I recently tripped and fell over uneven pavement outside a local business, injuring my shoulder, head, arm and knees.

Question

The business owner offered to pay my medical expenses, which total just over $3000.  They did open a case with their insurance company.  The hospital ER billed my medical insurance leaving a balance owed of $1400 and that's the amount their insurance company is paying me.  Am I not entitled to the full amount of the hospital bill?  I am in MN.

Tim Akpinar · Answer

A Minnesota attorney could advise best, but your question remains open for two weeks. If a claim is only for medical expenses, the claimant would generally be entitled to only the outstanding amount that was not covered. The premise of insurance law is to make the claimant whole for their loss. In terms of a damages analysis, the $1,600 damages incurred was already picked up by the carrier, so it isn't deemed a loss incurred. That's the way insurance protocols handle economic losses in most any jurisdiction. But if a claim is for pain and suffering and other elements, then the analysis is more involved, where non-economic losses enter the picture. In those settings, the carrier could come after its reimbursements with a lien that needs to be reconciled at the conclusion of a case - that would be something a Minnesota should advise on. In those settings, it would also make a difference if the hospital writes off the $1,400 based on medical necessity, fee schedules, operation of law, or other issues. Good luck

Q: I recently tripped and fell over uneven pavement outside a local business, injuring my shoulder, head, arm and knees.