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I Was Injured, Received Medical Treatment For My Injuries and Filed The Bills With My Health Insurance. Later, I Received A Questionnaire From My Health Insurance Carrier: Should I Fill It Out and Why?

September 21, 2015   |   Ann Ochsner

The short answer is “yes.”  Perhaps more important is for you to understand why you should fill it out.  You should fill out a questionnaire and return it to your health insurance carrier according to their instructions and in a timely manner because 1) you probably have an obligation to do so (either by contract or by law); and 2) your failure to do so could result in your health insurance company’s refusal to pay some of your medical bills.

 Why are they asking me all of these questions anyway?  Great question, but a full and complete answer could be the subject of an entire hard-bound book.  Instead, let me try to break it down into two main reasons.  First, your health insurance carrier is probably trying to identify whether there are other parties or types of insurance that may apply to, or be responsible for, payment of the medical expenses related to your injury.  For example, the questionnaire likely has a question about whether you were “on the job” when you were injured.  If you were on the job when you were injured then it is possible that workers compensation insurance may be obligated to pay for the medical treatment necessary to treat your injury.  Another example is that the questionnaire might ask you whether you were involved in an automobile collision and, if so, the names of the other drivers involved and the identity of the company providing automobile liability insurance company for each vehicle.  This scenario brings us to the second main reason why health insurers send out questionnaires about medical treatment received for injuries: certain types of health insurance plans may be entitled to reimbursement for the money they pay for your medical expenses for injuries caused by the negligence of a third party.  Health plans established pursuant to the Employee Retirement Income Security Act of 1974 (sometimes referred to as ERISA plans) may be entitled to be reimbursed from funds that you recover from a settlement or a lawsuit against the negligent third-party.  Other health insurers may also be entitled to reimbursement, such as Medicare, Medicaid, or the NC State Health Plan.

For the reasons discussed above, your health insurance company treats the questionnaire, and the information it seeks to get from you through the questionnaire, very seriously.  It may play a role in their decision whether to pay some or all of your medical bills.  If you fail to provide the information to your health insurance carrier in a timely manner, your health insurance carrier may have the ability to deny payment of your medical bills.  This could leave you responsible for the payment of hundreds, maybe even thousands of dollars in medical expenses.

So, if you were recently injured and sought medical treatment and then later received a questionnaire from your health insurance carrier, you should fill it out and send it back to them according to the instructions stated along with the questionnaire in a timely manner.  Of course, if you are represented by an attorney with regard to your injuries, you should notify him or her that you have received the questionnaire.  If you have specific questions about the questionnaire, you should seek the advice of counsel.

Blog Author Ann Ochsner practices law at the Whitley Law Firm. When you have been injured, there are laws that protect your rights and interests. The Whitley Law Firm in North Carolina has a great respect and concern for the law, for the concepts of fairness and justice, and for their seriously injured clients.  They have offices in Charlotte, Raleigh, New Bern, Jacksonville, Kinston, and Greenville and represent clients throughout the entire state in all types of civil matters, including personal injury cases (auto accidents, slip and fall injuries, motorcycle accidents, dog bites), workers’ compensation matters (workplace accidents and injuries) and social security cases. For more information, visit http://www.whitleylawfirm.com/ or call 1-800-598-0456.

About the Author

Ann Ochsner

Legislative Vice President

Ann Ochsner

Legislative Vice President

Ann Ochsner practices with the Whitley Law Firm in Raleigh. Well versed in civil litigation and appellate advocacy, she concentrates in automobile collisions, slip and fall cases, dog bites and general negligence. Ochsner has been an NCAJ member since 2011 and has previously served as NCAJ’s education vice president. She is a graduate of Methodist University and Campbell University School of Law.