Detailed Answer
Disclaimer: This article is for informational purposes only and does not constitute legal advice.
You asked whether an insurance adjuster can reduce your medical bills under “Rule 414” in New Hampshire. North Carolina’s Rule 414 governs expert testimony in civil trials, not insurance billing. New Hampshire has no counterpart rule allowing a claims adjuster to unilaterally slash your provider’s charges.
Under New Hampshire law, medical expense coverage in an auto‐accident claim generally arises from either Medical Payments Coverage (MedPay) or Personal Injury Protection (PIP). Both require the insurer to pay “reasonable and customary” charges up to policy limits. An adjuster may:
- Review your medical records.
- Verify that charges match customary local rates.
- Negotiate directly with health care providers or subrogation vendors.
The insurer cannot apply a non‐existent rule to arbitrarily slash bills. It must follow New Hampshire statutes and administrative rules. Key provisions include:
- RSA 264:39-a (Personal Injury Protection Coverage)
- NH Administrative Rule Ins 400 (Claims practices and unfair claim settlement methods)
If your provider’s charges exceed customary rates, the insurer may question them. However, they must:
- Inform you in writing of any reduction and explain how they calculated the allowable amount.
- Provide references to the policy provisions or rules supporting that calculation.
If you disagree, you can:
- Request an independent review from the New Hampshire Insurance Department.
- File a complaint under NH Insurance Department complaint procedures.
- Seek help from an attorney experienced in insurance law.
Helpful Hints
- Review your policy’s medical payment or PIP section carefully to understand coverage limits.
- Ask the adjuster for a written explanation of any reduction in billing.
- Compare billed charges with local “usual and customary” fee schedules if available.
- Keep complete medical records and itemized bills to support your claim.
- Contact the New Hampshire Insurance Department early if you suspect an unfair reduction.