Disclaimer: This article provides general information on Wisconsin law and does not constitute legal advice. Consult a qualified attorney for advice on your specific situation.
Detailed Answer
Ensuring the at-fault party’s insurer accepts liability for medical expenses in Wisconsin requires prompt action, clear documentation, and knowledge of state claim rules. Follow these steps:
1. Report the Claim Promptly
Notify the at-fault party’s insurer as soon as possible. Provide basic information about the accident, the parties involved, and your injuries. Early notice helps avoid delays or denials based on late reporting.
2. Gather and Submit Medical Documentation
Collect all relevant medical records, bills, and proof of payment. Under Wis. Stat. § 632.24, you must submit proof of loss and supporting documents for medical expenses. Include:
- Emergency and follow-up treatment records
- Itemized hospital, doctor, and therapy bills
- Receipts for out-of-pocket expenses
Send these documents to the insurer by certified mail or other trackable method.
3. Send a Written Demand for Coverage
After submitting your medical proof, send a formal demand letter. Summarize the accident, describe your medical treatment, and state the total expenses. Demand that the insurer accept liability and pay the covered amount.
4. Track the Insurer’s Response Time
Wisconsin law requires insurers to acknowledge or deny a claim within 30 days of receiving proof of loss. See Wis. Stat. § 632.32. If the insurer fails to respond within that period or unreasonably delays payment, you may have grounds for a penalty or bad‐faith claim under Wis. Stat. § 632.05.
5. Address Coverage Disputes Quickly
If the insurer denies or disputes your claim, review the denial letter carefully. They must cite a reason—such as lack of coverage, late notice, or disputed causation. Respond with additional evidence or clarification within 14 days. A timely, detailed rebuttal often resolves coverage issues without litigation.
6. Monitor Medical Liens and Subrogation
Health care providers or Medicare may place liens on any recovery you obtain. Obtain lien payoff statements and coordinate with the insurer to avoid surprise deductions. Clear communication helps the insurer understand total liability.
7. Consider Legal Assistance
An attorney can send a professional letter of representation, negotiate with the insurer, and file suit if necessary. Lawyers know the procedural rules, statutory deadlines, and evidence requirements that drive insurer decisions.
Key Wisconsin Statutes:
- Wis. Stat. § 632.24 – Notice and proof of loss
- Wis. Stat. § 632.32 – Acknowledgment and investigation of claims
- Wis. Stat. § 632.05 – Unfair claim settlement practices
Helpful Hints
- Keep a detailed accident journal: note dates, times, and conversations with providers and adjusters.
- Use certified mail or email read-receipt to document all submissions to the insurer.
- Follow up every two weeks if you haven’t heard a response.
- Request a copy of the insurer’s complete claim file under Wis. Stat. § 631.81.
- Ask your health care provider about lien‐reduction options to lower outstanding balances.