Can an Insurance Company Deny Treatment Recommended by a Doctor_ - Robert armstrong personal injury attorney north carolina

Who pays my medical bills after an auto accident?

When buying an auto policy, you may find yourself being offered Medical Payments coverage. Medical Payments coverage can pay your medical bills whether or not you were at fault for the accident. If you were not at fault for the accident, these funds can help keep your medical bills out of collections until you receive your recovery. You may also be able to collect a lump sum recovery to pay for your medical bills and other damages.

Can my auto insurance carrier refuse to pay my medical bills?

Auto insurance carriers may refuse to pay your medical bills by asserting that they are not reasonable or necessary. Your carrier may send your medical records to an outside party for review. Medical Doctors and others specialists will review the treatment you have had to date. Based on their recommendation, they may deem the medical treatment as not reasonable or necessary and refuse to pay the related bills. Issues with this process arise immediately; it is readily apparent that the outside parties are working for your insurance carrier, not you. They are neither impartial nor unbiased. More often than not they declare that your treatment isn’t covered under your policy, right when you need medical care the most.  

I wasn’t at fault for my auto accident. Can the insurance carrier deny my medical bills?

There are many reasons that either the at-fault driver’s insurance carrier or your own carrier may refuse to pay your medical bills.

  • The auto policy has lapsed.
  • You are partially at fault for the accident (Not applicable for Medical Payments coverage).
  • The policy was canceled because the applicant gave false information to the insurance carrier.
  • The medical treatment was not reasonable or necessary.
  • Prior or new medical conditions that have similar symptoms to your current injury.
  • Pre-existing injuries that were only aggravated by the accident.
  • There isn’t enough objective evidence in your medical records to support that your injury is real.  
  • The insurance carrier doesn’t believe you sustained the injury in the accident due to the time between the accident and when you first sought treatment.

Although a few of the above issues are clear-cut, such as a lapsed policy, most  are not. Proving to an insurance carrier that your medical treatment is necessary as a direct result from injuries you sustained in the accident can be difficult. The insurance carriers will work to find reasons to deny your claim or pay as little on your claim as possible. You need an attorney working for you to help you assemble the evidence you need to document that your injury is related, real, and deserves compensation.

The auto insurance carrier has denied my medical bills. What do I do?   

Whether it is your own insurance carrier or the insurance carrier of the at-fault driver, you will have to file a lawsuit. Insurance claims for medical bills are routinely denied by the insurance carrier. Hiring an attorney early on in the process will ensure that you have all the evidence you need to prove the insurance carrier should pay. If it becomes necessary to file a lawsuit, you will be ready.

While you can file a lawsuit on your own, it is not recommended. The rules of the Court can be complex. You will not only need the knowledge of an attorney but also their experience to avoid common mistakes. Most attorneys in North Carolina, and in particular the Wilmington area, will provide you with a free consultation. You can discuss your case with a professional to discover the ways in which an attorney can help you obtain payment for your medical bills. If you were not at fault, it is likely they can discuss obtaining a lump sum settlement on your behalf.     

While it is commonplace for an auto insurance carrier to deny your claim, it does not mean it is the end of your claim. Talk to an attorney today about getting the compensation that is due you, and get back on the road to recovery.