Detailed Answer
If an insurance adjuster denies that your medical treatment relates to your Missouri car accident, take these steps to protect your rights and strengthen your claim.
Step 1: Review Your Policy and Denial Letter
First, read the adjuster’s denial letter and your auto policy closely. Note any deadlines, coverage limits, and the specific reasons for denial (for example, lack of causation or treatment deemed excessive).
Step 2: Gather Key Evidence
- Medical Records: Obtain full treatment records, diagnostic imaging, and billing statements from each provider.
- Accident Report: Secure a copy of the Missouri State Highway Patrol or local police crash report.
- Physician’s Nexus Letter: Ask your primary treating doctor or an independent medical examiner to provide a written opinion linking your injuries and treatment to the collision.
- Expert Opinions: Consider a specialist’s report if your injury is complex (e.g., spinal, neurological).
Step 3: Send a Demand Letter
Prepare a clear, concise demand letter summarizing your accident, injuries, and medical expenses. Attach key records and cite Missouri’s Unfair Claims Settlement Practices Act (RSMo § 375.936). Request a written reconsideration and set a reasonable deadline (e.g., 30 days) for a response.
Step 4: Consider Mediation or File a Complaint
If the insurer still denies coverage or undervalues your claim, you can:
- Mediation or Appraisal: Some policies and courts offer alternative dispute resolution to resolve disputes faster.
- File a Complaint: Submit a written complaint to the Missouri Department of Commerce & Insurance at insurance.mo.gov or call 1-800-726-7390.
Step 5: File a Lawsuit if Necessary
When all informal efforts fail, you may file a personal injury lawsuit in the appropriate Missouri court. Missouri’s statute of limitations for tort claims is five years from the accident date (RSMo § 516.140).
Disclaimer: This article is for informational purposes only and does not constitute legal advice. Consult a qualified attorney to discuss your specific situation.
Helpful Hints
- Keep a daily journal of your symptoms, treatments, and how injuries affect your life.
- Obtain itemized medical bills and explain any unusual charges to your providers.
- Get at least two medical opinions if the adjuster challenges your treatment plan.
- Check for deadlines in your policy and Missouri court rules to avoid losing rights.
- Save all communication with the insurer, including emails, letters, and voicemails.