You should have tagged this onto your prior thread about the same topic. Here's the initial post in that thread (that Zigner linked):
"My wife is a sub, and PTA worker for the school. She is employed by the district.
A few days ago she slipped and fell at the school. there was a water fountain that had water on the floor. The mat was wet and so was the floor. She was there doing PTA work as she was part of the PTA. She was with another person and multiple people saw her fall. My wife works as a substitute in the school she is a preferred sub.
We found out today that she needs surgery because she tore her ACL. The school doesn't offer medical for subs. Everything so far has been out of pocket.
What is our recourse? File a suit? Ask them to pay medical?
I'm afraid there will be ongoing medical to rehab her leg.
My wife is scared about filing or suing the school. Thinking she will not get any more work or be retaliated against, our kids are both in this school as well."
The conclusion in that other thread is that there's no workers' comp claim because your wife was not acting in the course and scope of her employment at the time of the accident. You also explained that neither of you had personal medical insurance at the time of the accident. Moving to your questions in this thread:
Just FYI, omitting the subject of the sentence at the start of your sentences can make things hard to understand. I assume my additions above are accurate, but please say so if not.
That said, what sort of insurance is this? Are you referring to the school's premises liability coverage?
OK...it's important to know if this is liability coverage under which the PTA is the insured or personal medical coverage under which your wife is the insured.
If it's liability insurance, then it's a third-party claim, which means the insurer has no or limited duties to your wife. If it's first-party medical coverage, then the insurer has significant duties to your wife. Either way, she can complain to the
Consumer Services Division of the Office of the Commissioner of Insurance.
Beyond that, her only recourse is to sue the school and/or the PTA for negligence. I don't know if she has a viable claim, and this will be more difficult since the school is a public school, and there are specific processes that must be followed before you can sue a public entity. Conferring with an attorney is the thing to do. Note that there's a two year statute of limitations on negligence claims, and your prior thread indicated that the accident happened "a few days" prior to September 5, 2023.
