NY - aunt who sued 8yr old nephew over hug loses lawsuit

[Jmoose]

Insurance really can be crazy. A few years ago when my daughter was in college, she was crossing the street (in the crosswalk), and someone turned the corner in theor car without looking, and hit her. Along with that driver's auto info, our health insurer required us to provide them with OUR auto info, (for the process of subrogation), even though our daughter was on foot, 5 hours from any of our cars.

 

[Zuri]

My BFF had to sue her BIL HOI when her BIL accidentally hit her then 12 yo in the mouth with a piñata stick and broke her big front tooth. Her daughter required an implant which was over $5K. The HOI paid the claim and there was no ill will. They all agreed that was what HOI was for before any claim was made.

 

[Hope4More]

This my first post/reply on WebSleuths so please be gentle. :blushing:

This is case really bothered me for a week or two after I first read about it. So I did some sleuthing trying to find out more facts on the case and how insurance works so here is what I found. But first I have to say:

1. All insurance whether it is health, auto, or homeowners can be a headache to deal with and even if you the best policies in the world you are left with bills that you have to pay. For example deductibles, co-pays and such.

2. I do have sympathy for the "Aunt" and especially the little boy and what they have had to go through the past few years.

3. The story was sensationalized and the Internet Social Media did rush to judgement. The problem was almost every single story reprinted the same things over and over without ever asking pertinent questions most of us had.

4. My personal opinion is that she got bad legal.

However...

i think the biggest question that everyone was asking was did she have health insurance? Why didn't they pay? Did they force her to sue to recoup medical costs?

Only on an article by MarketWatch did I find at least part of the answer as the author actually contacted and spoke with one the partners of the 2 partner law firm. The partner said she did have health insurance but it did not cover all the costs associated with the injury. He declined to name the insurer or say how much was actually covered.

Most of us know that we would have to cover, especially with 2 surgeries, deductibles, co-pays with any doctor or therapy visits and pharmacy. So, yes getting sick or having an accident can be expensive even with health insurance I get that.

Gawker(I know not the best journalism) found out that the dad's homeowners policy was with Traveler's insurance...they actually used one of their contracted lawyers to defend the boy in the suit. On Traveler's website I looked at their standard HO policy that includes Liability protection and found that all their policies come with a Guest Injury clause or Medical Injury pay clause(almost all policies have this so does mine) that if guest that you invited is injured for any reason no matter who's at fault they cover that injury up to $1000 or if the homeowner increases it even more. That $1000 is their minimum. Now did she use that? Did the Dad make the claim? I assume,but couldn't find if there was a time limit from date of injury. If she used this could she not make a claim for more? I don't now.

So, did her medical Insurance force her to sue? I can't know for sure but Probably Not. I spoke with a friend in the insurance biz and this is what they told me. Please keep in mind Workers Comp and Auto Accidents are handled a different way. Health insurance will ask you if you have had an accident where it happened or if someone was at fault. Why? Because of course they want the other insurance to pay and save them money. It's called Subrogation and it happens behind the scenes. Because you or your company has a contract with the health insurance company they have to pay your medical bills per contract no matter what happened. But, health insurance will then go to the other party's companies insurance to reimburse them behind the scenes. That is also in your health insurance contract too. Sometimes they don't agree and the health insurance company will take the other insurance to court on your behalf. But the suit would read XYZ Health on behalf of Insert name. Not how Aunt's suit reads, this why I think it wasn't her health insurer forcing her to do this.

Obviously, the Aunt needed more so she or the dad made a claim to the Dad's Homeowners Liability coverage to cover costs. Now, the Liability part doesn't just pay out because she was injured on the property. There has to be some form of negligence on the part of dad(and/or anyone who lives permantly on the property.) So Traveler's did not see this as a negligent act of the boys loving hug and refused to pay. Rightfully so I think. It was an accident! Aunt and her lawyers didn't agree so they filed suit. They can't sue Traveler's as it is not her insurance company. Traveler's is doing what it's supposed to do which is protect the dad and son from being sued for liability which is what the policy is for. If Aunt wants to press the issue she has to file suit against the boy because he is the one who "caused her injury through a negligent act" and have a jury decide if that's the case. Traveler's offered her a $1(I saw some reports say it was her insurance that did this but it wasn't) to settle and probably show that it performed and acted it's best on behalf of its client the boy and his dad. My opinion, Traveler's knew they had no case and that is why they went and took this case to trial and Not offer a bigger settlement.

