What are the procedures for resolving a dispute over medical treatment costs with an insurer in a personal injury claim?

To resolve a dispute over medical costs with an insurer, you must provide detailed evidence justifying the treatment, negotiate directly with the adjuster, and be prepared to file a lawsuit if a fair agreement cannot be reached. Here are the steps to resolve the dispute: Step 1: Gather All Medical Bills and Records Collect complete, itemized bills from every provider, including hospitals, doctors, and physical therapists. Do not just use summary statements. You also need the corresponding medical records and physician's notes that show why the treatment was necessary. Step 2: Submit a Formal Demand Package Send a demand letter to the insurance adjuster. This letter should clearly list every medical expense and attach copies of the supporting bills and records you gathered. The letter should explain how your injuries necessitated the treatment and demand a specific amount to settle your claim. Step 3: Counter the Insurer’s Arguments The insurer will likely respond by arguing that some of your treatment was not medically necessary or that the costs were unreasonable. To counter this, get a letter from your treating physician. This letter should explain exactly why the treatment was required to address your injuries from the accident. Step 4: File a Lawsuit Before the Deadline If negotiations stall and the insurer refuses to offer a fair amount, you may need to file a lawsuit. In California, the statute of limitations for a personal injury claim is generally two years from the date of the injury. Filing a lawsuit gives you access to formal discovery tools and shows the insurer you are serious. Important Details and Nuances: California law requires you to prove that your medical expenses were both reasonable and necessary (CACI 3903A). During this process, the insurer has the right to request an Independent Medical Examination (IME), where a doctor of their choice examines you to provide an opinion on your treatment (CCP § 2032.220). Warnings and Limitations: Insurers must attempt to settle claims in good faith and are prohibited from misrepresenting facts (Insurance Code § 790.03(h)). However, simply disagreeing on the value of a claim does not automatically constitute bad faith. These disputes are complex and hinge on strong evidence. This is general information and does not constitute legal advice. For complex situations, consult with a qualified California attorney.