Homeowners Liability?

Question

Hello - A couple of months ago my neighbor came running to our house screaming that her house was on fire and that her dog was inside (it wasn't). My husband ran across the street with our fire extinguisher and sprayed the flames but had to run out because of the smoke. He went back in again and managed to put the fire out before the Fire Dept. arrived. Over the next several days his lungs were so irritated that he remained in bed. On day seven I drove him to the emergency room where he spent 16 hours to find via X-ray that he had a lung irritation but no damage: Which caused him to remain in bed for 2+ weeks. The visit cost over $500 dollars which our Insurance company Aetna refused to pay referring to the balanced budget act of 1997 defining an emergency. So we contacted my neighbors insurance company. Two months later, still no contact. We called her insurance company again (Allstate) and they said that they would look into it. Do we have a claim?

Answer 1

Technically, YOU can't put in a claim on THEIR homeowners policy. Only they can. What you CAN do, is file suit in small claims court, which will then probably encourage them to pass the papers along to their homeowners carrier.

They do have a "no fault" coverage on their homeowners policy called "medical payments". Usually it's somewhere between $500 and $3,000 (although the $500 is much more common than the $3k), which would pay your medical bills. It will NOT pay any pain and suffering or lost wages, or anything EXCEPT medical bills. I would expect that it WOULD cover this situation.

If you are trying to sue them for pain & suffering, or lost wages, I do NOT think you'd have a case - they were not negligent - your hubby ran into a burning house. Sure, he was trying to be nice. I think that's the last time you do that for THAT neighbor, if she won't even put in medical payments for you.

One last comment - Allstate has NO obligation towards you. You are not their client. There is NO good faith obligation for them to investigate or settle a claim with you.

OH, and I'd DEFINATELY appeal the Aetna denial. I'm not familiar with that act - but MOST accidental injuries consist of some type of emergency or other.

Answer 2

I'm a bit confused on Aetna's denial. The balanced budget act of 1997 was to balance the federal budget by 2002. What does that have to do with Aetna's liability?

There were major medicare and medicaid reforms in the balanced budget act. But I still can't figure out why Aetna would deny the claim.

I would call them back and get a better explanation of their denial.

I don't know that you would have a liability claim with Allstate but it should be covered under her Med Pay on her Homeowners. I would also call Allstate and ask them to pay the bill under their Med Pay.

Answer 3

First of all , your husband is a hero of sorts, and should get recognition for trying to save a dog or a dwelling.
The insurance company of the burning house should recognize that your husband limited their loss by intervening, and they should voluntarily contribute to his medical bills as a goodwill gesture, even though they are not legally obligated.
You don't say if your insurance company Aetna is house insurance or medical insurance.
If you had medical coverage, that should pay the medical bills for any reason.

Answer 4

When in doubt about who's insurance covers what... contact your state's insurance commission... they will help you with your claim !