Fall and (mild) injury and non-litigation resolution

[Aerides]

I recently tripped and fell in the (private/gated) parking lot of an HOA/condo community. Without getting into all the details, assume you agree I tripped over something that a reasonable person would say "well that's setup for someone to trip and fall"...

Cuts and scraps and a banged up arm. Face planted hard. I've healed up now, don't think I'll have any scars, but my face was a mess for a couple of days. Basically road-rashed my nose. Even my teeth hurt for a week.

I fell right as we were leaving, so went back to my FIL's condo for first aid. He mentioned something like "oh no, we've been telling the board they've got to do something, this isn't the first time someone's fallen there..."

My wrist had more pain and swelling the next day, so I visited an Ortho who xray'd and ordered an MRI for a potential fracture. Had me wear a wrist brace till diagnosed. MRI turned out negative, just bone bruising, and 3 weeks later I'm 95% resolved.

So, here I am, mostly all better but with about $600 in co-pays due to deductibles. I really don't think this fall was my fault; I believe the HOA could/should have taken better steps to reduce the hazard.

I don't want to go straight to a lawyer, but I don't think I should just suck this up. And I also want them to take steps to resolve the core problem of placement so others don't have the same risk. Had I been a young parent carrying a child, or more frail and older the outcome could have been far worse.

tl;dr: I want to write a letter asking for reimbursement, and a fix to the problem. Any tips?

 

[njhowie]

Write a letter to the HOA describing what happened, specifically where it happened, possibly include a picture of the problem area, your injuries sustained, and copies of the medical copay receipts that you want them to reimburse. Advise them that you believe they are responsible as the situation is a widely known hazard and you'd like to handle it without legal intervention. With that, they could simply turn it over to their insurance carrier which could/should pay it out of their liability coverage. Give them your contact information and a reasonable time frame in which you expect to hear from them - say 2 weeks. Don't make ultimatums out of the gate, as they may view the $600 as nothing more than a nuisance they can easily make go away.

I wouldn't go any further than that initially. Don't contemplate legal or other remedies until you hear back...you'll simply get yourself worked up, and possibly for no reason.

 

[SecondCor521]

Agree with @njhowie.

My son was injured by another person on a church property when he was about 10 and as a result had a chipped tooth. I just scheduled an appointment to talk with the person responsible for that church property, and they promptly and gladly paid for (or reimbursed, I forget) the tooth repair out of their general liability insurance.

I'd bet that the HOA or condo board has a similar umbrella liability insurance policy covering the common areas and it would be covered under that. And your claim against that policy may encourage the insurance company to encourage the HOA to fix the issue with the parking lot.

 

[ExFlyBoy5]

I recently tripped and fell in the (private/gated) parking lot of an HOA/condo community. Without getting into all the details, assume you agree I tripped over something that a reasonable person would say "well that's setup for someone to trip and fall"...

Cuts and scraps and a banged up arm. Face planted hard. I've healed up now, don't think I'll have any scars, but my face was a mess for a couple of days. Basically road-rashed my nose. Even my teeth hurt for a week.

I fell right as we were leaving, so went back to my FIL's condo for first aid. He mentioned something like "oh no, we've been telling the board they've got to do something, this isn't the first time someone's fallen there..."

My wrist had more pain and swelling the next day, so I visited an Ortho who xray'd and ordered an MRI for a potential fracture. Had me wear a wrist brace till diagnosed. MRI turned out negative, just bone bruising, and 3 weeks later I'm 95% resolved.

So, here I am, mostly all better but with about $600 in co-pays due to deductibles. I really don't think this fall was my fault; I believe the HOA could/should have taken better steps to reduce the hazard.

I don't want to go straight to a lawyer, but I don't think I should just suck this up. And I also want them to take steps to resolve the core problem of placement so others don't have the same risk. Had I been a young parent carrying a child, or more frail and older the outcome could have been far worse.

tl;dr: I want to write a letter asking for reimbursement, and a fix to the problem. Any tips?

THIS IS NOT LEGAL ADVICE... *IF* you tell your insurance what happened, they will quite likely seek indemnification from the HOA insurance company. Also, the HOA should provide you their insurance information if you request it and then you could discuss it with them. This will also put them on notice that the HOA has property that needs addressing. THIS WAS NOT LEGAL ADVICE.

 

[pb4uski]

+1 You should probably have reported it to the HOA soon after it happened but it isn't too late to do so. The HOA should report this to their insurer and I suspect that the insurer will contact you to get more information on what happened, what costs you incurred, etc.

