Can a qualified individual tell me, is this insurance fraud?

Question

I was hurt on the job and made a report of injury. My regular insurance covered the costs except my co-pays, and I did tell them this was a work related injury. Now the workers compensation insurance company has offered to pay all outstanding medical bills, which would be the co-pays. Would this be legal? I know all medical cost where from my work related injury and they went well over a hundred thousand dollars. This seems like fraud against my regular insurance carrier.

Answer 1

Fraud would be the submission of inflated costs, accepting money for injuries not sustained, and the like. Doesn't sound like it meets the requirement.

HOWEVER, your regular insurance company may want to go after the worker's compensation company for subrogation. You made absolutely certain that the regular insurance company knew that you were hurt on the job?

I would make sure that your regular insurance company knows the name of the worker's comp insurance company, and knows that they have accepted liability for it. Otherwise, they might just decide that they want YOU to reimburse them... I don't think you would be liable, but you don't need the hassle. Let the insurance companies duke it out.

Answer 2

No, many people have 2 insurance companies for just this reason. Many companies would rather pay 20% that is left over than 80% of the full cost, so enjoy your "good fortune."

Just as extra info: However, many companies such as "State Farm" will cancel you as an insurance company if they find out that you have another health insurance company. They would rather pay 100% than 20%. Go figure. How do I know? Lol, from experience that a good friend of mine had before he died. It ended up costing State Farm $80,000. Hope they hated it.

Answer 3

I don't know what state you are from but in Wisconsin if you get hurt on a job and your insurance company covers it , your insurance company can go after workman's comp insurance to get back all money paid out. The company you work for is responsible for all costs 100% even any medications needed

Answer 4

If you do not check a company before entering into a transaction, you could lose your money, time and credibility. Some widely used resources are the Better Business Bureau (www.bbb.org) and the national fraud center (www.fraud.org) these days, you can easily find out more about a company using the internet in a few minutes. From a company's website, you can details about its ownership, how old the company really is and feedback from the company's customers.
You can find more detailed information about a company at http://tinyurl.com/gtb89

Answer 5

The workers comp should repay your regular insurance company. If after it is proved and settled a workers comp, your regular health insurance company can come back and ask or even sue you for thier money back, since workers injurty is not a covered item normally.

So youi need to be sure the money to repay the health insurnace is included in the settlement.

Answer 6

I don't see it as fraud as long as you are not double-dipping. Double dipping is when you are getting compensated for the same thing by two or more sources. What it appears here is the basic coverage is paid for by your insurer and anything that you paid out of pocket is reimbursed by WCB. That seems fair to me, as long you are honest to both parties and keep good records of all claims and payments made.

If WCB should have covered something that your insurance did, in most jurisdictions, this would become a fight between your insurer and the WCB company, not involving you at all.

Answer 7

What do i imagine? i imagine Obama is status on the the bow of the large politically and the iceberg is in sight. His popularity rankings will proceed to plummet unabated till 2012. interior the coolest, inspite of how liberals shameless fawn over him, he will be a one-time period, caretaker president who will purely be noteworthy interior the annals of yank history for being our first black president, not something more suitable.

Answer 8

let the two big grown up insurance compamies worry about it. Thry sure arent worried about you!

Answer 9

Phil R is absolutely correct.