Detailed Answer
North Carolina’s Rule 414 does not apply in Ohio. Under Ohio law, an insurance adjuster cannot unilaterally reduce your medical bills based on out-of-state evidentiary rules. Instead, an adjuster pays medical expenses according to the terms of your policy and Ohio statutes.
First, review your auto insurance policy for Personal Injury Protection (PIP) or Medical Payments coverage. Ohio Revised Code §3937.18 (ORC 3937.18) governs PIP benefits, setting coverage limits and allowable expenses. An adjuster must pay or deny bills within those limits, but cannot reduce your provider’s billed amount unless the policy specifies a negotiated rate or network discount.
Second, Ohio law grants medical providers lien rights against auto insurance recoveries under Ohio Revised Code §2305.231 (ORC 2305.231). Through subrogation, your insurer may step into the provider’s shoes to recover payments made on your behalf, but this process does not decrease the provider’s original bill.
Third, administrative rules set standards for benefit payment. For example, Ohio Admin. Code 3901-1-54 (OAC 3901-1-54) clarifies timelines and methodologies for paying medical claims under auto policies. Adjusters must follow these rules rather than applying evidentiary reductions.
If your insurer offers a discount or reduced payout, confirm whether it matches your policy’s contractual or statutory guidelines. If you disagree with the adjuster’s calculation, you can request an itemized explanation, file a complaint with the Ohio Department of Insurance, or consult a qualified attorney.
Helpful Hints
- Review your policy’s PIP or MedPay limits and exclusions.
- Ask for an itemized bill to ensure all charges are accurate.
- Check if your provider participates in an insurer network or has a rate agreement.
- Understand provider lien rights under ORC 2305.231 before settlement.
- Keep communication in writing and request explanations for any reductions.
- File a complaint with the Ohio Department of Insurance if needed.
Disclaimer: This article is for informational purposes only and does not constitute legal advice. Always consult a licensed attorney for guidance on your specific situation.