Jury agreed that the boy wasn't negligent.


So, did the Aunt have to sue? My opinion is no she didn't have to sue and it was a weak case.

Sorry to be so long worded! And thank you for letting me vent.

Awesome sleuthing and analysis! Wow, and a fuller explanation than I've seen anywhere..:thewave:

My one point of disagreement is whether or not she "had" to sue. It sounds possible no insurance company forced her to sue to get her bills covered, but it also sounds like suing may have been her only possible chance of recouping a great deal of $$ spent on medical bills, or maybe even being able to pay them in the first place? Still unclear how much her own medical insurance covered or didn't cover.

Bottom line there is Im unsure the fact her medical insurance wasn't named as a plaintiff in the suit against Travellers means that she wasn't forced by them to sue, though I understand your point. Insurance law seems horribly complex and muddied, designed more to protect insurance companies than to dispense actual, paid for benefits....

 

[Madeleine74]

Yes of course if you are willing to pay your own medical bills, without the use of any insurance, be it your own or anyone else's policy, even if your expenses are the result of an accident, no one will mind. Of course as we know, even what seems like not serious or life threatening injuries can run in the many thousands of dollars.

Who would want to pony up many thousands of dollars for medical expenses for an injury rather than go the route of getting the insurance company or HOI to pay? Not I! I'd go the same route this woman did, if I had to.

And I can safely say that I think 99% of people would as well.

 

[DryHeat]

Awesome sleuthing and analysis! Wow, and a fuller explanation than I've seen anywhere..:thewave:

My one point of disagreement is whether or not she "had" to sue. It sounds possible no insurance company forced her to sue to get her bills covered, but it also sounds like suing may have been her only possible chance of recouping a great deal of $$ spent on medical bills, or maybe even being able to pay them in the first place? Still unclear how much her own medical insurance covered or didn't cover.

Bottom line there is Im unsure the fact her medical insurance wasn't named as a plaintiff in the suit against Travellers means that she wasn't forced by them to sue, though I understand your point. Insurance law seems horribly complex and muddied, designed more to protect insurance companies than to dispense actual, paid for benefits....

Thank you so much. I totally agree that the laws seem to protect insurance companies. Especially in Connecticut where the lawsuit took place and where many big insurance companies are based. It's a shame that even with "good" health insurance you can end up with thousands of dollars in out of pocket expenses. This is happening in my family(my mom's breast cancer treatment) right now so it hits close to home for me.

i agree she may have felt or was told by her lawyer that suing to trigger the HOI Liability policy was her only option other than taking on the medical debt herself.

 

[DryHeat]

Yes of course if you are willing to pay your own medical bills, without the use of any insurance, be it your own or anyone else's policy, even if your expenses are the result of an accident, no one will mind. Of course as we know, even what seems like not serious or life threatening injuries can run in the many thousands of dollars.

Who would want to pony up many thousands of dollars for medical expenses for an injury rather than go the route of getting the insurance company or HOI to pay? Not I! I'd go the same route this woman did, if I had to.

And I can safely say that I think 99% of people would as well.

While I would of course use my health insurance I wouldn't have sued The boy to trigger the HOI Liability.Why? A few reasons:

- The boy was giving her a hug. Was he a little too enthusiastic? Sure. But did he do it with malice or negligence? No. He had no clue that his aunt,who was in her 40's at the time, would fall down and break her wrist. He was 8 year old, acting as 8 year olds do. It was an accident, sometimes bad things happen and it costs you money.

- I would of used the Guest Medical Pay of the HOI on the dad's policy even if it was only $1000. Would probably not make a dent in co-pays or deductibles but better than trying to prove an 8 year old negligent and taking him to court.

- While she filed the suit about a year before the mom died...his mom died! She could have dropped it. Hasn't the kid been through enough?

- Even though the boy said he understood, it was fine and he loved his aunt. She still got up on the stand, with him in the court and said that he was and I'm paraphrasing "that he needed to be punished" and he was "negligent" and it was "his fault." My kids are around his current age and they said they would still be hurt and take it to heart.

