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Home My WebLink About8.c. Insurance Claim Reimbursement0 Qk,QQA1 j?C!. TO: Mayor.. Knu't:.<soil C:t:at.►nci.lmeml::err:s: Mapper �Tucker- Wal £siY W1 i. F ri::ams Stephan Ji l4: RE: Inssur"cance Cl a:i I7Y i _. u c k. i n n Attached ].4s a let'.:t»ear. from our insurance �LYrt CFCeitrry'a adjustor t1:7 'I Helen Lucking in regards to a. claim she t:s►.►t:mi.tt:ed to the city relative to an injury ur-y est- e incurred on a city street. As yc:a►_► see the claim was turned down. Mrs Lucking then submitted the claim to t:'.t'e city itself for payment. `[ ::am recommending that the claim be turned down. Paying such a claim, after having it turned d down by the insurance company, would set a dar'1gercr►_►-:s pr"'Faf.=F?t.;tent:.. 1't' a claim is turned r.:ic:lwn and they claimant tai st' es to pursue the matter further it would be best to have the matter settled in the courts. l don't wish t:.r.:1 have a citizen inc::►_Fr- c?mpefYsies rit_►e to having to go to court but we have insurance for the purpose of protecting the city r.':tS::tr"_ainst valid claims where it is de?•t.er'tYi1')E?d we hive 6a liability. f: ur" insurance company is t: el l i "g us we don't have that:. liability in this case. therefore any action other than denying the claim would be a dangerous precedence. . wM'�F�"!Afl4MNNtfRrr�6^Rvi4.�,qy.�4.:�we�s�iv+3+�Y-+�M'4M+i•'w.u,.�....m. CLERK'S OFFICE W tA 21 /,.,6 xe�zlll 1C7/7 e�L:�-z-� • s GAB Business Services Inc 380 Lafayette Freeway Road Suite 118 P O Box 7007 St. Paul Minnesota 55107 Telephone 612-292-1234 Branch Office September 23, 1987 Helen Lucking 14755 Cambrian Rosemount, Minnesota 55068 Dear Ms. Lucking: alA4..I N'UN: ,,I SLB. GAB F I L E N0.: 56542-03318 ICY-.�L) INSURED: CITY OF ROSEMOUNT CLAIMANT:HELEN LUCKING D / A : _5—? -87 --------------- On -----On June 2, 1987, this office received an insurance claim submitted our insured. At that time we were instructed to make an inspection on a trip and fai.l claim submitted by you. Because the envelope you sent your original claim assertion into the city in was last. We did not have your address and we were unable to conl:act you, however, we did make a full investigation of the claim. Our investigation has revealed no N ability on behalf of the city. Whereas it is true that the sidewalk where you tripped is somewhat spalled and is obviously in Tess than perfect condition. It is not in such a condition as to warrant the cify being liable for your claim. At this time we deny any liability on the part of the city in regards