Can an insurance adjuster reduce my medical bills under Connecticut law?

Detailed Answer

Under Connecticut law, no provision equivalent to North Carolina’s Rule 414 permits a claims adjuster to unilaterally cut down your medical bills. Generally, an insurance adjuster reviews submitted medical charges and pays according to your policy’s terms—such as the “usual and customary” fee schedule in a Personal Injury Protection (PIP) policy—but cannot impose additional reductions beyond those contractual limits.

Key Connecticut rules and statutes:

• Conn. Gen. Stat. § 38a-317 – Requires PIP insurers to reimburse reasonable and customary medical expenses up to policy limits. It does not authorize arbitrary bill reductions. Link: cga.ct.gov §38a-317.
• Conn. Gen. Stat. § 52-184 – Governs interest on judgments, relevant if your medical provider obtains a judgment for unpaid balances. Link: cga.ct.gov §52-184.

What this means for you:

1. An adjuster can question whether a treatment was “reasonable and necessary.” They may request medical records or peer reviews before payment.
2. If they dispute the charge, they must notify you and your provider, explain the basis, and follow the timelines in Conn. Gen. Stat. § 38a-317.
3. They cannot reduce your bill simply by invoking an unrelated or out-of-state rule.

If your insurer refuses to pay or improperly lowers your benefits, you can file a complaint with the Connecticut Insurance Department or ask a court to enforce the statute.

Helpful Hints

• Review your insurance policy’s definitions for “reasonable and customary” charges.
• Keep copies of all medical bills, treatment notes, and correspondence with your insurer.
• Respond promptly if the insurer requests more records or peer review.
• Negotiate with your medical provider: many offer payment plans or discounts for self-pay balances.
• File a consumer complaint with the Connecticut Insurance Department if your insurer violates statute timelines.
• Consult a personal injury attorney to challenge an insurer’s refusal or underpayment in court.

Disclaimer: This article is for educational purposes only and does not constitute legal advice. Always consult a qualified attorney for advice specific to your situation.