- Dad's HOI premiums probably just went up.

For me it seemed frivolous and ethically not right. Now, if lets say the same thing happened but she fell into a hole that the dad knew was there and didn't fill in and fix. Then yes, if the HOI didn't pay my claim I would sue. Because the dad was negligent not fixing a known problem on the property.

As I said in a post previous my mom who is in cancer treatment is fighting her insurance company for payment on her surguries. We pay premiums and such for coverage and to have to fight insurance companies is a nightmare especially when your hurt or sick is terrible. But I think in this case the jury and Traveller's insurance the Dad's HOI made the right call. Just my opinion.

 

[Lilibet]

Do we know if her quite substantial medical bills ended up being paid by her own medical insurance after she lost the suit? Or is she completely on her own? If her own medical insurance did end up paying did losing the suit open the way for it to pay?

 

[Madeleine74]

For me it seemed frivolous and ethically not right.

And that's fine. You'll never be forced into an action that feels wrong.

The problem is using 'feelings' to judge something that isn't about feelings. This is a business/financial situation. The insurance companies have rules and do their best to preserve their own (ets). Sometimes legal action is the only way to shake that tree loose. No one is asserting this aunt made up the claim of being injured. This 'lawsuit' was a required step to getting her medical claims handled and paid. Losing in court was, in the end, another formality. The process had to be followed.

I think people should save their outrage and judgment for those folks who spend time bilking the system and, in essence, stealing benefits they do not deserve & are not entitled to, who are not sick and are not injured. There are thousands of people in the U.S. who fall under that umbrella, collecting Medicare and Medicaid monies. The amounts are hundreds of million$.

 

[Lilibet]

:goodpost:
The Thanks button wasn't enough Madeleine!

 

[nrdsb4]

I don't have any outrage for the aunt, but I do wonder why it was necessary for her to advance the point that the kid owed her money because he "should have known" that his actions would result in harm. That's just not true with 8 year olds. They have not developed the capacity to adequately assess risk or foresee the consequences of their actions. Even teens lack mastery of that. I don't get why her case didn't just simply hinge on the fact that his actions caused her injuries, period. That has never been up for debate.

 

[Hope4More]

I don't have any outrage for the aunt, but I do wonder why it was necessary for her to advance the point that the kid owed her money because he "should have known" that his actions would result in harm. That's just not true with 8 year olds. They have not developed the capacity to adequately assess risk or foresee the consequences of their actions. Even teens lack mastery of that. I don't get why her case didn't just simply hinge on the fact that his actions caused her injuries, period. That has never been up for debate.

Have you read this thread? What she said in court she had to say in court. Her ability to sue, then the case argued to a jury, was entirely contingent upon the question of whether or not her "nephew" was negligent (BTW he isn't her nephew, he is the son of her cousin).

She had to use those words. She did not have the option of saying, it was just an accident, no worries, can you please tell Travellers to pay my med bills?

She knew, as did her not-nephew, as did an outraged SM reading public, that a hug wasn't negligence. So did Travellers. Maybe her attys miscalculated and thought Travellers would find it less expensive and cringeworthy just to settle, and never expected it to go to trial. Who knows.

But again (and again). Her own not-nephew went public to say she'd never do anything to hurt him or his family and that what happened in court was misunderstood.


Why is that not good enough? Isn't the word of this "victim" to be trusted?

 

[LinasK]

Have you read this thread? What she said in court she had to say in court. Her ability to sue, then the case argued to a jury, was entirely contingent upon the question of whether or not her "nephew" was negligent (BTW he isn't her nephew, he is the son of her cousin).

She had to use those words. She did not have the option of saying, it was just an accident, no worries, can you please tell Travellers to pay my med bills?

She knew, as did her not-nephew, as did an outraged SM reading public, that a hug wasn't negligence. So did Travellers. Maybe her attys miscalculated and thought Travellers would find it less expensive and cringeworthy just to settle, and never expected it to go to trial. Who knows.

But again (and again). Her own not-nephew went public to say she'd never do anything to hurt him or his family and that what happened in court was misunderstood.


Why is that not good enough? Isn't the word of this "victim" to be trusted?

Why does it matter whether he was her nephew or her little cousin?? I fail to see how it is relevant to her lawsuit. He's still related to her, just in a different way...

