Disclaimer: This article is for informational purposes only and is not legal advice.
Detailed Answer
North Dakota Rule of Evidence 414 applies only to the use of evidence in sexual‐assault cases. It has no bearing on your medical bills or insurance claims. An insurance adjuster cannot rely on Evidence Rule 414 to reduce your medical charges.
Instead, insurers pay medical expenses according to your policy terms and any provider agreements. Key factors include:
- Policy Coverage: Your insurance policy defines covered treatments, payout limits, deductibles, and copays.
- Provider Networks: In-network providers agree to discounted rates under contract.
- Usual, Customary and Reasonable Charges: Insurers often cap payments at a threshold based on regional cost data.
- Provider Agreements: Some medical providers accept an insurer’s negotiated rate as full payment.
An adjuster may negotiate with a medical provider or apply policy-based discounts. They cannot unilaterally lower a valid, documented bill beyond what your policy or the provider agreement allows.
Relevant North Dakota Statutes
Unfair Claim Settlement Practices (NDCC § 26.1-41-08)
North Dakota law prohibits insurers from engaging in unfair claim settlement practices such as misrepresenting policy provisions or unreasonably denying payments. See NDCC § 26.1-41-08.
No-Fault Auto Insurance Benefits (NDCC § 26.1-41-09)
If you make a claim under your auto policy’s Personal Injury Protection (PIP) coverage, NDCC § 26.1-41-09 requires insurers to pay medical expenses regardless of fault. See NDCC § 26.1-41-09.
Helpful Hints
- Review your insurance policy to understand covered services and limits.
- Request an itemized medical bill from your provider.
- Compare the bill to your insurer’s Explanation of Benefits (EOB) to identify discrepancies.
- Ask your adjuster for a written explanation of any rate adjustments.
- Negotiate payment plans or discounts directly with your provider if underpayment occurs.
- Keep detailed records of all communications with insurers and providers.
- File a complaint with the North Dakota Insurance Department at https://www.nd.gov/ndins/ if you suspect unfair claims practices.