Detailed Answer
Under North Carolina Rule of Evidence 414, evidence of a persons prior conduct in sexual-assault cases is admissible. However, that rule does not apply in Montana. Instead, Montana law governs when and how an insurance adjuster can challenge or reduce medical expenses.
1. Montanas Collateral Source Rule:
Montana Code Annotated (MCA) §27-1-741 prohibits deducting benefits a claimant receives from collateral sources (like health insurance) from the damages awarded. In other words, a defendant or its insurer may not reduce your recoverable damages by the amount your health insurer or other collateral source paid on your behalf.
Mont. Code Ann. §27-1-741.
2. Network Agreements and Reasonable Charges:
Separately, when you submit medical bills to your own insurer or to the at-fault partys insurer, the adjuster may apply network discount rates if your provider participates in an insurers preferred provider network. Outside of network, insurers often rely on “usual, customary, and reasonable” (UCR) rates or independent review organizations to determine what they consider a reasonable charge. They cannot unilaterally reduce your billed charges for litigation purposes, but they can negotiate payment amounts based on policy terms and network contracts.
3. Disputing Bill Reasonableness:
If an adjuster denies or disputes certain charges as unreasonable, request a written explanation and the methodology they used to determine the reduction. You may provide evidence showing that your providers fees align with local UCR data or peer-reviewed guidelines. If you remain at an impasse, you can seek an independent medical review or involve the Montana Commissioner of Insurance.
4. Litigation Implications:
During a lawsuit for personal injury, Montana law generally prevents a jury from hearing about payments made by health insurers, Medicare, or other collateral sources. Your attorney can file a motion in limine to exclude evidence of collateral payments, ensuring you recover full damages for medical expenses without offset.
Key Takeaway: An insurance adjuster in Montana cannot reduce your recoverable medical damages based on what your health insurer paid. They can negotiate payment rates under policy terms, but Montanas collateral source rule (MCA §27-1-741) protects your right to full compensation.
Disclaimer: This article is for informational purposes only and does not constitute legal advice. Consult a qualified attorney for guidance on your specific situation.
Helpful Hints
- Keep all medical bills, EOBs (Explanation of Benefits), and insurer correspondence.
- Ask your provider for a clean, itemized statement showing UCR comparisons if denied.
- Document any network discounts or negotiated rates applied by insurers.
- Request a peer review or independent medical review if charges are contested.
- Contact the Montana Commissioner of Insurance for unresolved billing disputes.