Detailed Answer
Understanding North Carolina Rule 414
North Carolina Rule of Civil Procedure 414 governs the admissibility of certain evidence in North Carolina courts. It does not regulate how insurance adjusters set or pay medical bills. It applies only in North Carolina litigation and carries no force in Rhode Island.
Rhode Island Law on Insurance Adjusters and Medical Expenses
In Rhode Island, insurance adjusters must follow the states Unfair Claim Settlement Practices Act. Under R.I. Gen. Laws § 27-7.1-2 (see webserver.rilin.state.ri.us/Statutes/TITLE27/27-7.1/27-7.1-2.HTM), an adjuster cannot arbitrarily reduce or deny medical bills unless they reasonably question the necessity, reasonableness, or the policys coverage terms. Common lawful reasons include:
- Lack of medical necessity
- Charges exceeding usual and customary rates
- Services not covered by the policy
An adjuster must also honor any valid assignments of benefits you signed with your medical provider. They cannot invoke an out-of-state court rule to cut your bills.
What to Do If an Adjuster Tries to Reduce Your Bills Improperly
If you believe an adjuster is acting unfairly, you can:
- Review your insurance policy and provider assignment agreement.
- Request a written explanation of benefits showing how the adjuster calculated payments.
- Submit medical necessity documentation or peer reviews.
- File a complaint with the Rhode Island Department of Business Regulation, Division of Insurance (dbr.ri.gov/divisions/insurance).
Disclaimer: This article is for educational purposes only and does not constitute legal advice. Consult a licensed attorney or the Rhode Island Division of Insurance for guidance specific to your situation.
Helpful Hints
- Always keep copies of your policy and benefits assignment forms.
- Document phone calls and emails with your adjuster.
- Ask for an itemized explanation of benefits (EOB).
- Know your policys network rules and coverage limits.
- Use medical peer review letters to support necessity.
- Research Rhode Islands unfair settlement statutes before disputing a denial.