My son was hit in the mouth knocking out his front tooth the parent of the child paid me for the dental bill,after I found out it was covered from our insurance so I submitted the claim and kept the monies for which I used for my loss of wages for having to take my son to the dentist and now she is unwilling to pay for the rest of his dental bills .
My question is ,is she responsible for his dental and was I in the wrong.

Your lost wages are not covered by either the dental insurance or the other party responsible for the damage. I am not clear with you keeping her money for your wages and that there is still some expense left unpaid. What did she give you, what did the insurance pay and what was the total bill?

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Originally Posted by tootsy

my son was hit in the mouth knocking out his front tooth the parent of the child paid me for the dental bill,after i found out it was covered from our insurance so i submitted the claim and kept the monies for which i used for my loss of wages for having to take my son to the dentist and now she is unwilling to pay for the rest of his dental bills .
my question is ,is she responsible for his dental and was i in the wrong.

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Legally in some States you have a problem - the parent would have paid either the entire bill OR the difference between the insurance and the total bill. You cannot under insurance law, at least in NYS, recover TWICE, which you have done. If you collect from the other party you must repay the insurance company or it's insurance fraud.

If you want to be paid for other than medical bills the other person can either pay willingly OR you can take him/her to Court and ask for the other expenses. You can't resort to self help.

People ask a similar question all the time - you did not but I'm sure someone will mention it. If you are paid by a insurance company to repair the damage to your car, do you have to repair the damage or can you keep the money? Depends on the company and the papers you sign.

She paid me for the cost of the dental work but I already told her that I would submit it through our insurance ,that dental claim is already paid for so the money she gave was used to pay for the time I had to take off work

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Originally Posted by tootsy

she paid me for the cost of the dental work but i already told her that i would submit it through our insurance ,that dental claim is already paid for so the money she gave was used to pay for the time i had to take off work

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I understand. If she gave you money and said, "Here, this is for the dental bills but if they are paid, then you use it to reimburse yourself for the time you lost from work," no problem.

If she said, "Here, this is for the dental bills," I see a problem.

You have under the law at this moment been paid twice for the dental bills. Does the insurance company know this was a liability claim and the person responsible paid the bills?

EDIT: It goes to the intent for which the money was given by the "Defendant." You wouldn't have defrauded her - although she will claim she gave you money to pay the dental bills, you didn't use the money for the bills, if it goes that far. You possibly defrauded the insurance carrier and enriched yourself at their expense - at least that's how the law is written.

I've been involved in more than a few insurance fraud investigations and it's going to come down to intent (in my eyes, in my State).

tootsy, I asked several questions in post #2, try to answer them. My experience says Judy is correct so far but we still do not have the details. Also, how much did you reserved for you time off?

When this happened she told me she would pay for the damages I told her that I would submit it through our insurance later on through the week she brought over the money 300 dollars and change whatever the amount was, I forget
But I had not had the time to submit the bill to the insurance company but it was finally submitted . I had to take 3 days off work to take my son to the dentist to get his tooth repaired . I'm sure the money she gave me she thought was going to pay for his damages but I told her I would submit it to our insurance so now she is unwilling to pay for any further dental work because she said that had submitted it through our insurance

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Originally Posted by tootsy

when this happened she told me she would pay for the damages i told her that i would submit it through our insurance later on through the week she brought over the money 300 dollars and change whatever the amount was, i forget
but i had not had the time to submit the bill to the insurance company but it was finally submitted . i had to take 3 days off of work to take my son to the dentist to get his tooth repaired . I'm sure the money she gave me she thought was going to pay for his damages but i told her i would submit it to our insurance so now she is unwilling to pay for any further dental work because she said that had submitted it through our insurance

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You did not answer my question - was there an understanding that if insurance paid the dental bill you would keep her money, that it was "your" money no matter what? You could use it to pay the dental bill OR reimburse yourself for your time off.

DID YOU TELL YOUR DENTAL INSURANCE THAT IT WAS A LIABILITY/NEGLIGENCE MATTER, PAID FOR BY THE OTHER PARTY?

It took 8 hours a day for 3 days to repair your son's tooth? You are going to have problems with this if she takes you to Court for the return of her money OR if you take her to Court for more money.

I think the Court is going to see this as you enriching yourself at the other party's expense. That's my "legal" opinion - and I work a lot of negligence cases.

No there was no agreement at all and in order to get my sons tooth fixed I had to take the entire day off but no it did not take 8 hours long on the three days

Ok, the Insurance should not legally pay if someone else is responsible for the bill ( it is in every medical insurance policy I know of) So if you took money for the bills, you in fact owe the insurance back all the money they paid you. And the person owes for the balance of the bills.

So that is the real issue, you did not have a right to claim it on the insurance if someone else was paying for it.

Thank you for your answers so if I pay back the insurance company she is still responsible for the dental work , and can I still get in trouble with the insurance company if I pay the money back?

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Originally Posted by tootsy

thank you for your answers so if i pay back the insurance company she is still responsible for the dental work , and can i still get in trouble with the insurance company if i pay the money back?

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You said there are additional dental bills? Will they be covered? If the insurance is NOT going to cover them, use the money the other person has already paid you toward those bills.

If ALL the dental bills will be covered, I'd call and talk to the insurance company - ask them how they want you to proceed. They may want their money back; maybe they won't. I've seen companies refuse because they don't want to deal with the paperwork (which always amazes me!).

You do realize you have a legal action here against the person who caused this injury - without knowing the details it's hard to give much advice but I'm sure pain and suffering were involved as well as your mileage, lost time from work and so forth. But you have to claim against the other people to get this type of relief.

I would suggest that you run this whole situation past an Attorney.

Here are the details
On the last day of school my son went over to a friends to play the other kid can around the corner and shot him with a rock in the mouth with a sling shot , the mother of the boy brought my son and her son to my house to explain what happened , she offered to pay for the damages I told her take I would submit it though your insurance but she insisted on paying .
The next day I had to take my son to get his tooth fixed and the bill was for $318 I sent the bill in to the insurance office then two days later she bought over the money .
The insurance company paid for the damages and I kept her money .
I had to return my son to the dentist 2 more times with in that next week ,so I used the money from her to cover the loss of wages I had .
So I is now two months later and the tooth is now completely death and he need a root canal which is paid for and a crown which is only 50% covered
I took the estimate from the dental office to her house and she denied to pay the bill .
So I called the insurance company today and they said to return the money to them or to her but if I return the money to her is she still going to be liable for his dental bills ?