Handling a Dispute When an Insurance Adjuster Questions Your Accident-Related Medical Treatment

Disclaimer: This information is for educational purposes only and does not constitute legal advice. Consult an attorney for advice about your specific situation.

1. Detailed Answer

1.1 Understand Your Policy and Washington Law

In Washington, every motorist must carry liability insurance under RCW 46.30.020. If another driver’s insurer denies that your medical treatment stems from your car crash, review your policy’s declarations and coverage limits. Washington law bars insurers from unreasonably delaying or denying claims under the Unfair Claims Settlement Practices Act (RCW 48.22.020).

1.2 Gather and Organize Medical Evidence

Compile all treatment records, imaging (X-rays, MRIs), physician notes and hospital bills. Ask your treating doctor to provide a written opinion linking your treatment to the collision. Submit a detailed chronology of symptoms, doctor visits and therapies to your insurer.

1.3 Send a Formal Demand with Supporting Documents

Draft a demand letter explaining why your treatment is necessary and causally related. Reference the medical evidence and cite Washington’s policy requirements. State a reasonable deadline for a response (e.g., 30 days).

1.4 Request an Independent Medical Examination (IME) if Needed

If the insurer disputes the link, they may offer an IME under RCW 48.22.020. Attend that exam with your complete medical file. A neutral examiner can corroborate your treating provider’s findings.

1.5 File a Complaint with the Washington Office of the Insurance Commissioner

If the insurer still refuses to pay, file a complaint with the Washington Office of the Insurance Commissioner (OIC). The OIC enforces RCW 48.02.080 (unfair claims practices). You can submit a complaint online at insurance.wa.gov or by calling 1-800-562-6900.

1.6 Consider Legal Action Before the Statute of Limitations Expires

Washington’s statute of limitations for personal injury claims is three years from the date of the accident under RCW 4.16.080. If you exhaust administrative remedies without success, you can file suit in Superior Court to recover medical expenses, lost wages and, if applicable, pain and suffering.

2. Helpful Hints

• Keep chronological, dated notes of every doctor’s appointment and conversation with the insurer.
• Send all documents via certified mail or an equivalent service to create a clear record.
• Maintain copies of every bill, receipt and insurer correspondence.
• Act promptly—missing deadlines can forfeit your rights under your policy and Washington law.
• Consider hiring an attorney experienced in Washington car-accident claims to guide you.
• Use the OIC’s online tools and guides at insurance.wa.gov/complaints.