Accident at carwash and insurance

[sparkey]

My wife had a fall from a ladder while doing some work at our carwash which caused the need for knee surgery. Now I am recieving letters from her health insurance company inquiring where the accident happened because it appears they want the carwash insurance to pay the bill instead of her health insurance. Can her health insurance make the carwash insurance pay this bill? I don't see the carwash being liable for creating any unsafe conditions being she is not a paid employee and she is the one who put the ladder up which she fell from?

 

[Washmee]

Don't you pay into the Workers Compensation system? If you don't, the carwash is liable for her injuries as far as your medical insurer is concerned. Even though you state she is not an employee, she was still performing a task related to operating the wash. Its possible your liability carrier might deny the claim on the grounds that she is an employee and should have been covered by Workers Comp. You might need the help of an attorney on this one.

 

[sparkey]

I don't have workers comp because I don't have any employees.

 

[Washmee]

I don't have workers comp because I don't have any employees.

You don't pay yourself a salary? Are you a corporation?




Ohio BWC FAQ

2Q. What if I own my own business, do I still need coverage?
2A. Owners of sole proprietorships, partners in a partnership and individuals incorporated as a corporation (with no employees) are not considered employees and have the option whether or not to cover themselves.

3Q. What are the pros and cons of sole proprietors, partners, individuals incorporated as a corporation (with no employees) or family farm corporate officers electing to cover themselves?
3A. The benefit of elective supplemental coverage is that sole proprietors, partners, individuals incorporated as a corporation (with no employees) or family farm corporate officers can report a work injury against their policy and upon BWC approval of the claim, medical bills and lost time wages can be paid. The liability of elective coverage is that sole proprietors, partners, individuals incorporated as a corporation (with no employees) or family farm corporate officers must report their wages to BWC and pay the appropriate premiums on their net income.
Minimum/Maximum payroll reporting requirements
4Q. If I incorporate my business will I have to get workers' compensation coverage?
4A. All employees including corporate officers, except for individuals incorporated as a corporation with no employees or family farm corporate officers, are considered employees and must have an active workers' compensation policy covering them.

Is your wife considered a volunteer?

11Q. Can volunteers be covered?
11A. Coverage is not available for individuals who volunteer for private employers including non-profit organizations. However, public employers such as villages, townships etc., are required to obtain coverage for volunteers who provide emergency services. Click below for more information on coverage for volunteers.
Volunteers Performing Emergency Service Duties
Volunteers Performing Non-Emergency Duties

Remember that if you choose not to cover yourself, and you are injured at work, BWC will not provide coverage. And other insurance may not cover your work-related disability or medical bills. Contact your insurance carrier if you have any questions.

Good Luck.

 

[mjwalsh]

My wife had a fall from a ladder while doing some work at our carwash which caused the need for knee surgery. Now I am recieving letters from her health insurance company inquiring where the accident happened because it appears they want the carwash insurance to pay the bill instead of her health insurance. Can her health insurance make the carwash insurance pay this bill? I don't see the carwash being liable for creating any unsafe conditions being she is not a paid employee and she is the one who put the ladder up which she fell from?

Sparkey,

Is the health insurance creating a situation where they are forcing your wife to sue herself with you in tow of course so that your liability insurance will then at that point kick in? Is it Bl Cr Bl Sh?

Is it that black & white that the ladder incident is the sole cause for the need for surgery?

Your post alerted us to another potential shenanigan from some of these big outfits --- considering how much is paid into health insurance these days this does not seem right for them to do this. A liability claim could kick up your premium on your general insurance whereas your health insurance may be in a group that could make it less likely to go up specifically because of a claim.

Keep us posted --- sometimes lawyers & government agencies are extremely fixated on some minutia in contracts so let us all know so we understand the potential. It seems like how an incident is recorded has a bearing on how it proceeds.

