize giving false information to an insurance company with the intention of receiving insurance funds is a felony punishable by prison time and a substantial fine.

In most states just telling an insurance company you fell in the rain for the purpose of receiving insurance proceeds could be enough for you to be considered committing a felony.

You were legitimately injured. You have a legitimate right to be reimbursed for your medical bills. In addition to your medical bills you have a right to request your insurance company compensate you for your out of pocket expenses related to the injury.

They can include the cost of prescription and over the counter medications and aids, any of your lost wages as a result of your treatment and recovery time, and another amount for the pain and suffering you endured, and may continue to endure.

Don't sell yourself short! That's what you pay insurance premiums for.

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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