I own an insured tree felling company. A relative asked for my help to clear land for their home. I was not getting paid and no contract was made because it was free help.
While working to clear their land, I had an accident and broke both ankles. One ankle required surgery to place screws to hold the bone in place.
As a family, we used my wife’s health insurance through her employer. But now her insurance company is asking where and how did it happen? They are looking for someone to pay the bill.
Can they go after our relative? Could they go after my tree company’s insurance? I was just helping as a friend not a business.
Please let me know what my wife’s health insurance company might do.
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.
Answer
Dear Anonymous,
Thanks for your question. Your wife’s insurance company is likely asking questions about your accident to see if it can assert a medical lien. Based on the facts in your email, though, we don’t believe the insurer can assert one.
Medical Liens in General
Medical liens are often used by insurance companies to get reimbursed for the payments it makes to claimants in connection with their injuries.
For example, in your case, your wife’s insurance company paid for the medical care you received following your injury. If some other entity, like another insurance company, also paid for your medical expenses, then your wife’s insurer could try to assert a lien over that money. The lien is to get reimbursed for some of the money the company paid on your behalf.
Medical liens are usually legal and are often controlled by state laws.
Relative’s Homeowner’s Insurance
Premises liability is a legal concept that means a property owner is financially responsible for negligently causing someone to suffer an injury on their property.
Negligence means that a person failed to act reasonably under the circumstances or failed to correct some hazard on their property.
If a homeowner negligently caused someone to suffer an injury on their property, then the injured victim can look to the person’s homeowner’s insurance to receive compensation for their losses.
There is no evidence in your email that your relative was negligent in causing your accident. Without negligence, there is no basis for you to receive any money under your relative’s homeowners liability policy. With no basis, you can’t receive compensation under that portion of the policy, and there is no money for your wife’s insurer to assert a lien over.
Med-Pay Coverage
Keep in mind that most homeowner’s policies have two kinds of coverage for injuries – liability coverage and Med-Pay coverage.
While we already mentioned liability coverage, Med-Pay coverage pays an injured victim for a limited portion of their medical expenses (usually up to $5,000). The coverage applies if you were injured while on the policy holder’s property, even when the homeowner wasn’t negligent.
From the information you provided, it seems that you didn’t receive any money from your relative’s insurer. However, if your relative’s homeowner’s policy provided Med-Pay coverage, and you did receive money under it, your wife’s insurer could try to assert a lien over that money.
Your Company Insurance
Your company insurance doesn’t apply to your situation.
While doing the work for your relative, you were not acting as the owner or an employee of your company. As you stated in your email, there was no contract in place for the work and you weren’t getting paid.
Since your company insurance is out of the picture, then there is nothing for your wife’s insurance company to assert a lien over.
Pennsylvania Law
Pennsylvania recognizes the “Made Whole Doctrine” when it comes to medical liens. The Doctrine was established in the legal case Nationwide Mut. Ins. Co. v. DiTomo.
The Made Whole Doctrine states that an insurer cannot enforce its right to a medical lien unless an injured party received the full amount of their losses from a third party.
Under this Doctrine, your wife’s insurer couldn’t assert a lien against a payment under your relative’s Med-Pay coverage unless that coverage compensated you for all of your losses. But given that Med Pay is typically for a limited amount of an injured victim’s medical expenses, the Made Whole Doctrine would likely prevent the assertion of a lien in your case.
Help From a Personal Injury Attorney?
If you didn’t receive any money under your relative’s homeowner’s policy, then you likely don’t need help from an injury lawyer. While you should answer any questions from your wife’s insurer, try to keep your answers short and avoid offering too much information.
If, though, you did receive a Med-Pay payment, we’d recommend talking to a personal injury lawyer for help.
Medical liens can get confusing. Further, Pennsylvania law doesn’t always aggressively uphold the Made Whole Doctrine. This means your wife’s insurer may not easily back down from an assertion of a medical lien.
Learn more here: Does Homeowner's Insurance Cover Injured Workers?
The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney.
Find a local attorney to give you a free case review here, or call 888-972-0892.
We wish you the best with your claim,
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