Question about Med Pay Insurance from injury?

Question

Long story, short: I fell and broke my nose while I was pumping gas at a local convenience store. The date of my injury was 1-31 and my health insurance was to become effective on 02-01, just hours away from the time that the accident occurred. My emergency room visit, so far, has totalled approx. $4000. My provider won't cover it because we arrived at the emergency room on 1-31. My question is: We were told by an insurance agent that the convenience store has Med-Pay insurance just to cover medical payments for injuries that occur on the premises. We don't want to sue or do anything else that goes beyond our medical payments, but would this be covered under the gas station's med-pay policy? We don't want anything extra, just help with the medical payments. Thank you again for your time.

Thank you for your prompt responses. Great advice, however I just received a phone call from the risk management dept of the convenience store and was told that they are self-insured and do not carry Med-Pay coverage. I told him that I couldn't see how they had been negligent in any way, but that I do have legitimate, documented medical expenses that are going to cost approx. $4000, when all is said and done. Do I have any other recourse?

Answer 1

The station has Liability Insurance....file a claim for Med bills and personal injury, at the deposition, ask for med bills only and wave the Personal Injury. Their Insurance Co. should be happy to pay the bargain and be done with it. If not...ask for big money for your injuries and hang tough with a good Attorney.

Answer 2

Med Pay is a liability section. It's moderately likely to be $1,000 limit, IF they have it. Gas stations are "high risk" from a gl point of view, so it's not particularly "guaranteed" that they have the med pay section on their liability policy.

If they DID have med pay, it would pay the med pay limit towards your medical bills. But the limit could be anywhere from $500 to $5,000, or as I said before, non-existant.

Did you file an incident report with the gas station at the time it happened? You can tell them you want them to open the claim, and file for medical bills . . . but their insurance company has NO obligation to do it directly on YOUR word. Which means . . . you might end up having to sue them in small claims court after all.

Answer 3

Did you report your injury to the gas station such that they have a record? You need to call and speak to the manager about how to make a claim. The reason you fell may also be payable as a liability claim against them. It doesn't necessarily mean you have to sue them or have an attorney represent you. Basically, put the gas station on notice that you want to file a claim for your injuries. Ask them who their insurer is and how to contact their agent and what their policy number is. Be sure to have the date and time of your injury and be prepared to give a recorded statement to their claim rep about how the injury happened. If they have medical payments coverage for injuries on their premises, they'll let you know. If your injury was caused by some negligence on their part (a condition of the pavement or other situation that caused you to fall through no fault of your own) they could be liable for your injuries and would owe you for reasonable medical expenses as well as payment of pain and suffering--which doesn't necessarily mean early retirement and a trip to the Mediterranean for you! "Pain and suffering" would pay for such things as lost wages and consideration for the discomfort, inconvenience and level of disability the injury may have caused you.

Answer 4

If the gas station has medical payments insurance coverage (some do, some don't), it will pay your medical bills only, without regard to fault.

Suggestions, simply call the gas station, and ask they present a claim to their insurance company. If the insurance company provided medical payments coverage, they are required, in most states, to tell you they have it and offer the coverage to you.

If this is not something that the gas station is at fault for, they are not required to pay for anything else. To recover for a personal injury claim, you must show fault. However, for medical payments, it's payable without regard to faule.

Answer 5

If you reported the incident/accident to the gas station at the time of injury, there should have been an incident/occurrence form filled out at that time. The gas station would be liable for your medical bills if you tripped over something, or fell because the ground was uneven or slick, something of that nature.
If you did not report it, you will probably need a witness to the incident and an attorney to recoup your incurred medical bills.

Answer 6

Contact the manager of the gas station and ask that person if you file your claim with him or his district manager or the owner. They all have policies that cover these things, because accidents do happen, and since you were injured on their property during normal business hours, it should be covered under their insurance.

Keep copies of EVERYTHING you submit, along with dates of submission and who you sent it to and who you spoke with. You should be dilligent on following up on this to make sure it gets paid - otherwise you might get stuck with the bill.

Good luck. Feel better!