What to Do if an Insurance Adjuster Disputes Your Medical Treatment Is Related to Your Car Accident in New Mexico

Disclaimer: This article is for educational purposes only. It does not constitute legal advice. Consult a licensed attorney for guidance on your specific situation.

1. Understand Your Policy and Medical Payments Coverage

Review your auto insurance policy to confirm you have medical payments coverage (MedPay). In New Mexico, insurers often offer MedPay under NMSA 1978, § 66-5-301. MedPay helps pay reasonable medical expenses regardless of fault. If the adjuster denies treatment as unrelated, note which policy provision they cite and gather your policy declarations page.

2. Gather Clear Medical Evidence

• Medical Records and Bills: Obtain all records, imaging reports, bills and itemized charges from the hospital, clinic or specialist.
• Physician’s Affidavit or Letter: Ask your treating doctor to prepare a written statement linking your injuries and treatment to the accident. A clear causation opinion can persuade an adjuster.
• Chronology of Care: Prepare a timeline showing when symptoms began, treatments occurred and how your condition progressed after the collision.

3. Request an Independent Medical Examination (IME)

If the insurer distrusts your doctor’s opinion, propose an IME by a neutral physician. Under common practice, each party selects an examiner or agrees on one jointly. The examiner’s report can resolve disputes over causation.

4. Send a Detailed Written Demand

Draft a demand letter to the insurer. Include:

• A summary of the accident facts.
• Copies of all medical evidence.
• A clear statement of the coverage section (e.g., MedPay under NMSA 1978, § 66-5-301).
• A deadline (e.g., 30 days) for a decision.

5. File a Complaint with Regulatory Authorities

If the insurer continues to deny your claim without valid basis, you may file a complaint with the New Mexico Office of Superintendent of Insurance (OSI). Unfair claim practices may violate New Mexico law, such as NMSA 1978, § 59A-23-3.

6. Consider Small Claims or District Court

If your total medical expenses are within the small claims limit (typically $10,000 in New Mexico), you can sue in small claims court. For higher amounts, file suit in district court to enforce your MedPay coverage.

Helpful Hints

• Document every call or email with your adjuster, including dates and summaries.
• Keep copies of all bills, records and correspondence in one organized file.
• Ask your provider to use accident-specific diagnostic codes (e.g., ICD-10 code V43.52XA for passenger car collision) to reinforce causation.
• Consider a demand packet with a cover letter, table of contents and tabbed evidence for clarity.
• Act promptly—Missed deadlines can bar recovery of medical payments benefits.