this could also be the reason that they have not offered medpay.

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PostPosted: Tue Jul 01, 2008 6:38 pm   Post subject:   

Tscope what kind of documents to go along with the photos? How should this letter go? Its pretty obvious the owner is at fault maybe they can add some negligence on her part. She will accept within reason. These type of cases both are at fault to some degree and she knows this. But she would have to prove her side. Hopefully this letter can make the adjuster reevaluate. But probably not because it is difficult. Thanks a ton tscope, lori & other members your the best!Very Happy


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PostPosted: Tue Jul 01, 2008 8:30 pm   Post subject:   

Quote:
How should this letter go?
I can't write the letter for you. There are 3 pages of good information here.
Quote:
Its pretty obvious the owner is at fault maybe they can add some negligence on her part.
Obvious to one person, yes.



Also, if your GF has medical bills I'd _certainly_ ask if the policy contained Medical Payment coverage. If it does, this should have been offered.
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PostPosted: Wed Jul 02, 2008 12:39 am   Post subject:   

William no negligence has to be necessary for med pay so get to that NOW...when she composes her letter send pics of the danger, and her injury if you have them along with medical bills, doc notes etc...but get on the medpay right now..



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PostPosted: Wed Jul 02, 2008 12:46 am   Post subject:   

When is she suppose to ask for the med pay? I was not clear on this? Was it later, after everything else is settled? Smile





Oh, "NOW". okay.



Yeah, my manager hates me as well...

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PostPosted: Wed Jul 02, 2008 12:51 am   Post subject:   

Quote:
When is she suppose to ask for the med pay? I was not clear on this? Was it later, after everything else is settled? Oh, "NOW". okay. Yeah, my manager hates me as well...
Ok Touchy Todd...I had a long day too Rolling EyesWink ( No offense, William ) but I think he some times wants REALLY direct answers....so thought I would just make that point very clear... Wink


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PostPosted: Wed Jul 02, 2008 4:54 am   Post subject:   

The original post states the three reasons that the adjuster denied the claim. To me the most important would be proof that it happened on their insured's property. I know its after the fact, but she should have told the landlord or management the day it happened or the following day at the latest. I would also agree with tscope, and is the reason that I don't see this going anywhere without an attorney. Due to the delay in reporting with no witnesses there is no proof or at worst case a chain of events…..fall-go to doctor same day sort of thing, they are going to hang their hat on that the accident didn't happen on the property - this could also be the reason that they have not offered medpay. Their not going to offer medpay when they dispute that the accident happened on their insured's property - it would put them on the hook if liability does exist. This is where I agree with tscope, the carrier will attempt to settle with an attorney due to legal costs or possible jury award depending on the area the suit would be brought but they will continue to blow your girlfriend off without an attorney unless she would file suit herself.



Also don't take the above post as me disbelieving the facts of the accident as you stated, it is just showing the carrier's side of the claim. If insurance companies gave money to anyone who claimed they fell on someone's property without proof……

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PostPosted: Wed Jul 02, 2008 5:39 am   Post subject:   

Quote:
this could also be the reason that they have not offered medpay. Their not going to offer medpay when they dispute that the accident happened on their insured's property - it would put them on the hook if liability does exist.
Extremely good point! Great response in it's entirety.
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PostPosted: Wed Jul 02, 2008 2:08 pm   Post subject:   

How would proximate cause come into play in this situation?


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PostPosted: Wed Jul 02, 2008 3:03 pm   Post subject:   

Quote:
How would proximate cause come into play in this situation?
Proximate cause is what really caused the situation to happen. There might be other things that also "helped" create the situation but the Proximate Cause is the thing that started it all. While you could determine what the Proximate Cause was in this loss, I don't see why that would really be important.



Example: The proximate cause of the injury might be a loose railing. But if the person was carrying a ton of grogery bags, the bags might have also helped lead to a fall and injury. But the loose railing would have been the main reason why the fall happened.
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PostPosted: Wed Jul 02, 2008 5:34 pm   Post subject:   

How can my gf prove it happened at the apartment?


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PostPosted: Wed Jul 02, 2008 6:05 pm   Post subject:   

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How can my gf prove it happened at the apartment?
Based on what you have stated, I don't know of any way to absolutely prove that the accident happened at all. But on most claims there is almost never proof like this. As I mentioned before, it's what a jury is going to believe. If they can be shown there was an injury, it's highly likely that the injured person was in the area they state the accident happened, it can be shown there was an injury and the injury agrees with the description of what happened, and there is a hazard/defect that also agrees with the explanation of what happened... is a jury going to make that leap of faith and take the person at their word that it happened? I say in this case, yes. But that is why claims are usually settled prior to going to a jury... no one know what a jury will think. In this case I think the insurance company should be more worried about what a jury might think. A property owner collects a _lot_ of rent every month. In return they are expected to use some of that money to maintain a safe living environment. The jury would see in this case (?) that this was not done. How are they going to react to that? They are just people and they do form opinions. Do they really expect people to video tape their lives 24/7 so they can have everything on tape? Nope. Most of the time if they don't see any problems with the statement of the injured person, they will take them at their word. Also, hows it going to look when the property owner gets in front of the jury and tries to tell them that despite everything else mentioned, there is no _proof_ that the accident happened? It will probably just piss a jury off.
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PostPosted: Wed Jul 02, 2008 11:58 pm   Post subject:   

William, who did she call immediately after she fell? anyone? her mom? did someone come over to help her? (what is her injury by the way?)...



Something I forgot to ask..has gf EVER EVER had another slip and fall, trip, whatever claim EVER?



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PostPosted: Thu Jul 03, 2008 10:10 am   Post subject:   

Most likely she would tell her mother. I know the injury was to her arm because when she was falling she streched out her hand. A normal reaction someone do when they realize they are falling. I will ask her of full details of whats in the med report. No she never had any claim before. She state to me yesterday she is just might drop it. She have to much other things going on and this one more isnt making it easier. She probably just chalk it up as a mistake, experience and just let it be. Last thing she needs is trial i heard those things can be stressful at times. She is tryin to get over a sexual assault that happened to her by a family friend. And no it didnt take place at the appt. complex. Part of the med bills that wasnt covered by her insurance she will just have to make a payment arrangement.


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PostPosted: Thu Jul 03, 2008 10:24 am   Post subject:   

Well, it's up to her, if she wants to pursue it....the reason I asked about who she called etc...that could go to help prove when it happened, etc.



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