to your claim for damages and would respectfully request that if you have any questions or comments regarding our decision, you should contact us at the above number. Also enclosed is the letter and medical bills that you sent into the city. Sincerely, Gregory H. Smith Adjuster GHS1dmb Encl. cc: Toombs Insurance Agency Y i i S'7 el C"JIt IvEb i 9 AIJG z 61987 AUG 191987 RC...... CLERK'S OFFICE CITY OF ROSEMOUNT .L- �7LGl..'�� iLdi l-L-w�1 J�.-t�--�r--fz�-u,� G�-'�it�-2-�-�.-c. •- 1 U X81 ASSOC O OPED I C CONSULTANT-3- 17 ON ULTANT-3-17 W EX NGE ST SUITE 607 `T PAUL MN 551 02 RESPONSIBLE PARrY NAME WAYNE LUCKING 14755 CAMBRIAN RDSEMOUNT MN 55068 Insert this stub with your payment in the enclosed return envelope APPOINTMENT PHONE NO. x:21 _01319=9 HELEN LUCKING 4 �11I t�t) ENTER o/1YMENT NEpE ()5QZ HELEN 25605 1 CLOSED REDUCTION. 1813.4 YOUNG COLLES FRACTURE I ism ]PATIENT NAME PROCEDUREJ PL I PROCEDURE DESCRIPTION DIAGNOSIS I, m CODE CODE 05HELEN 90060 3 ESTABLISHED PATIENT- 81:3.4 YOUNG. .1 MD INTERMEDIATE SERVICE 05k HELEN 73100 3 XRAY -WR I ST, AP AND 813.4 YOUNG MD LATERAL VIEWS 05.13 HELEN 99984 PREVIOUS STATEMENT 06%1 HELEN 90060 3 ESTABLISHED PATIENT- 813.4 YOUNG MD INTERMEDIATE SERVICE 005 HELEN 90060 3 ESTABLISHED PATIENT- 813.4 YOUNG MD INTERMEDIATE SERVICE 1 I 0j03 HELEN 90050 3 ESTABLISHED PATIENT- 813.4 YOUNG MD LIMITED 'SERVICE 1 1 I 1 1 I 1 7207227CYES NO NAMEfADDR 5TOTALCHAROES► BLUE SHIELD NO. 24. ACCOUNT NO.. 26' CCEPT ASSIGNMENT ASSOC ORTHOPEDIC: CONSULT 32. RESPONSIBLE PARTY NAME 30. SOCIAL SECURITY NO 17 W EXCHANGE ST SUITE 607 AU Ni t.1 HYSICIALITr T— 33. CLINIC FEDERAL '�T P L SUPPER TELEPHONE NO. _�?�1=�c_t.j_. LD NUMBER cc 10 ++ 1' 14755 CAMBRIAN AVE' ROSEMOUNT MN 55068 I 1 REFERRING PHYSICIAN RETURN THIS TOP PORTION BY DETACHING HERE YOUNG AMOUNT DUE AMOUNT ENCLOSED ST. PAUL RADIOLOGY, P $ PATIENT CRED TS ICR) THE BUSINESS OFFICE 7311.0 2 X—RAY, 41IST, COMPLETE• 901 LOWRY MEDICAL ARTS BUILDING 14 0 1 1 SAINT PAUL, MINNESOTA 55102 vITNIM04 OF THREE VIENS I PHONE: (612) 228-9155 73110 ACCOUNT NUMBER X-RAY, WRIST, COMPLETE, LUCKING, HELEN STATEMENT DATE 20576864 08/13/87 10 WAYNE LUCKING PROCEDURE CODE 14755 CAMBRIAN AVE' ROSEMOUNT MN 55068 I 1 REFERRING PHYSICIAN RETURN THIS TOP PORTION BY DETACHING HERE YOUNG AMOUNT DUE AMOUNT ENCLOSED $ 14.50 $ TRANSACTION ION PROCEDUREOD PL DESCRIPTION PATIENT CRED TS ICR) 05 110? ,1A7 7311.0 2 X—RAY, 41IST, COMPLETE• LUCKI14G, HELEV 14 0 1 1 vITNIM04 OF THREE VIENS I 05 i0? iA7 73110 2 X-RAY, WRIST, COMPLETE, LUCKING, HELEN 14 0 I i H ATNIMI14 JF THREE VIENS I TRANSACTION DATE PROCEDURE