Accident Questionnaire After Overdose

In October, I signed in to the ER for an overdose. I stayed there for about 36 hours and then was transferred to inpatient for a week. Today, I get a letter that came in the mail referring to a $6,000 claim.

The questionnaire simply asks: Was it a Car or Work Accident? Assault? Other? Or No accident?

Then it goes into, whose fault was it, and their info if it was someone. And then there is three lines to explain why I received treatment.

My insurance excludes any self injury not a result of a medical condition. I've been diagnosed with MDD, self inflicted injury, and the new psychiatrist filed under unspecified bipolar. They've paid for my outpatient bill, my counseling services (which they only pay for if there is a medical reason), and my inpatient. Although all of this is true, there is no official dx on my health history on the insurance website of anything mental health related.

I'm afraid if I say "no accident" that they will say they will not pay, but if I say other, how do I word it as "impulsive?" The official discharge from the ER was "Overdose Intent Unknown".

Should I call and talk to someone, or just write what happened?

I think they want to know if it is a work or accident because if it is, they can go after workman's comp or the car insurance. Basically they are looking for some else to pay. I got the same letter when I started physical therapy.

I kept getting forms like that a few years ago...I was having stomach problems..I finally got fed up and wrote in large letters all over the form to stop asking if it was an accident. Yeah they just want to bill someone else. It was related to BP that's an illness.

I actually never fill out those forms. They are looking to see if someone else's insurance could be liable for and pay for the claim. I simply throw them away and they pay the claims. I have never found them to push for a response. I'd say throw it away. I've learned not to give insurance companies any more information than the doctor/hospitals provide.

lolagrace makes a good point. Never assume you have to answer a question, just because it was asked of you. I've had a few experiences that have taught me that it is often safer to simply not answer a question, than to answer it falsely. (And I was told that once by a very good lawyer.)

As posters above have said, your insurance company is trying to see if anyone is to blame for your injury. If someone were to blame, the insurance company would have a right to sue them to be reimbursed for the medical bills they paid . . . and you would have a legal obligation to reasonably assist them toward that end.

In your case, there is no one who caused you injury, so there is no basis for your insurance company to pursue reimbursement from a third party. (Like there would be, if someone put drugs in a drink you were having and that caused the overdose.)

As far as what to fill in under "other?" I would say you may not really be competent to answer that (or so it could be argued.) Notice what the ER put on the discharge form: "Intent Unknown." Why do you think they said that? Part of the reason is that they know insurance companies are going to do what your insurance company is now doing. Insurance companies have lawyers who know how to get cute. Well, so do hospitals. Their lawyers are every bit as cute. The hospital isn't going to say that you deliberately overdosed yourself because they are afraid that might lead you to suing them for making an unwarranted assumption.

Maybe you did deliberately take an overdose. Then, again, a cute lawyer working for you could argue, "My client was so confused he/she didn't really know what he/she was doing. My client was half out of her mind dealing with unbearable stress and really wasn't fully aware of what he/she was doing. She was trying to alleviate stress and completely lost track of how much of the drug that he/she ingested. It was never my client's knowing intention to seriously self-harm." Or: "My client was transiently psychotic and out of touch with reality to the point that he/she did not appreciate the risk of serious harm in taking that amount of the drug." Or: "My client cannot even remember what happened prior to going to the ER." Who's to say otherwise?

Intent can be a tricky thing to nail down. That's why the hospital has instructed doctors in the ER to write "Intent Unknown." The doctor who treated you might feel very confident that you knew exactly what you were doing, but he's not going to even go there. Why should he? Better for the ER physician to say, "I'm not a mind reader, and I wasn't with the person when they overdosed to observe their state of mind " This is how smart people avoid getting sucked into something they don't want to get sucked into.

The insurance company knows you are not a lawyer and might well blurt out something that it is not in your interests to say. So they ask you these big wide open questions that are purposely designed to elicit as much out of you as they can extract. Don't take the bait.

I think I'ld do like lola and just not even return the questionnaire. Personally, I would put it neatly away in a file labeled Communication from Insurance Company Then I would add any more such forms or letters that the insurance company sends out to that file.

If at some point, you feel obligated to respond, then you might say that your reason for going to the ER was not due to a car or work accident or to any assault. Then say nothing further. Do not go saying, "I did something impulsive." You are not a psychiatrist. It's not your job to diagnose yourself, or explain why your mind was in the state it was in. As far as anyone is concerned, you have no idea on earth why you did what you did. No law compels you to explain that. So don't even try. You just refer them to the medical record. They can take depositions from the whole ED and inpatient staff, if they so desire . . . which they are not going to do.

If the insurance company telephones you with prying questions, simply say: "Send me your inquiries in writing. I don't discuss my medical history on the telephone."

In short: Say and write nothing, or next to nothing. Then don't worry about it. They are going nowhere with this.

Yup. I've found our insurance company sends that form out as a matter of routine for any visit to the ER. I swear they don't even look at the diagnosis because they've sent them to us for asthma attacks, gallbladder attacks that ended up with admission and surgery, kidney failure, etc. Some computer generates that questionnaire to be sent out for any ER admission under the assumption that it could be some work or car accident where someone else is liable.

To some extent, they're "fishing."

Absolutely.

Yes. I agree. Throw it away. Don't give them info.

Thanks for the advice everybody!