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My neighbor does odd jobs for me such as taking out the trash, cleaning out the gutters, etc. They fell off a ladder and required medical attention. Recently, they received a letter from their insurance provider that states:

If another person or entity caused or may be responsible for the injury/illness treated, we have processed the claim in accordance with your contract benefits. However, we may be able to recover the expense of these services from the party causing the injury. Before we can close this matter, we require additional information from you.

Are they obligated to respond? If so, how should they respond?

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    We certainly can't answer without knowing what information is being requested, but even if we did know that, the question is probably off topic as a request for legal advice. There's probably a way of phrasing the question so it is on topic and elicits useful information for you, but it's difficult to suggest an alternative way of asking the question because it's not clear what information you seek. That is, are you asking what response would be most favorable for you or most favorable for your neighbor? – phoog Jun 25 '18 at 19:07
  • First of all, do they have to respond? Could they be denied coverage if they don't? Am I required to respond if the insurance company contacts me? If I become liable because they were injured on my property, will my home insurance try to sue my neighbor to recover costs? – indigo1234 Jun 25 '18 at 19:15
  • Do they have to respond probably depends on the contract between them and their insurer, as does the question of consequences for failing to respond. If you are liable then your home insurance will cover the costs to the extent that the terms of your coverage require them to; if they sue someone else it is to establish that the other person is liable. Your liability or lack thereof is only firmly established once any court actions are resolved. – phoog Jun 25 '18 at 19:41
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Are they obligated to respond? If so, how should they respond?

If your neighbor does not respond, he may be denied coverage.

If you don't respond, the insurer might infer consciousness of guilt on your part, or suspect that you are liable. That could prompt the insurer to proceed more aggressively, including court proceedings.

Before you speak with the insurer, you might want to research the laws of your state/jurisdiction regarding premises liability, and your neighbor (or preferably both of you) should read the terms and conditions of his policy. That way, neither of you will inadvertently say something in a way that the insurer can use against either of you when in fact neither of you could truly be held liable. That being said, be truthful in your answers, lest the insurer prove fraud or liability.

If I were you, I would start by searching for "premises liability" in the field "This Exact Phrase" at leagle.com to get acquainted with how courts analyze the applicable laws. Possibly add "insurance" in the field "All these words", and take it from there. Don't forget to select your jurisdiction in the drop-down list "Court".

  • Is there any chance that the OP would be considered the injured party's employer under worker's compensation law? – phoog Jun 25 '18 at 19:50
  • @phoog That's a good question. It depends on the OP's jurisdiction. For instance, under the Michigan Workers' Disability Compensation Act, MCL 418.115(a) and (b) give the definition of private employer, which doesn't seem applicable to OP's situation. Additionally, MCL 418.118(2) provides that no private employer is liable to someone "employed by him as a household domestic servant for less than 35 hours per week for 13 weeks or longer during the preceding 52 weeks". From OP's description, it seems unlikely that he'd be subject to the Act. – Iñaki Viggers Jun 25 '18 at 20:15
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In Colorado, at least, you might very well have strict liability for his injuries under worker's compensation principles for someone who does not have a worker's compensation policy in place, even if he was not compensated monetarily.

Many other U.S. states would have similar rules, although others would analyze this on negligence principles applicable to a licensee under a premises liability scheme.

Either scenario might be covered by your homeowner's insurance policy.

Not answering would probably have significant negative consequences for your neighbor. Answering is likely to result in a subrogation claim by his insurer against you.

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