my mother lives in an ass't living home. She gets up once a night to go to the bathroom. 5 weeks ago she fell and broke her wrist and the care giver found her the next morning asleep on the floor. Mom went by ambulance to the hospital. Now the health insurance has asked a 3rd party to ask about the accident and wants insurance info for the ass't living home. I do not feel that the home is responsible at all for my mother falling. Mom turns on the light when she gets up, has a night light, the bathroom has a night light. It was an accident. The home has now put a mattress alarm on my mother's bed so that they will know when she gets up and they will get up with her now. How is it their fault? Mom fell. She fallen here at my house before. What do I tell them?
We've had 4 of these in 15 years. All related to going to the ER and a claim filed. It's standard for questionnaire to be sent. As others have said, insurers are looking to see who else can share the costs paid. If the incident happened on private property, then the property owner will likely get a letter asking for their insurance as your insurance company will seek shared costs from them. Answer in as least # of words possible. You weren't there so probably most ? you cannot answer.
Do not second-guess your insurers. They are not looking for someone to blame, in a forensic sense anyway; they are asking reasonable questions to establish the facts of what happened. Those questions you cannot answer - for the simple reason that you were not on the scene and do not know exactly what happened - you refer to the manager at the ALF.
There's probably an inquiry because the event was a fall, and that can result in a lawsuit. In addition, there are so many ambulance chasing lawyers that an insurance company staff could easily anticipate that one would be involved. Frankly, I'm not surprised that they're not in hospital and nursing home parking lots hovering around like vultures and handing out cards.
I also recall that I was asked once if there was joint liability after something happened to me - I don't even remember what it was.
I suspect that statisticians have identified certain activities and events in which liability can be attributed to another entity, and they're just doing the best to manage their exposure.
I just think that it is ashame that they seem to want to blame somebody for my mother falling so they can make them pay out. The form even asks is I have contacted a lawyer.
In the post title, you state that you need to respond to the insurance company, and in the body of the post you referred to yourself as a "third party."
The insurance company contacted you specifically for a reason. Do you hold any health care or financial proxies for your mother, and/or are you named in her HIPAA releases? If so, that makes sense that the company would contact you to provide information for your mother.
I've seen a similar instance, which I suspect may be the case here. After my father fell, his secondary health provider requested information on the fall, to determine if there was any liability of the facility at which he fell.
I believe their point was whether or not they could subrogate against the facility where he fell. If you're not familiar with the term, subrogation a process by which liability against a third party is assessed and "negotiations" are initiated to share the medical costs.
"Going after" a facility at fault could allow them to recover some of the medical expenses they paid for your mother's fall, and/or address what they might consider issues that affect the AL's coverage and rates.
That kind of request is legitimate; answer it truthfully and to the best of your knowledge, but don't offer the opinion that you don't feel the AL home is at fault. It isn't an issue of your opinion but rather the criteria by which the insurance underwriters/adjustors will evaluate the claim.
If you don't have insurance info for the AL home, just state it.
It's to your credit though that you don't fault the AL home for the fall.