I am 80 years old and tripped on a display in a major department store and broke my shoulder. I had total shoulder replacement surgery and will be affected the rest of my life.
Medical bills totaled over $112,000. Medicare paid my medical expenses.
The store has video but will not allow me to see it. The store is self insured and the adjuster says the company would like to settle with me, but by looking at the video they are not liable. The adjuster states I just tripped on my own and it’s unfortunate, but they want to settle. They offered $10,000, which is a very low offer.
1) With my medical expenses of approx. $112,000 being paid by medicare, wouldn’t I need to settle for more than medical expenses? Don’t I have to pay medicare back?
2) Why would the adjuster be willing to settle with me and yet at the same time tell me there is no liability on their part?
3) I think I tripped on the display, but the adjuster says I didn’t by looking at the video, yet will not allow me a copy to view. How can I know the truth without seeing video?
Thank you for any information you can provide.
Disclaimer: Our response is not formal legal advice and does not create an attorney-client relationship. It is generic legal information based on the very limited information provided. Do not rely upon the information in our response, or anywhere else on this site, when deciding the proper course of a legal matter. Always get a personalized case review from a local attorney.
Unfortunately, unless the store video is subpoenaed, you don’t have a legal right to see it. The video is proprietary, and belongs to the store. The only way you would have a right to see the video is if it was subpoenaed after a lawsuit has been filed (or under special conditions, before a lawsuit is filed).
Federal law requires you to report the store injury to the Medicare Coordination of Benefits (COB) Contractor. The COB Contractor is a privately owned company which processes reimbursement of Medicare benefits after the Medicare recipient has settled a personal injury claim, or after a court award.
The COB requires you notify them of the details of your injury, the name of the store’s insurance company, and, if you were represented by an attorney, the attorney’s name and contact information. You are not represented by counsel, so this provision does not apply to you.
Unfortunately, Medicare reimbursements are not negotiable with COB. The law requires the COB to recover specific amounts paid out in the Medicare insured’s behalf. Of course, any amount over the reimbursed amount required would be yours to keep.
It is common for insurance companies to offer settlements without accepting liability. While doing so would appear convoluted, it happens all the time and is perfectly legal.
Hopefully you will heal quickly and be back to your normal activities.
Learn more here: Retail Store Injury Claims
The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney.
Best of luck with your claim,
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