This section includes the following related topics:
- Compensation for crime victims
- Medical payment coverage
- Health insurance coverage
- Liability insurance coverage
When an accident of any sort happens, one or more insurance policies may provide coverage. The person who caused the accident might have liability coverage, and the victim might have health insurance, or might be qualified for government provided health care or other assistance. All of these sources might be used to pay the losses, partially or entirely, depending on the type of insurance.
Insurance covers accidents and statutory liability
If the incident is not an accident, but was intentional, only the victim's insurance will provide coverage. Dog bites are 99.9% accidents, so both kinds of insurance are available if the dog owner and the victim have them. Government provided health care applies to both accidents and intentional injuries.
Government assistance for crime victims
If the dog owner committed a crime related to the dog attack, the victim might qualify for government assistance in some jurisdictions. For example, California has laws that provide for payments to crime victims, and has sentencing provisions that require a convicted defendant to give a certain portion of his or her earnings to the victim.
Who insurance covers
Insurance covers the named insured for all the perils mentioned in the policy, except for those that are excluded. Other people might also be covered. For example, the standard homeowners policy covers all residents of the household who are related to the named insured, or are dependents under the age of 21, or are petsitters who are not being paid. Dogs belonging to the named insured and all dependent under the age of 21 are covered (if coverage is provided for dog-inflicted injuries at all).
Liability insurance covers the person or company that is liable for the accident (see Who insurance covers, above). The key concepts here are "liable" and "accident." This type of insurance does not apply if the defendant is not liable for the accident.
Medical payments coverage for the owner of the dog
Homeowners and renters insurance cover several types of losses. One type is a dog attack for which there is liability. Another type is any kind of accident that requires medical attention resulting in treatment costs, whether there is liability or not.
For this second type of accident, there is usually a small amount of money available because of something called the medical payment provision, or guest medical provision, of the policy. The so-called "med pay" is sent out when the insurance company is given adequate proof that there were medical bills incurred following an accident that fell within the scope of the policy. The most common limits for medical payment coverage fall between $1,000.00 and $5,000.00 per claim.
One of the duties of your attorney is to get all of the available money, and to pay off anyone who has a claim for medical treatment. To do this, the attorney should make a claim against something that is referred to as the medical payment provision of the homeowners or renters insurance policy. By doing so, your lawyer can get some limited funds very early in the process of resolving the claim. Keep in mind that one cannot get more than the policy limit of the medical payment section of the policy.
Some people get confused about the medical payment policy limit. They get the mistaken idea that this might be all the money that is available for medical treatment costs in a dog bite case. That is absolutely not true. When the full claim for everything is presented, it will include a demand for all medical costs, past and future. The insurance company will end up paying for all those costs, but the payment will be under the liability provision of the insurance policy. That is a different coverage with much higher limits.
A common mistake: sending medical bills directly to the dog owner's insurance company
It is a common mistake to send the victim's medical bills directly to the dog owner's insurance company. While the insurance company is obligated to pay medical expenses under the medical payments coverage (if any), there are reasons why the victim's attorney should be the one who sends the bills to the insurance company:
- The medical payment claim has to be made formally, by an attorney, to ensure that anything at all is paid.
- The insurance company will only pay the limit of the medical payment coverage, which might be $1,000.00 to $5,000.00. Therefore the insurance proceeds have to be strategically applied against only the most important and pressing medical bills.
- The attorney is in the best position to determine which medical bills are the most important and pressing. For example, an upcoming surgery might require a surgical suite fee paid in advance, which the victim might not be able to afford. That kind of bill is important and pressing. An experienced attorney will be able to prioritize competing claims to the limited amount of medical payment proceeds.
- The attorney may be able to convince certain health care providers to refrain from collection proceedings until settlement money (or money from a judgment) is available. This is referred to as a "lien," meaning that the provider has a legal right to be paid from the funds that later come into the attorney's hands from the injury claim.
The people who work at doctors' offices are not actually authorized to send claims to the insurance company for the liable party in an injury case -- believe it or not. Therefore, the claims are on the wrong forms (there really are no forms for this, because attorneys handle them differently each time), the insurance company gets confused and sends confusing letters to the doctors' offices, the medical payment coverage limit is exceeded and then nobody gets paid, and generally speaking nothing but confusion and hard feelings result from this. Frequently the doctors feel that the victim has mislead them by giving them incorrect insurance information, and the quality of care can actually suffer.
Property damage coverage for the owner of the dog
The dog owner's insurance policy might provide not only liability payments, but also property damage coverage for the victim's torn clothing, broken glasses, etc. Like the medical payments coverage, this is a separate and distinct policy provision, with its own limit. A standard limit is $500.00.
Health insurance for the victim
The victim might have some kind of health insurance. For example, a child might be covered under a parent's work policy. There are all kinds of health insurance plans, and many people have them.
The victim often is reluctant to use his or her insurance. One fear is that the insurance company will drop the victim. If the coverage is under a group policy, this is not likely to happen. If the victim was not responsible for the dog attack, it also is not likely to happen.
Any time a claim is made, whether against the dog owner's policy or the victim's policy, a record of it is kept in a national registry that the insurance industry maintains for the purpose of fraud prevention. Therefore, the victim's insurance company can find out about the attack at any time, so failing to make a claim will not keep it secret.
Kenneth Phillips usually advises clients to use their own insurance because certain health providers, such as hospitals and ambulance companies, refuse to wait for the settlement or judgment, use bill collectors to harass the victim, and send negative reports to credit reporting agencies. These companies do not consider themselves bound by the ethical precepts of physicians, who take an oath to render medical assistance whenever necessary, even to people who cannot pay, and who therefore routinely enter into arrangements to be paid after the settlement or judgment. The practices of such companies are unfair and unwarranted, and should be changed someday.
A great article about obtaining health insurance benefits for reconstructive surgery can be found at the website of Medem, entitled Insurance Coverage: A Patient's Guide.
Strategy for paying medical bills
You can deal several different ways with creditors like doctors, ambulance companies and hospitals. First choice is to ask them to "accept insurance." This means that they will take as full payment whatever your health insurance company will pay them.
Beware of something called "full balance billing." This is best illustrated with an example. If the creditor has an agreement with health insurance companies like Blue Shield or Blue Cross, that agreement says that the provider can charge you CERTAIN LIMITED AMOUNTS for services. In other words, the regular price might be $4,000.00 but the agreement might say that you get it for $400.00 (which is an example of something that really happened in a different case). Some providers take the position that, even though they agreed with the health insurer to take only the $400.00, they can turn around and bill you for the difference. In the view of many, that is INCORRECT and unfair. Do not agree to pay the full balance. Keep in mind that one of the services that an attorney will provide is the negotiation of such bills.
Second choice is to ask them to "take a lien" on the "case." This means that they will agree to not press you for money until the case or claim settles, at which time they will be paid through the settlement. The advantage is that you do not have to come up with the money now (which in any event would be repaid to you out of the settlement). The other advantage is that you or your attorney would have a chance to negotiate (i.e., reduce) their bill. If they agree to this, they will provide you with a form to sign, which you should permit your attorney to review before you actually sign it. If the provider does not have the form, tell them to call your attorney, who will send a form to them.
Third choice is to pay the amount (either the amount that they ask for or an amount that you negotiate), and get reimbursed from the settlement.
If you fail to do any of these things, the likely outcome will be that the matter will be turned over to collection. However, there have been cases where the provider "writes off" the balance (i.e., reduces it to zero).