Detailed Answer
When an insurance adjuster tells you that your medical treatment isn’t related to your car accident, you can take clear steps under Montana law to challenge that decision. An adjuster must base denials on evidence, not assumptions. You can reconstruct a record of your injuries, explain how they tie to the crash, and enforce your rights under the policy and state statute.
1. Gather and Organize Your Medical Evidence
Collect all medical records, imaging reports, therapy notes, and invoices. Create a timeline showing when you were treated and why. Highlight statements from doctors linking each treatment to crash-related injuries. Solid documentation helps meet your burden of proof. Under Mont. Code Ann. § 27-1-205, you must prove causation by a preponderance of the evidence. See § 27-1-205.
2. Obtain a Doctor’s Causation Letter
Ask your treating physician to provide a signed letter stating that, in their medical opinion, your treatment directly stems from the accident. A clear causation opinion carries weight. Make sure the letter references your crash date, diagnoses, and how each injury requires specific therapies or procedures.
3. Use Your Right to an Independent Medical Examination (IME)
Under Mont. Code Ann. § 61-6-201, your insurer may require you to undergo a reasonable physical or mental exam by a doctor they choose. You must get at least 20 days’ notice of the exam. If the adjuster refuses to consider your evidence but pushes for an IME, prepare by bringing all relevant records to that exam. See § 61-6-201.
4. Review Your Insurance Policy Language
Check the definitions and exclusions in your auto policy. Identify the coverage that applies—liability, personal injury protection (if elected), or uninsured/underinsured motorist (UM/UIM). Each coverage may have different proof requirements. Highlight any policy provisions that require the insurer to pay “all reasonable medical expenses” for crash-related injuries.
5. Send a Coverage Demand Letter
Draft a letter to the adjuster summarizing your evidence, attaching the doctor’s causation letter, medical bills, and records. Cite the policy and applicable statutes. Demand that the insurer either admit coverage or explain the specific legal and factual basis for denial. Give them a deadline (usually 30 days) to respond.
6. Consider Arbitration or Lawsuit
If the insurer still denies coverage, check whether your policy offers binding arbitration. For UM/UIM disputes, Montana law allows arbitration if both parties agree. Otherwise, you can file a petition in district court. A court will review your evidence and the insurer’s denial. If the court finds bad faith, you may recover attorney fees and penalty interest.
Helpful Hints
- Keep a single folder for all accident-related documents.
- Request itemized bills showing dates, providers, and CPT codes.
- Follow your doctor’s treatment plan closely and note any gaps.
- Send all correspondence to the insurer by certified mail.
- Consult a Montana attorney if the insurer denies valid claims.
Disclaimer: This article is for informational purposes only. It does not constitute legal advice. Consult a qualified attorney for advice about your specific situation.