Detailed Answer
When an insurance adjuster argues that your medical treatment isn’t related to your car accident, you face a common hurdle in securing benefits under Oklahoma law. Under Oklahoma’s Personal Injury Protection (PIP) statute, 36 O.S. § 3636, your auto insurer must cover “reasonable and necessary” medical expenses incurred from an auto accident up to your policy limits. If the insurer disputes causation, follow these steps to protect your rights.
1. Review Your Policy and the Law
First, read your PIP declaration page and coverage documents. Confirm your coverage limits and any exclusions. Under 36 O.S. § 3636(A), PIP pays up to $10,000 or more (if you purchased higher limits) for medical treatment regardless of fault. Review the exact language and note time limits for filing claims.
2. Gather Comprehensive Medical Evidence
Document every treatment related to the accident. Collect:
- Emergency room records and ambulance reports
- Physician notes detailing crash history and findings
- Diagnostic images (X-rays, MRIs) with radiologist reports
- Physical therapy or specialist visit notes linking symptoms to the accident
Ensure each report clearly states that symptoms arose due to the collision.
3. Obtain an Independent Medical Examination (IME)
If your provider’s notes aren’t enough, request an IME from a neutral doctor. An IME can reinforce your claim by providing an impartial opinion on causation and necessity of treatment. Oklahoma courts often give weight to these objective assessments.
4. Submit a Formal Appeal to the Insurer
Issue a written demand letter outlining:
- Your claim number and PIP limits.
- Summary of medical evidence establishing causation.
- A deadline (e.g., 30 days) to reverse the denial.
Include supporting records and an affidavit from your treating physician.
5. File a Complaint with the Oklahoma Insurance Department
If the insurer refuses to reconsider, file a consumer complaint online at the Oklahoma Insurance Department (OID Complaint Portal). The OID investigates bad-faith practices and may pressure the insurer to comply with 36 O.S. § 3636 and the Prompt Payment Act, 36 O.S. § 607.1.
6. Consider Small Claims or Lawsuit
For disputes under $10,000, you can file in Small Claims Court in your county. For higher amounts, file a petition in district court. In court, you can seek:
- Recovery of owed medical expenses.
- Statutory interest under the Prompt Payment Act, 36 O.S. § 607.1.
- Attorneys’ fees if the court finds bad faith denial under 36 O.S. § 1250.15.
Consult an attorney if you proceed to litigation, as procedural rules and deadlines apply.
Disclaimer: This article is for informational purposes only and does not constitute legal advice. Consult a licensed attorney to discuss your situation.
Helpful Hints
- Keep a detailed treatment diary: Note pain levels, dates of treatment, and daily activities affected.
- Follow your doctor’s plan: Missed appointments can weaken your causation link.
- Respond promptly: A delay in appealing can trigger policy deadlines.
- Photograph vehicle damage and accident scene: This supports the force impacting your body.
- Obtain witness statements: Third-party accounts help establish crash severity.
- Archive all correspondence: Save emails, letters, and notes of phone calls with the insurer.