Injury from breaking up fight.

[TNfan]

Jurisdiction

Tennessee

If a person is with two individuals who are in an argument, and while trying to break up the argument, the individual gets punched by one of the two arguing, and suffers an injury (cut lip), can his health insurance cancel his policy? He had to go to the ER for stitches. The 3 individuals were drinking. The injured person was not aggressive toward the others, just trying to stop a fight. Insurance company is wanting details.

 

[adjusterjack]

can his health insurance cancel his policy?

Depends on the terms and conditions of the policy. Read it.

Insurance company is wanting details.

So, give them the details.

 

[cbg]

It is quite unlikely, under the current health care laws, that the health insurance will be cancelled. It is much more likely that they are asking for details to determine whether they should be looking for reimbursement from one of the other participants' insurance carriers.

One thing I can tell you, however, is that if they are looking for details, they're not going to pay the claim until they get them.

 

[TNfan]

It is quite unlikely, under the current health care laws, that the health insurance will be cancelled. It is much more likely that they are asking for details to determine whether they should be looking for reimbursement from one of the other participants' insurance carriers.

One thing I can tell you, however, is that if they are looking for details, they're not going to pay the claim until they get them.

I do realize they are looking to see who was at fault. I'm wondering if because this happened while all 3 were drinking, is there a possibility the injured persons health insurance could be cancelled.

 

[TNfan]

I do realize they are looking to see who was at fault. I'm wondering if because this happened while all 3 were drinking, is there a possibility the injured persons health insurance could be cancelled.

I did look at the policy and I do not see anything that appears like his policy could be cancelled. The only thing I see is if he made an intentional misrepresention of the facts (I'm assuming on this "Acts of Third Party/Subrogation Inquiry Form"). One of the questions asked is "Were you under the influence of drugs or alcohol at the time of the injury?". Does this mean any amount of drinking or does it mean legally intoxicated? Not sure how to answer this question. Thanks for any help. Want to reply honestly and correctly on this form.

 

[cbg]

Read the first sentence of my post again.

Under the current health care laws, it doesn't matter if they were drinking or not. The days when a health insurance carrier can cancel your insurance out from under you are over.

 

[adjusterjack]

One of the questions asked is "Were you under the influence of drugs or alcohol at the time of the injury?". Does this mean any amount of drinking or does it mean legally intoxicated?

Any amount of booze or drugs puts you "under the influence" so you answer the question truthfully.

Of course, before you admit to any use of illegal drugs, I suggest you talk to a criminal defense attorney.

 

[TNfan]

Any amount of booze or drugs puts you "under the influence" so you answer the question truthfully.

Of course, before you admit to any use of illegal drugs, I suggest you talk to a criminal defense attorney.

No illegal drugs. Just some guys drinking.

 

[Highwayman]

The injured person should be dealing with this themselves. You sticking your nose into someone else's business is hardly helpful.

 

[TNfan]

The injured person should be dealing with this themselves. You sticking your nose into someone else's business is hardly helpful.

Trying to help guide a young adult.

 

[zddoodah]

can his health insurance cancel his policy?

Depends on the terms of the policy.

Insurance company is wanting details.

Probably for subrogation purposes.

One of the questions asked is "Were you under the influence of drugs or alcohol at the time of the injury?". Does this mean any amount of drinking or does it mean legally intoxicated?

"Under the influence" means exactly that, and "legally intoxicated" doesn't have any meaning outside of the DUI context.

 

[cbg]

Okay, let's cut to the chase.

TNFan, is the insurance you are so worried about provided by an employer? For the purpose of this question, I don't care if it's the individual's own employer, their spouse's employer, or their parents' employer. All that matters is whether or not it is employer-sponsored insurance.

 

[TNfan]

No, it is not provided by an employer. It's insurance he bought on his own

 

[cbg]

In that case, there is about a .0001% chance of cancellation, but ONLY if it says right in the policy in so many words that coverage can be cancelled after an injury that occurs when the policyholder has been drinking. If you can't find that spelled out in the policy (and you won't) then the policy cannot be cancelled, period, full stop. About the only way an insurance carrier can cancel an individual policy under today's laws is if you don't pay the premiums or if you deliberately falsify your application.

If you'd said yes to the employer sponsored part the answer would be an unqualified NO. It's just not that easy for a health insurance carrier to cancel coverage out from under you these day.

I work with health insurance and health insurance laws every working day of my life.

Stop worrying. It isn't going to happen.