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Accidents and Liability Insurance Issues

by Barbara Brabec

A fall on black ice leads to scary discoveries about medical liability insurance and the financial pitfalls of falling on public property

ON MY WAY TO CHURCH one Sunday in March, I parked in the shopping mall's parking lot where the owner had given my church permission for its parishioners to use those spaces. I locked the car and started to walk across the parking lot thinking I needed to avoid the puddle of water I saw there. The next thing I remember is waking up with a blazing headache and wondering what the heck I was doing flat on my back with all those people looking down at me. Fortunately, some other church goers had seen me fall and one of them had immediately called an ambulance whose sirens I could hear in the distance. I wanted to get up, but they were smart enough to tell me to lie still until the ambulance arrived because I had been unconscious for a little while. I did have the presence of mind to ask where my purse was as they loaded me into the ambulance, but the ride there and entry into the ER was all a blur.

Obviously, the water I thought I saw was actually black ice, and I had absolutely no recollection of starting to fall. Usually I know when I'm going down and I've learned to always "let myself go" as I try to fall flat on my back if I'm going backwards, and never try to stop a face-forward fall with my hands because I can't afford to break an arm or a wrist. I guess my body was well trained because this time I did fall flat on my back, doing no damage to it save for a few strained muscles. My head took the brunt of the fall, giving me my first concussion, so they did a cat scan to see if there was any bleeding in the brain. Fortunately there wasn't (Harry always used to say I was hard-headed), but this is when I learned I had a small benign meningioma--which was a new word in my medical vocabulary--and I was advised to never again hit my head like that.

"It's like football players who get hit in the head too often," the ER doctor said. "The last thing you want to do is hit your head again because it could lead to serious medical complications because of the meningioma." Falls aside, the doctor added that this was nothing to worry about, however, and that many people have these benign tumors and only learn about them if they happen to have a cat scan for something else.

The Financial Consequences of
Falling on Public Property

On releasing me, the ER doctor said something about medical liability insurance which I didn't grasp at the time but only understood a few days later when I called the hospital to tell them they had some outdated information about me in their files. That's when I learned that Medicare wouldn't cover the ER expenses because I had fallen on public property. Thus began a couple day's investigations into how I could get this bill paid for. I had assumed (and you know what they say about that word), that Medicare and my supplemental insurance would cover all hospital expenses, but now I was told that the owner of the shopping mall was liable. To make a long story short, I learned that the mall would not assume liability for a fall caused by "normal winter conditions," and that by shoveling the snow they had taken "prudent steps" to protect the public. Fortunately, they DID have an accident policy that would cover up to $5,000 of medical expenses. Since my ER visit and routine follow-up doctor appointments were only around $3,000, I was home free, financially speaking.

As time passed, I began to wonder what would have happened if I'd broken a hip or a wrist and had a large medical bill as a result. On talking to the mall's insurance agent and a couple of other insurance experts, I learned that Medicare would NOT automatically pick up the difference after the first $5,000 was paid. To resolve this, I would have had to sue the owner of the shopping mall knowing full well they wouldn't pay because I couldn't prove negligence on their part. Maybe after a few years of court hassles and a lot of financial expense to me, Medicare MIGHT pay the medical bills because I had then made every effort to collect. I have no idea how someone who isn't on Medicare would get their medical expenses paid if they fell on public property, and I wonder, too, how the new health care insurance policies will deal with the issue of liability insurance in a case like this.

All this has certainly made me realize the danger of falling on anyone's property but my own, and even here I was advised to check to be sure my own homeowner's insurance didn't include me as one who could collect medical expenses if I had an accident in my house or yard. The bottom line is that, given my age and legs that do not always keep me steady on my feet, I hereby resolve to never again go out again if winter conditions are icy and a fall is even remotely possible. You'll have to figure out your own strategy for dealing with this kind of unexpected life event.

Pleasant Personal Lessons

We all learn new things from every life experience, and in this case I learned that I had a supportive family at the church I've been attending for the past year. Being without family in the area and not wanting to bother a friend, I was feeling very lonely when I looked up and saw one of the pastors walk into the ER room. Someone who saw me fall told her I was on the way to the hospital, and she arrived shortly after I got there. In addition to giving me great emotional support, she arranged for two church deacons to give me a ride home afterwards. They also drove my car home from the parking lot and made sure I had everything I needed for the next couple of days, following up with phone calls just to be sure. I had a few days of headaches, body aches, and a sense of just not "being right," along with occasional dizzy spells for a couple of weeks. It took another week or so before I felt like my brain was once again communicating properly with all my body parts, but the fall left me with no long-term problems.

We've all heard stories of how a bump on the head has sometimes led to the death of an individual who didn't seek proper medical attention immediately, so I didnít take this bump on my head for granted. On being dismissed from the ER, I was told I shouldn't be alone the first night "just in case," but as a widow I had no options for having someone stay with me that night, so I did the next best thing. I arranged for one of my sisters to call me in the middle of the night to see if I could be easily awakened, and if not, she had the number of my good neighbor across the street who was "standing by" with a key to my house and his cell phone ringer set to high so he'd hear it if he got a call. I told my sister to ask me what my social security number was when I woke up because that would tell her my brain was working okay, and she gave me a laugh when she said she doubted she could recall her own social security number if asked for it in the middle of the night.

I wouldn't want to take another fall and bump on my head like this one, but I have to say that all the things I learned as a result of this accident made whatever discomfort I had well worth the experience.

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