 

[Hope4More]

Why does it matter whether he was her nephew or her little cousin?? I fail to see how it is relevant to her lawsuit. He's still related to her, just in a different way...

Nope, doesn't matter whatsoever in terms of the case itself. I mention it to make the point that the original reporting was so badly researched that the reporter didn't get ANY of the basic facts straight, including the relationship between Evil Auntie and her huggy Victim.

Yet, those wrong "facts" and that slipshod reporting keep getting referred to and relied upon.....

 

[nrdsb4]

Have you read this thread? What she said in court she had to say in court. Her ability to sue, then the case argued to a jury, was entirely contingent upon the question of whether or not her "nephew" was negligent (BTW he isn't her nephew, he is the son of her cousin).

She had to use those words. She did not have the option of saying, it was just an accident, no worries, can you please tell Travellers to pay my med bills?

She knew, as did her not-nephew, as did an outraged SM reading public, that a hug wasn't negligence. So did Travellers. Maybe her attys miscalculated and thought Travellers would find it less expensive and cringeworthy just to settle, and never expected it to go to trial. Who knows.

But again (and again). Her own not-nephew went public to say she'd never do anything to hurt him or his family and that what happened in court was misunderstood.


Why is that not good enough? Isn't the word of this "victim" to be trusted?

He's EIGHT. or so by now. NO, his words aren't relevant. He's too young to understand this.

And NO, I do not buy that she had no other choice but to say he "should have known" better. Nope. Just don't.

 

[Lilibet]

He's EIGHT. or so by now. NO, his words aren't relevant. He's too young to understand this.

And NO, I do not buy that she had no other choice but to say he "should have known" better. Nope. Just don't.

He WAS eight at the time of the injury. He is at least eleven and is now old enough to understand this and to say how he feels about his "aunt."

I know several children between six and ten who have been told repeatedly not to run and play roughly in the vicinity of adult friends. They disobey and do what they want. So I can certainly say they know better if they cause someone to fall and get injured. I'm not saying he was told not to jump on her, but IF HE WAS, then yes, he certainly was old enough to know better.

I would really like to know whether everyone who thinks the "aunt" was wrong to sue is willing to chip in for her medical bills. If she has an option to be paid is she supposed to just go broke because she could NEVER sue her "nephew" even if the law makes that her only option and her relatives understand? I hope none of you folks are ever in this situation and have to go through what this woman has endured.
JMO

 

[krkrjx]

Her attorney has stated it is impermissible in CT to sue home insurance co's directly.

Is it also impermissible in CT to sue homeowners?

But OK to sue minors?

If so I'm glad I don't live there with minors in my home.

 

[krkrjx]

Is it also impermissible in CT to sue homeowners?

But OK to sue minors?

If so I'm glad I don't live there with minors in my home.

Not able to add so will do so here:

In all seriousness, if one cannot sue a homeowner's insurance, they would have to sue the homeowner directly. And if they win, the homeowner would have to make a claim to their insurance and if insurance refused to pay, sue their own insurance company.

Oh wait, it's impermissible to sue an insurance company in CT.

Hmmm....if such legislation exists I have no doubt it came about through lobbying by insurance companies.

 

[LinasK]

Not able to add so will do so here:

In all seriousness, if one cannot sue a homeowner's insurance, they would have to sue the homeowner directly. And if they win, the homeowner would have to make a claim to their insurance and if insurance refused to pay, sue their own insurance company.

Oh wait, it's impermissible to sue an insurance company in CT.

Hmmm....if such legislation exists I have no doubt it came about through lobbying by insurance companies.

And I still fail to understand why her own medical insurance wouldn't pay. Kaiser???

 

[Hope4More]

Is it also impermissible in CT to sue homeowners?

But OK to sue minors?

If so I'm glad I don't live there with minors in my home.

Seems like it is far more hazardous to be an adult there with serious injuries that multiple insurance companies can refuse, with impunity, to cover.


BTW and directed in general. Eight year old children aren't imbeciles. They are perfectly capable of understanding the gist of what's going on around them.

And by the age of eleven? My goodness. Many kids at that age are articulate and aware enough to not only get what happened in that courtroom but to have written a more informed article than that first godawful hack who chose sensationalism over doing due diligence and getting the facts straight.