Question
What is the name of your state? FL
Two Part Question:
1. A friend was injured in a home I WAS buying. The injury took place prior to my closing on the home. He had to be taken to the hospital for a minor injury and the bill was $3600. Who is liable for the emergency bill?
2. Same friend quit his job but had insurance. I signed him up for COBRA the day he got his first notice of coverage. The plan admin has denied his claim. From what I can determine from the law, we responded within the time necessary for him to continue his coverage. I have confirmation from his plan of his COBRA coverage predated before the accident. Does he have a case and should the insurance provider cover his claim?
Thanks in advance,
Ed
Answer
1. Your friend is not covered on YOUR health insurance. Find out if your homeowner's insurance will cover it. Otherwise, it's between the two of you. There is no law specifying who is responsible in this situation.
2. What do you mean, YOU signed him up for COBRA? HE has to do that. Please clarify.
Answer
Understood. He isn't covered under my insurance. I didn't even have a home owners poilcy when the accident happened.
I registered him for COBRA insurance on his plan administrators website. It said that he was covered as of 5/14/04. THe accident happened on 5/20/04. We registered for COBRA online on 6/09/04. He had received the first letter from his administrator stating he was eligable.
So is he covered by his ins for the claim? And if not who is liable for the bill? What claim could he have against me? I offered to pay half but he is insisting on not paying anything. As far as I can tell this will probably end up in court. Just wanted to know what the case could potentially be against me.
Thanks.
Answer
With regards to the COBRA, has a payment been sent in? Registering him is not enough; payment must be made before the coverage is in effect. Was that done?
And again, why did YOU sign him up for COBRA? Why did he not do it himself?
Answer
I did it for him since his internet access was down. I just registered him. As far as the payment goes, he's said he did send in the payment. We still have a 45 day grace period from when the sign-up occured 6/9 to make payment even if he didn't.
But in regards to my questions:
Who is liable for the bill?
Would there be any other reason why he wouldn't be covered if we folowed all procedures etc.. regarding the COBRA election?
Thanks
Answer
1.) Who is liable for the bill?
I already answered this question.
2.) Would there be any other reason why he wouldn't be covered if we folowed all procedures etc.. regarding the COBRA election?
Did you think I was asking questions just to hear myself talk? I couldn't answer your question until you answered mine. If you want an answer, you need to provide full information.
Yes; if the procedure or treatment he received is not covered under the policy, then there would be no coverage. If they have not yet received or processed his payment, there will be no coverage until the payment is received or processed AND, as you correctly point out, that payment must be received within 45 days of June 9. (They have no obligation to pay anything until they actually have his check in their hands.) In addition, if the check was not for the FULL amount due retroactive May 14 and all the way up to the day the check is mailed, they don't have to make any payments until they receive the remainder. Again, the full payment MUST be received within 45 days of June 9. Finally, if the company has reason to believe that he did not actually sign up for COBRA (due to the fact that someone else enrolled him) then the coverage might not be in force as yet.