CODE PL DESCRIPTION PATIENT CHARGES OR CREDITS (CR) ()5; 11 ;R7 71110 2 X-LtAY, 14RTST, �n�PLFTE, I_II(KTNG, IHFLI: v 1 14, I I MTA!1H1lH 3F TIi12=F VIFroS - I � I 1 I I I I _ 1 TRANSACTION DATE PROCEDURE CODEPL DESCRIPTION PATIENT CHARGES OR CREDITS ) I 1 1 n t;01 ;R7 731111 2 X—RAY, I�IgT5T, �nMPLETF, t_UCKING, HFLEN 1450 MTAT'4114 3F TlR_F VIF4S ' � � � 1 I 1 1 1 , I I I 1 ' nE1jR PAT. ENT-. Pi CASF SEF TGIF_ REVERSE Sih OF THIN STATEM NT F1)P Z pU TANT N. tJRA'JCF FILING I"IFIRMAT10 . 1 32. RESPOPNOSIBLE PAR NAME A PAY THIS q 2 q LI_ICKING, :^IAYNF 057 A 1 <Iss,s AMOUNT 114.90 E�II aige.S Carondelet Community Hospitals STATEMENTOF ACCOUNT —IF YOU HAVE ANY OU . ESTIONS CONCERNING THIS BILL, St. Mary's Hospital & Rehabilitation Center EUSINESS OFFICE St. Joseph's Hospital RETURN WITH YO.WREMITTANCE CALL*6,Ij.,,,, PAGE NO. I A Member of Carondelet LifeCare Corporation ;PLEAS PATIEK"178 NAME ACC00WAUMS 1 A-71 1-210 11 T Pi 64 DATE, 423.3, A YN E DATE 0 ESCRIPTION i &IWDATE -, I! 111 31*84 77*71., size uz E. Gig A 5/01/87 5/02/87 34C22GO4 32010100 PHY SERV GRIEF 90505 INTERMECIA71E X5200 5/02/87 --20418S9 SLING 25eI6 61547 5/02/87 32041515 CAST SHCRT ARM 34.56 5/02/87 32042301 SYRINGE & NEEDLE PACK 3.47 (mASTR CARD Opay) S/GZ/87 32042434 LOCAL AKESTHESIA J3480 .15al 5/02/07 07556004 VAIST 3V 73110 45o29 5/02/e7 07556004 WRIST 3V 73110 45:29 5/02/87 18200071 ACEI & COCE 83 4.80 --- WE HAVE POILLED THE FC-LILGWING INSURANCEC23. 5/12/67 MUTUAL CF GNAHA FRCM 05/01/e7 THRU 05/12/167 PLEASE MAKE CH ST. JcSEPHS__ 'is INCSPITAL b EXCHAINGE 5 ST* PAULe 111111114 $510 ;j IV X YCU I 01 lij iK IN: ZES NO' 'AND-ACCOUNTN0MBER ON ALL jNqUIRIES AND CORRESPONDENCE. 'g!pti %i "M `�tffln' «,4 71" N PLEASE PAY - THIS AMOUNT AMOUNT`ENCLOSED STATEMENT DATE, 423.3, A YN E DATE 0 ESCRIPTION "ONUf5"HOM _:TA INSURA1.CE A "FPWATa or oa�2T COMMUNITY 057686S HELEN AMOUNT 52*00 6�127 1 0579297 G LUCKING HELEN If You wish to Pay the amount due with Visa. or Mostar Card, pi so 52*00 61547 0581199 Ga LICKING HELEN N EZC4E;E 70990 CARD NUMBER (ALL DIGITS PLEASE) ACCOUNT BALANCE pop. 'AND-ACCOUNTN0MBER ON ALL jNqUIRIES AND CORRESPONDENCE. 'g!pti %i "M `�tffln' «,4 71" N PLEASE PAY - THIS AMOUNT AMOUNT`ENCLOSED E INSURANCE FORD MEMORIAL HOSPITAL WANY. IF YOU "ONUf5"HOM _:TA INSURA1.CE A "FPWATa or oa�2T COMMUNITY PHON If You wish to Pay the amount due with Visa. or Mostar Card, pi so Ifil out the below;nformctian and RETURN THIS COPY. M N EZC4E;E CHARGE. VISA EIMASTERCARD CARD NUMBER (ALL DIGITS PLEASE) _j (mASTR CARD Opay) EXPIRATION DATE: X SIGNATURE -- OLA" CUSTOMERS ONLY j,