To my knowledge there is only one attorney on this forum & I sure hope he does not distort what I am writing as to have given out legal advice & have me arrested or force some kind of convenient fine etc. Hopefully it is just a false fear --- maybe some of us need some reassurance & encouragement so we are hopefully not intimidated too much.

MJ

 

[Earl Weiss]

1. Free legal advice is wirth what you pay for it.

2. Laws vary from state to state. So, a lawyer in your state or perhaps someone at your premises liability carrier would best be able to answer your question.

My gut feeling, (FWIW which is $0.00) is to tell the health ins. comapny to get plucked and pay the medical bills. . Simply state that the sole cause of the accident was the persons own fault and she was not acting in any employment capacity whatsoever when the incident occurred, and no other insurance coverage applied.

 

[Indiana Wash]

1. Free legal advice is wirth what you pay for it.

2. Laws vary from state to state. So, a lawyer in your state or perhaps someone at your premises liability carrier would best be able to answer your question.

My gut feeling, (FWIW which is $0.00) is to tell the health ins. comapny to get plucked and pay the medical bills. . Simply state that the sole cause of the accident was the persons own fault and she was not acting in any employment capacity whatsoever when the incident occurred, and no other insurance coverage applied.

I saw a lawyer show on TV once, I and I agree with the above statement.

 

[sparkey]

I am a sole propriership LLC so I should be exempt from workers comp. My wife I guess would be considered a volenteer since she doesn't get paid. I am not sure if I have a problem yet. She just keeps getting letters in the mail asking more details on where the accident happened. She keeps throwing the letters in the trash but I am sure eventially they will contact her in person. The funny thing is the letters say if it happened at home they want the name of your home insurance provider? Looks like they want someone else to pay up besides them.

 

[Earl Weiss]

I am a sole propriership LLC so I should be exempt from workers comp. My wife I guess would be considered a volenteer since she doesn't get paid. I am not sure if I have a problem yet. She just keeps getting letters in the mail asking more details on where the accident happened. She keeps throwing the letters in the trash but I am sure eventially they will contact her in person. The funny thing is the letters say if it happened at home they want the name of your home insurance provider? Looks like they want someone else to pay up besides them.

You may be a "Single Person LLC" but a "sole Proprietor LLC" would be an oxymoron.

I would suggest that she respond to the letters. Ins. Companies can deny coverage for "Lack of cooperation".

 

[Indiana Wash]

I am a sole propriership LLC so I should be exempt from workers comp. My wife I guess would be considered a volenteer since she doesn't get paid. I am not sure if I have a problem yet. She just keeps getting letters in the mail asking more details on where the accident happened. She keeps throwing the letters in the trash but I am sure eventially they will contact her in person. The funny thing is the letters say if it happened at home they want the name of your home insurance provider? Looks like they want someone else to pay up besides them.

Hmm, saving a hundred or two $$$ which it would cost to get the opinion of a professional and instead risking thousands. Would that be something like not washing the salt off your vehicle and hoping it doesn't eventually rust it?

 

[Washmee]

I am a sole propriership LLC so I should be exempt from workers comp. My wife I guess would be considered a volenteer since she doesn't get paid. I am not sure if I have a problem yet. She just keeps getting letters in the mail asking more details on where the accident happened. She keeps throwing the letters in the trash but I am sure eventially they will contact her in person. The funny thing is the letters say if it happened at home they want the name of your home insurance provider? Looks like they want someone else to pay up besides them.

Thats a common strategy by all insurance carriers, to look for someone else to accept liability. Insurance rates are determined by assessing risk. Your health insurer assumes that you are covered by workers comp when you are at work and the rates are set accordingly. If you wanted your health insurer to cover you while at work, your rates would be higher, more exposure for the insurance company. I still think you should consult an attorney on this issue. Hopefully your wifes claim will be paid, but ignoring it will not make this issue go away. In my experience, its always best to get out in front of issues like this one, so they don't show up later and bite you in the butt!