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Detailed Answer

Disclaimer: This article is for informational purposes only and does not constitute legal advice. Consult a qualified attorney to discuss your specific situation.

1. Pennsylvania Does Not Follow North Carolina Rule 414

In North Carolina, Rule 414 of the Rules of Evidence governs testimony about injury-related medical expenses. Pennsylvania does not have an equivalent “Rule 414” that allows an insurance adjuster to unilaterally reduce your medical bills. Instead, Pennsylvania’s approach centers on negotiation, provider contracts, and statutory reimbursement rates.

2. No-Fault (PIP) Coverage and “Reasonable and Customary” Rates

Under Pennsylvania’s Motor Vehicle Financial Responsibility Law, injured motorists receive Personal Injury Protection (PIP) benefits for medical expenses up to the policy limit. Insurers must pay “reasonable and customary” charges. The Public Utility Commission implements these standards in Title 31 of the Pennsylvania Code:

• 31 Pa. Code § 62.3 – Definitions and general provisions.
• 31 Pa. Code § 62.51 – Payment schedules and rate caps. View § 62.51

An adjuster may compare your bills to these schedules, but cannot impose a reduction beyond what a provider agrees to accept or what the law allows for PIP. If a provider’s charge exceeds the cap, the insurer pays up to the cap and you may remain responsible for any excess balance unless the provider writes it off.

3. Negotiation with Medical Providers

Outside of PIP, in liability or workers’ compensation claims, adjusters typically negotiate directly with hospitals, doctors, and billing agencies. The provider can choose to accept a lower payment in full satisfaction. This is a matter of contract, not a statutory “rule.” You may receive a balance-billing notice if the provider does not agree to the reduced amount.

4. Medical Liens and Patient Protections

If you recover damages in a lawsuit or settlement, medical providers (and some insurers) may assert a lien on your recovery under 42 Pa.C.S. § 8003. View 42 Pa. C.S. § 8003. Before any reduction, you have a right to notice of the lien amount and an opportunity to negotiate or dispute the lien in court.

5. Key Takeaways

• Pennsylvania has no direct analogue to North Carolina’s Rule 414.
• Under PIP, insurers pay “reasonable and customary” rates as defined in 31 Pa. Code § 62.51.
• Adjusters may negotiate reductions with providers but cannot unilaterally lower bills.
• Medical liens under 42 Pa.C.S. § 8003 protect provider reimbursement from settlements.
• Always review your bills, ask for itemized statements, and consult an attorney if a dispute arises.