Auto Insurance Claims: regarding a pulmonary embolism and genetic predisposition, regarding a pulmonary embolism and genetic predisposition

Question
Hi Anne,
I hope you can help and thanks in advance. I am aware that I live in Canada but my question is related to something specific.

I live in Quebec and we have a public insurance for car accident. I was involved in a bus accident in NY in 2006. I did got many health issues since this accident but the one I have trouble with right now is the pulmonary embolism.

I was taking birth control pain since many years already and at that time of the accident, the hospital put me on heparin and told me I can still take the birth control pill while on heparin.

When I left the hospital, they didn't give me anything related to this, judging I have no risks to develop anything (even though I was in bed for 5 days without moving).

12 days after the accident, (4 days after I left the hospital) I've developed a massive pulmonary embolism with a lung infractus.

Now, I find out that the insurance never paid me anything regarding the pulmonary embolism because they said I was genetically predisposed to get one. (They did the tests to know all this)

Honestly, no one in my family never has any issues with blood, nor myself (in my entire life - which was 32 years - the year of my accident).

What I think, they have to pay for this, since there`s predisposition to get a pulmonary embolism. I wouldn't have any pulmonary embolism if I wouldn't have stayed in the bed for 5 days and if the hospital would have given me Coumadin, to lower the risks.

Who has to pay me a settlement for this? The hospital or the insurance? What should I do in order to get my money? what should I prove? I was an active person before, doing exercises regularly and eating well.

Thanks for your help.

Karine

Answer
Hello Karine,

This is a highly complex dispute. You really need to talk to an attorney in NY.

Here is my first impression

You would not have any rights against the insurance company if you gave them a release. If they got a release and paid you for pain and suffering, then you settled the claim and that's that. (There are ways to defeat a release/settlement, but that is very hard).

Regarding the Hospital, well, you would have to show medical malpractice. This is a different cause of action. you would also have to show causation (it was their malpractice that cause the ultimate harm).

In addition, malpractice statute of limitations could be an issue here (some states apply the "Discovery Rule" some don't - I am not sure what NY does, you need to look that up).

The best thing for you is to talk to an attorney in NY and see what they can do. There is too many issues here.

Good Luck
Anne
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