Detailed Answer
Under Kentucky law, there is no “Rule 414” granting an insurance adjuster authority to unilaterally cut your medical bills. Kentucky’s Rules of Evidence (KRE) apply in courtrooms, not to private insurance claims. An adjuster may negotiate or contest medical charges only as permitted by your policy terms, provider agreements or state statutes.
How Insurers Handle Medical Bills in Kentucky
- Policy limits and coverage: Your auto or health insurance policy sets the maximum benefits and outlines covered services.
- Provider networks: If you see an in-network provider, the insurer pays the contract rate. Out-of-network bills may be subject to “usual and customary” reimbursement guidelines.
- Reasonableness review: Insurers often audit bills for duplications, excessive charges or non-covered services before issuing payment.
- Statutory subrogation: Under KRS 304.39-320, if your insurer pays your medical expenses for a car wreck, it can seek reimbursement from the at-fault party’s insurer. That process does not let the adjuster reduce a valid medical charge—it only allows recovery after your provider has been paid.
Key Kentucky Statutes
- KRS 304.39-110 (Medical Payments Coverage):
Kentucky Legislature - KRS 304.39-320 (Subrogation Rights):
Kentucky Legislature
When an Adjuster Can Challenge Charges
An adjuster can dispute your bills if they believe charges exceed what’s reasonable or fall outside your policy. They will typically request medical records, itemized bills or peer reviews. However, they cannot arbitrarily reduce a valid charge without your consent or a court order.
Disclaimer: This article is for educational purposes only and does not constitute legal advice. Consult a qualified Kentucky attorney to address your specific situation.
Helpful Hints
- Review your insurance policy to understand covered limits and exclusions.
- Ask providers for an itemized bill and check for errors or duplications.
- If your bill is denied or reduced, request a peer review or independent medical examination under your policy.
- Keep detailed records of payments, denials and adjuster correspondence.
- Consult a Kentucky attorney if you face unfair bill reductions or coverage disputes.