Optum Recovery Services wants to know if my claim is related to an injury–it is, but I don’t want to sue over it. What are my options?
I have a torn meniscus among other issues with my knee and, at the time I first went to the ER and then in a follow-up with the orthopedist, I was reasonably confident that the injury came about because I had fallen down the stairs in my apartment building a few months prior because the lights were turned off. For a brief moment I considered suing my landlord but A. I didn’t feel I had any real proof that I fell at the time B. I didn’t expect to recover much, if anything, in damages to make it worth the upheaval in my life considering I was insured and C. I don’t want to move, which would almost certainly be the end result whether I won or lost after suing my landlord.
I related the story of my fall to the two HCPs and they noted it in my file, but after MRIs, etc, the HCP has insisted my knee issues are not acute and that they are largely the result of cartilage loss that may have been aggravated by the fall but that he didn’t feel was primarily caused by the fall (a 2nd opinion doctor concurred that at least part of my knee issue is long-term damage to the joint).
I feel like I’m in a bind, here. Even though the diagnosis ultimately says my injury was not caused by the fall, I absolutely did go on record with the HCP saying I believed that was what it came from, and I also complained about the fall to family and friends. I know the insurance company is going to want to recover their money regardless of what happens so even if I say, “Yes, I fell, but the doctor said my injury wasn’t due to that” I am afraid they will take action against the landlord, whom I already decided I don’t want to get into any kind of contentious issue with.
But I’m also afraid of going on record saying, “No, this wasn’t an injury” and then finding MYSELF sued by the insurance company for contradicting what I said earlier to the HCP.
What is my liability if I simply answer “no” to the questionnaire that’s asking if this was an injury?