Disclaimer: This article is for informational purposes only and does not constitute legal advice. Consult a qualified attorney to discuss your specific situation.
Detailed Answer
If an insurance adjuster denies or disputes that your medical treatment relates to your Massachusetts car accident, follow these steps to protect your rights and pursue coverage:
1. Review Your Policy and PIP Coverage
Massachusetts requires Personal Injury Protection (PIP) benefits under M.G.L. c. 90, § 34M (read statute). PIP covers up to $8,000 in medical expenses regardless of fault. Confirm your policy limits, exclusions, deadlines, and your obligation to seek medical care promptly.
2. Gather Thorough Medical Documentation
Insurance companies typically require records that link treatment to the accident. Collect:
- Emergency room and follow-up notes
- Diagnostic imaging (X-rays, MRIs) with physician interpretations
- Physician reports explicitly relating your injuries to the crash
- Billing statements and invoices itemizing dates and services
3. Send a Formal Dispute Letter
Write a clear, dated letter to the adjuster or claims manager. Include:
- Policy number and claim number
- Summary of your medical treatment
- Copies of records linking treatment to the accident
- Request for written explanation if they still deny coverage
4. File a Complaint with the Massachusetts Division of Insurance
If the insurer fails to respond or continues to deny benefits, file a complaint online with the Massachusetts Division of Insurance. Provide your policy details, correspondence, and medical documentation. The Division investigates unfair claim practices and can compel insurers to act.
5. Consider an Independent Medical Examination (IME)
Under M.G.L. c. 90, § 34M, the insurer can request an IME at its expense. You may also seek an IME by an independent specialist. A neutral opinion can strengthen your claim.
6. Seek Legal Advice and Litigation if Necessary
If disputes persist, consult a personal injury attorney experienced in Massachusetts car accident claims. An attorney can:
- Evaluate whether to pursue a declaratory judgment on coverage
- File a breach of contract or bad faith claim under M.G.L. c. 93A
- Negotiate a settlement or represent you in court
Helpful Hints
- Keep a detailed injury diary. Note pain levels, treatment dates, and therapy progress.
- Send all correspondence via certified mail to create an official record.
- Track deadlines. PIP claims typically require prompt notice and prompt treatment.
- Get a second medical opinion if your treating doctor’s causation opinion is unclear.
- Ask your provider to include “related to motor vehicle accident” in each visit note.
- Review your policy’s arbitration or appraisal clause before filing suit.