Has your health insurer asked what happened? If not, I'm surprised. As ExFlyBoy states, they would probably seek reimbursement from the HOA or the HOA's carrier for costs that they paid under your health insurance policy.

Insurers are very accustomed to dealing with so-called slip and fall claims.... as are lawyers.

 

[SecondCor521]

I'll add another thing.

My son was once a bicycle commuter, and on his bicycle commute one day he was half run over by a person in a pickup truck. His bicycle was totaled, and he also sustained minor physical injuries.

While I personally am not much in favor of bilking insurance companies and I don't think one should just ask because they can, I do think that it is reasonable to consider some compensation for pain and suffering. The guideline I eventually found was that being in pain could be compared approximately to a yucky job. So if you'd need to be paid, for example, $15 an hour to clean sewers, then the idea is that your X weeks of suffering is worth $15 an hour too, and do the math to get a total.

I also advised my son to consider how he would feel about asking for whatever number he came up with, either on the high side or the low side.

Eventually he arrived at a number that was very reasonable based on the amount of pain and suffering (not much, but not zero either) and duration (about two weeks). He asked for that from the insurance company, on top of the cost of replacing the bicycle, and they agreed to the number quite readily. IIRC it was perhaps $1K or so.

 

[Aerides]

Thanks all. The incident was less than 30 days ago and I plan to write this week. I wanted to wait to get my full diagnosis. Had this all resolved with the first doctor visit, and the xray cleared me, I'd probably not go to the trouble...except the potential for others to have a similar accident bothers me.

My health insurer hasn't asked, I guess that would only happen if the doctors office submitted the claims that way? Not sure.

My thoughts are to keep the initial letter short and mostly detail free (I don't even actually have them all the medical bills yet, just what my insurance site shows they will charge me). Don't want to tie my hands this early. Putting a timeframe on when I expect to hear back is a good idea.

 

[latexman]

I really don't think this fall was my fault; I believe the HOA could/should have taken better steps to reduce the hazard.

Yes, the HOA should have reduced the hazard, but we are all responsible for our safety. You "tripped over something". It's not like something fell on you, or hit you. It took two to do this tango.

I'd acknowledge that in the letter and ask for only $300.

My $0.02.

 

[Sarah S]

I think there is likely still to be a question from your insurer. We always had to document a date of injury when seeing someone for a problem related to a fall so if your diagnosis was wrist pain it probably had a date attached.

Even without that, however, some diagnoses trigger a letter. I have a neurological disease. I see a neurologist regularly. Suddenly after one visit I got a letter from my insurance asking about an injury related to that visit. Clearly my neurologist used a different diagnostic code to trigger that.

Given covid and the holidays I am not surprised you have not yet received a letter but one vey likely will be forthcoming

Good luck

 

[SecondCor521]

I think there is likely still to be a question from your insurer. We always had to document a date of injury when seeing someone for a problem related to a fall so if your diagnosis was wrist pain it probably had a date attached.

Even without that, however, some diagnoses trigger a letter. I have a neurological disease. I see a neurologist regularly. Suddenly after one visit I got a letter from my insurance asking about an injury related to that visit. Clearly my neurologist used a different diagnostic code to trigger that.

Given covid and the holidays I am not surprised you have not yet received a letter but one vey likely will be forthcoming

Good luck

I thought the reason for this type of thing is because injuries, if workplace related, are covered under workman's comp. So the insurance companies would be interested in foisting those claims off of themselves and onto the employer's WC insurer.

 

[MarieIG]

I thought the reason for this type of thing is because injuries, if workplace related, are covered under workman's comp. So the insurance companies would be interested in foisting those claims off of themselves and onto the employer's WC insurer.

Not only if work-place related. Carriers look for "tortfeasors" against whom they can seek reimbursement. For example, the injured person's carrier make seek to obtain reimbursement for all their expenses prior to the injured party receiving any payment on a claim.

P.S. The condo may have a med-pay policy which covers up to a certain amount towards medical bills arising out of injuries in the common area.

 

[harllee]

I would definitely put the HOA on notice of the injury but I would not ask for a specific amount at this point--you are only 30 days out and could still have more problems from your fall. I would just tell the HOA that you will be seeking reimbursement on the future once you know all your injuries and cost. If the HOA was truly at fault I would also ask for payment for pain and suffering.

 

[ExFlyBoy5]

I would definitely put the HOA on notice of the injury but I would not ask for a specific amount at this point--you are only 30 days out and could still have more problems from your fall. I would just tell the HOA that you will be seeking reimbursement on the future once you know all your injuries and cost. If the HOA was truly at fault I would also ask for payment for pain and suffering.

