Disclaimer: This article is for educational purposes only and does not constitute legal advice. Consult a qualified attorney for guidance on your specific situation.
Detailed Answer
Under Georgia law, there is no “Rule 414” granting an insurance adjuster the power to unilaterally reduce your medical bills. Georgia is a fault-based insurance state, not a no-fault state like some others. Medical expenses you incur in a covered loss are generally paid according to the policy terms, subject to reasonableness and necessity reviews.
Here’s how Georgia law controls an adjuster’s handling of medical bills:
- No equivalent to North Carolina’s Rule 414: North Carolina’s Rule 414 (N.C. Admin. Code 19 NCAC 02 F .414) applies to how adjusters handle medical liens in certain no-fault scenarios. Georgia has no direct counterpart. Adjusters do not cite a Rule 414 to cut bills here.
- Policy terms and reasonableness: Insurers in Georgia must follow your health-insurance or auto-insurance policy. They typically authorize payments for medical services that are deemed reasonable and necessary. If an adjuster believes a charge exceeds customary fees, they may request documentation, dispute the amount, or offer a lower “usual and customary” rate.
- Unfair claims practices: Under O.C.G.A. § 33-6-2, insurers must not engage in unfair settlement practices, including unjustified delays or underpayments. You can file a complaint with the Georgia Office of Insurance and Safety Fire Commissioner if you suspect bad faith. (See https://law.justia.com/codes/georgia/2021/title-33/chapter-6/article-1/section-33-6-2/)
- Provider negotiation and liens: Health care providers in Georgia may have liens under the Hospital Lien Act, O.C.G.A. § 44-14-470. Providers often settle liens for less than the billed amount. These negotiations occur between providers and insurers or at case settlement. (See https://law.justia.com/codes/georgia/2021/title-44/chapter-14/article-5/section-44-14-470/)
In practice, an insurance adjuster may review each bill and challenge portions they deem excessive or unrelated to your covered injury. They cannot cite a non-existent Georgia “Rule 414” to make reductions, but they can rely on policy language and Georgia statutes governing fair claims practices and provider liens.
Helpful Hints
- Review your policy’s definitions of “reasonable and customary” charges.
- Obtain itemized medical bills and explanations of benefits (EOBs).
- Ask your provider if they will negotiate or write off part of the bill.
- Document all communications with the adjuster and insurer.
- Consider getting an independent medical review if a dispute arises.
- File a complaint with the Georgia Office of Insurance and Safety Fire Commissioner for unfair claims handling.