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Dental Trauma - Insurance - City Liability Colorado

Discussion in 'Health Insurance, HMO, HIPAA & Disability' started by talerco, Oct 25, 2019.

  1. Oct 25, 2019 #1
    talerco

    talerco Law Topic Starter Member

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    Jurisdiction:
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    Two questions;
    My grandson (8) broke / lost 6 teeth at City skate park. Tony Hawk he isn't. Surgery to try to save a few. 1 day hospital - years of dental work. Estimate - $20,000-$30,000. 2 broken jaw bones and broken nose - not out of alignment so little work done. Mom is a teacher covered by Kaiser.
    Insurance docs say they do not cover 'dental trauma'.
    Have not received bill.
    1. Any hope - advise - on separating broken bones, scraps etc. from dental trauma. Surgery was only to get teeth back in position. How can she get the most paid for by insurance?
    2. I assume there is a sign at the skate park. Any chance of City liability?
    I realize both of these are long shots at this point. Just hoping for hope.
    Thanks!
     
    talerco, Oct 25, 2019
    talerco, Oct 25, 2019
    #1
  2. Oct 25, 2019 #2
    cbg

    cbg Super Moderator

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    I take it Mom does not have dental insurance?
     
    cbg, Oct 25, 2019
    cbg, Oct 25, 2019
    #2
  3. Oct 25, 2019 #3
    adjusterjack

    adjusterjack Super Moderator

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    Is there a definition in the policy for "dental trauma"? Seems to me that broken jaw and nose ought to be separate.

    For the kind of money this is going to cost you it would certainly be worth having a lawyer review the coverage. What kind of lawyer? Call up a large firm and ask for somebody experienced in unraveling health insurance denials.

    Can't say until you explain exactly how the accident occurred.
     
    adjusterjack, Oct 25, 2019
    adjusterjack, Oct 25, 2019
    #3
  4. Oct 25, 2019 #4
    talerco

    talerco Law Topic Starter Member

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    There is limited dental but with 2 kids in braces and this guy pre braces the yearly max is used by about January 3.
     
    talerco, Oct 25, 2019
    talerco, Oct 25, 2019
    #4
  5. Oct 25, 2019 #5
    talerco

    talerco Law Topic Starter Member

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    No known witnesses and he doesn’t remember. He was using a scooter. Current thought is that he was doing some spin/ jump thing he had been trying and the scooter is what actually hit his face. But really, no one knows.
     
    talerco, Oct 25, 2019
    talerco, Oct 25, 2019
    #5
  6. Oct 25, 2019 #6
    justblue

    justblue Well-Known Member

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    How would the city/town be liable for that? He was recklessly operating his scooter (as most 8 year old boys are wont to do) and had an accident. Thank goodness he wasn't hurt worse than he was.

    Thank God I have girls... They have a way of making you gray before your time...but in general they don't do the dare-devil stuff.

    Thank You @adjusterjack for fixing my typo!!! ((hugs))
     
    Last edited: Oct 25, 2019
    justblue, Oct 25, 2019
    justblue, Oct 25, 2019
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    hrforme likes this.
  7. Oct 25, 2019 #7
    cbg

    cbg Super Moderator

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    1.) Without seeing her insurance policy no one can answer that.
    2.) Sorry, not seeing any city liability
     
    cbg, Oct 25, 2019
    cbg, Oct 25, 2019
    #7
    justblue likes this.
  8. Oct 25, 2019 #8
    adjusterjack

    adjusterjack Super Moderator

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    Meaning no parental supervision of an 8 year old on a potentially dangerous device.

    The city/town would not be liable for that. Sorry.
     
    adjusterjack, Oct 25, 2019
    adjusterjack, Oct 25, 2019
    #8
    hrforme and justblue like this.
  9. Oct 25, 2019 #9
    army judge

    army judge Super Moderator

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    army judge, Oct 25, 2019
    army judge, Oct 25, 2019
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  10. Oct 26, 2019 #10
    talerco

    talerco Law Topic Starter Member

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    Thanks to all for your consideration and feedback. Pretty much what I thought. We will go over the hospital bill when it arrives and try to be sure as much is covered as possible.
    All us parents do the best we can. All my kids are grown. The other day my wife and I were remembering one son who played football and lacrosse and rode dirt bikes. We laughed that he would only participate in sports where they have an ambulance standing by.. Still has all his teeth. I broke my 2 front teeth on a ‘real skate board’ in 1961.
     
    talerco, Oct 26, 2019
    talerco, Oct 26, 2019
    #10
  11. Oct 28, 2019 #11
    zddoodah

    zddoodah Well-Known Member

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    Not really sure what the first two sentences here mean. As for the question, we're not familiar with the terms of your grandchild's parents' medical/dental insurance policy.

    Unlikely at best. Your post indicates no reason to believe your grandchild's injuries resulted from anything other than his own lack of skill or caution for his own safety.
     
    zddoodah, Oct 28, 2019
    zddoodah, Oct 28, 2019
    #11

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