Insurance Paranoia Question

[JoeyGee]

Seven weeks ago today I was cutting some MDF strips on my TS. Working late and rushing, I got careless and nipped my thumb on the blade. Thankfully, it wasn't too deep and too bad. I did go to the ER to have it checked out. There wasn't enough "meat" left to stitch, but not enough gone to warrant a graft. It's pretty much healed now. I was very, very fortunate.

Anyway, I just got a letter from my insurance company asking me for all the details of the accident, making sure it wasn't work related and/or there wasn't some negligent party to go after instead. I am sure that's all it is, but I'm concerned if I fill out the details I will get another nice letter stating such dangerous activities aren't covered and I am now 100% out of pocket.

I know I am just being paranoid, but has anyone ever received such a letter? I have no reason to believe there would be such a "dangerous activity clause", but you never know... This is a new insurance company as of 1/1, so I have no experience with them--United Health Care, if it makes any difference.

[atgcpaul]

About five years ago I cut my right index finger while doing a stupid cut with one of those Irwin framing saw with the Japanese teeth. I got 5 stitches and have a nice scar to remind me of my stupidity. Anyway, the nurse at the hospital typed out the details of the accident. Weeks later I got a call from the CPSC (not my insurance company) with some survey type questions about the accident. They thought it was a table saw accident.

Anyway, maybe it is just information gathering for their own information, and they want to make sure you shouldn't have a different level of insurance (in case you were doing this as a business).

Using a kitchen knife is dangerous. I'm sure more people injure themselves that way than with TSs every year. I would think "dangerous" is too subjective a term to drop your insurance.

[cabinetman]

Read the fine print on your policy. See how it's worded. Seems like a kitchen knife is a very popular type of injury.

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[tommyt654]

Don't be too surprised to see your insurance rates go up next yr.,thats the norm in these case's. They'll use anything to adjust your rates for profit nowadays

[greenacres2]

Hey Joe--that's a very normal procedure to make sure that the claim is being paid by the right party. Even in cases where the "fault" would be extended to another party's casualty carrier, larger claims get paid anyway and the major medical company subrogates (seeks reimbursement). That way the patient can still get treated. Do complete and return the form as your claim will not process with UHC until you do.

No need to worry about your rates next year for that--pretty small expense compared to some of what we see. Chronic illness, and debilitating injury are what have serious impact. (gall bladder and appendix removal are "expensive", but since they are a one-time occurence for most humans they have very little impact) On the flip side, the company you mention has had relatively large rate increases to small group clients (2-50 employees) in our area. On the 100 and up employee market, they are much better.

Finally, a woodworking question i can answer!!

earl

[Cubsfan]

I think that's just standard procedure. I assume they're trying to find out if someone else can cover the cost (i.e. if it happened during work, then they'd tell you to work with worker's comp).

I got the same type of letter last year when I sliced off the tip of my finger with a knife when I was out camping. Filled it out and never heard another thing.

[greenacres2]

Correct Cubsfan. It's easier to correct the claim before it processes than after. I got injured on a volunteer fire call a few years ago, and the ER and other initial charges got processed through the department's workers comp. Two weeks later, with all the pre-surgery paperwork completed with the same info--the hospital, surgeon, anesthesiologist and radiology ALL got billed to my major medical instead of workers comp. The ER stuff with no effort prior was correct, and the forms they made me spend 2 hours filling out later were completely ignored!! And for some reason, it's the only accident claim i've ever had that i didn't get the letter before the major med processed it...

Shoot, it would have been faster to not fill out the papers and just fix it after they (all parties involved except me for once!!) screwed it up anyway.

Okay, calming down now.

earl

[Cochese]

About five years ago I cut my right index finger while doing a stupid cut with one of those Irwin framing saw with the Japanese teeth. I got 5 stitches and have a nice scar to remind me of my stupidity. Anyway, the nurse at the hospital typed out the details of the accident. Weeks later I got a call from the CPSC (not my insurance company) with some survey type questions about the accident. They thought it was a table saw accident.

Anyway, maybe it is just information gathering for their own information, and they want to make sure you shouldn't have a different level of insurance (in case you were doing this as a business).

Using a kitchen knife is dangerous. I'm sure more people injure themselves that way than with TSs every year. I would think "dangerous" is too subjective a term to drop your insurance.

Someone at the hospital didn't do their job correctly, most likely the ED coder. That's who I (basically) supervise now.

In coding, if someone presents with an accident, there are E-codes which we can amend to explain exactly how someone was injured, if that information makes it to the chart. If the nurse just wrote saw, then the coder may have assumed table saw. The CSPC calling you is exactly why those codes are there, for reporting to government agencies along with your payor.

As for insurance for the OP, my work offers supplementary insurance for basically anything. Used to be through Unum, but now it's via Mutual of Omaha. For a few bucks each paycheck I'm covered for any kind of accident for anything, plus hospital reimbursement costs. Something any of us may want to look into with how often we work with dangerous tools.

Something I thought was a no-brainer considering I get paid with my fingers (bring on the jokes).

[BigguyZ]

I've gotten that questions a couple of times. First when I nearly cut off my finger with the router table, and then again when I had an MRI done to look at my shoulder (I have severe arthritis, as it turns out). Neither were work related issues.

But be aware, I procrastinated on getting the communication back for the shoulder, and they witheld payment for the MRI until I confirmed it wasn't a work issue. So I wouldn't wait to send it in.

Are you insured through work, or do you buy your own? If it's the former, I wouldn't imagine they'd have much recourse to raise your rates or limit your coverage.

[cwsmith]

I think there's always a concern for the objectives of your insurance company's investigative questions following an accident. I think this is especially true when you're a relatively new customer too.

The problem is that you must follow up fairly quickly, as otherwise they might get to thinking you're covering up something.

I have yet to be injured in my shop, but if and when it happens I suspect the insurance company will want to know exactly how much of this dangerous activity I'm involved with (or so I suspect).

I remember when I was a young guy, the insurance had some definite concerns when I stupidly stated I was on a search and rescue team and often flew in our squadron's plane as a certified "observer". They didn't like that at all and though it may be only a few times a year, I had to get a "rider" to the policy.

On the other hand, I think we sometimes forget that our insurance company is a "for-profit" business. If the accident is possibly the fault of an unsafe tool, practice, or in a managed work situation... they want to make sure the proper people are libel for the expenses involved. Before "No-Fault" car insurance, it was a nasty business reporting a "fender-bender"... I was with Allstate back then, and they'd fight "tooth and nail" to avoid paying out and if it wasn't the other guys fault, then for a young guy like me, they would be determined to come up with a reason to kick me up to "high-risk".

Hopefully, your situation is simply that they want to make sure that someone else shouldn't be paying instead of them.

CWS