Disclaimer: This article is for informational purposes only and is not legal advice. Consult an attorney for guidance specific to your case.
Detailed Answer
After a car accident, your personal injury protection (PIP) coverage under Rhode Island’s Motor Vehicle Reparations Act generally pays for reasonable and necessary medical expenses related to the crash. Per R.I. Gen. Laws § 31-10-2, your insurer must cover treatment that is causally connected to the accident.
If the insurance adjuster disputes whether your treatment is related, follow these steps:
- Gather objective medical evidence: Obtain complete medical records, diagnostic test results, and a physician’s written opinion linking your injuries and treatment to the accident.
- Submit a formal appeal: Draft a letter to the insurer, reference your policy’s PIP benefits, and attach all supporting documents. Ask the insurer to reconsider within the time frame specified in your policy.
- Invoke your state regulator: If the insurer still denies coverage, file a complaint with the Rhode Island Department of Business Regulation, Insurance Division (dbr.ri.gov). Insurers must avoid unfair claim practices under R.I. Gen. Laws § 27-9.1-4.
- Consider direct action: Rhode Island law allows you to sue an at-fault driver’s insurer directly for unpaid benefits. See R.I. Gen. Laws § 31-31-5.
- Seek legal advice: A personal injury attorney can help assess your claim, prepare legal documents, and represent you in court or arbitration if needed.
Helpful Hints
- Keep a chronology of treatments, dates, and expenses.
- Ask your healthcare provider for a detailed narrative report.
- Review your insurance policy’s definitions of “reasonable” and “necessary” treatment.
- Note all denial letters and record the dates you receive them.
- Explore Rhode Island’s mandatory arbitration (R.I. Gen. Laws Chapter 10-18) for small claims under $5,000.