What types of medical bills must an insurance company cover?

by Anonymous

In Nov 2015 I fell in a shower at a hotel adjacent to the swimming pool after swimming. In Minnesota it's very difficult to establish liability for this type of accident, so no attorney would take the case. The hotel did have a $5,000 insurance policy to cover medical expenses, as so far have been.

I am in recovery mode and still have physical therapy. The attention is now focused on healing of nerves, muscles, soft tissue at the surgery site (have metal rod and screws in the bone).

The treatment I am using is through a licensed Doctor of Pastoral Science and Medicine; Traditional Doctor of Naturopathy... to name just a few of her credentials.

She's established a protocol based on my symptoms (and her expertise) that I should used a specialized form of massage to break up scar tissue and help the muscle neurons to fire again. She also uses Hyperbaric Oxygen Therapy to accelerate healing through release of stem cells 8 fold (based on clinical studies) and laser therapy, also to accelerate healing to facilitate restored mobility and pain reduction.

Shouldn't the insurance covering my bills from the accident pay for these bills as well? Does it have to be a bill from a conventional M.D.? Why? Thanks for the information.

Visitor Question:
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ANSWER for "What types of medical bills must an insurance company cover?":

Anonymous (Minnesota):

Your first clue is not being able to find an attorney to agree to represent you. Personal injury attorneys make their living representing clients who have been injured as a result of another’s negligence. When negligence is established, the negligent party often becomes liable for the injuries and resulting costs sustained by the client.

In your case, for the hotel to be liable will require proof of negligence. While your fall was unfortunate, there doesn't seem to have been an action or omission by the hotel or its employees which would have caused you to unnecessarily slip and fall in the shower.

The hotel’s insurance company likely agreed to compensate you not based on their insured’s negligence, but instead based on the hotel’s General Liability policy. A general liability policy will often pay an injury claim made by a guest regardless of negligence.

According to the Pastoral Medical Association, Doctors of Pastoral Science treat patients by restoring and protecting "the Almighty's God’s safe natural health care concepts as the ecclesiastical pursuit it is, to assure bible based natural health services..."

It is fair to say the hotel’s insurance company will likely not agree to compensate you for the treatment provided by a Doctor of Pastoral Science. Rarely, if ever do insurance companies attach legitimacy to treatment based on the Almighty’s ecclesiastical pursuit.

If you were able to show the hotel’s negligence resulted in your fall and resulting injuries, AND you can provide medical bills from a licensed physician who treated you, then you might expect further compensation from the insurance company. Absent those requirements, we can only hope your pastoral treatment will be successful and you will soon become fully healed.

If you’ve visited with only one attorney, you may have not have gone far enough. Go online and research personal injury attorneys in your area. Make appointments with several. Most injury attorneys will not charge for an initial office consultation.

See if other attorneys feel the same way as the first. If so, then you may be in a precarious position. However, if you find one or more attorneys who believe your case is viable, then retain the attorney with whom you feel most comfortable.

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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