Good luck trying to do that without legal representation. As soon as that demand is made, the HOA will probably stop talking to you and then you are almost stuck having to get a lawyer involved. --again-- NOT legal advice.

 

[H2ODude]

" He mentioned something like "oh no, we've been telling the board they've got to do something, this isn't the first time someone's fallen there..."

Not a lawyer but in my experience the HOA being given prior notice of a hazard that has gone without action opens them way up and should make them quite responsive.

 

[braumeister]

I'm on the maintenance committee of my HOA board and believe me, we would be very responsive to such a request, turning it over to our HOA insurer immediately. Our board president is a lawyer, and we have run into a slightly analogous situation in the past, with a good outcome.

By all means, don't hesitate to make a claim for your OOP medical costs. It's not unusual and should be routine.

 

[ExFlyBoy5]

" He mentioned something like "oh no, we've been telling the board they've got to do something, this isn't the first time someone's fallen there..."

Not a lawyer but in my experience the HOA being given prior notice of a hazard that has gone without action opens them way up and should make them quite responsive.

Or clam up and not say a freaking word.

 

[ExFlyBoy5]

I'm on the maintenance committee of my HOA board and believe me, we would be very responsive to such a request, turning it over to our HOA insurer immediately. Our board president is a lawyer, and we have run into a slightly analogous situation in the past, with a good outcome.

By all means, don't hesitate to make a claim for your OOP medical costs. It's not unusual and should be routine.

Not only to mention, the board members should be *slightly* concerned as they can be brought into a lawsuit as well. Quite often, HOAs won't get D&O's coverage which...well, not too smart IMHO. Our last community got hemmed up in a lawsuit and while it was eventually settled...it caused a lot of gnashing of teeth with the board members and as far as I know...they still have a lot of openings since no one wants that kind of trouble.

 

[Koolau]

A friend fell getting out of an elevator because the unit did not match up with the floor height (creating a trip hazard.) She had her hands full of groceries and did not see the problem. She broke here wrist, requiring surgery. Total costs were near $5K. I don't know if her HE paid or not. The owner of the elevator (a condo) had placed NO signs, indicating an issue even though residents confided that the issue had been going on for quite some time.

I happened to stop at my insurance agent's office shortly after this incident and they had placed 3 signs inside their elevator and 2 signs on the door outside BECAUSE of a similar (temporary) issue.

Resolution: Condo would not do anything. She got a lawyer for a contingency (I assume 1/3). The ruling: The condo was NOT at fault after several evidentiary hearings with costs! YMMV

 

[Car-Guy]

Write a letter to the HOA describing what happened, specifically where it happened, possibly include a picture of the problem area, your injuries sustained, and copies of the medical copay receipts that you want them to reimburse. Advise them that you believe they are responsible as the situation is a widely known hazard and you'd like to handle it without legal intervention.

+1

I fell right as we were leaving, so went back to my FIL's condo for first aid. He mentioned something like "oh no, we've been telling the board they've got to do something, this isn't the first time someone's fallen there..."

Did your FIL see this happen or even better, did anyone else not in your family witness this? Even without a witness, he can at least backup that you were there and needed first aid immediately after leaving which should be proof enough.

 

[youbet]

Since your FIL was very aware of the risk, did he provide adequate warning and suggest work-arounds for avoiding the parking lot’s uneven surface? What thought did he give to the well-known risk when he invited you? It seems like he needs to be part of the solution.

 

[Trailwalker]

If you choose to move forward without a lawyer, you should not admit any comparative negligence. This is a negotiation and it's up to the other side's insurance adjuster to make that argument (which they probably will).

I would recommend that you talk to a good personal injury lawyer. The case may not be taken because of the potential low damages amount. You have $600 in copays etc., but your total medical specials are mostly likely substantially higher, and you mention that you aren't completely recovered. It's worth a consultation. Pain and suffering, not completely healed. There are things worth talking about. You can walk away if you aren't comfortable with the initial consultation (which is usually free).

I played an insurance defense lawyer in a former life, but this is not legal advice, and it was a long time ago. My first jury trial was a slip and fall, and the plaintiff did not win.

 

[Jerry1]

You can get advice from a lawyer without having them sue the HOA. I would sit down with a lawyer, explain how you want to proceed and get their advice. Once you put something in writing, you never know what damage you could do to you case. You can be pretty sure that anything you send to the HOA will reviewed by their lawyer. You can take the high ground, but don’t risk your case in case things don’t go as planned.