Detailed Answer
Disclaimer: This article is for informational purposes only and does not constitute legal advice. Always consult a licensed attorney in South Carolina for guidance tailored to your situation.
North Carolina’s Rule 414 governs how NC courts consider medical bills in personal injury cases—it has no effect on insurance adjusters or bills in South Carolina. In our state, insurance adjusters must follow South Carolina’s insurance regulations, not rules adopted by another jurisdiction.
Under South Carolina law, an adjuster can question the necessity, reasonableness, and customary nature of medical charges, but they cannot unilaterally impose a discount based on an out-of-state court rule. Instead, they negotiate directly with medical providers or use contractual agreements your insurer has with health care networks.
If an insurer misrepresents policy provisions, undervalues bills, or uses unfair tactics, that may violate South Carolina’s Unfair Claims Settlement Practices Act. See SC Code Ann. § 38-77-130, which prohibits deceptive or unfair acts in settling claims.
Key points under South Carolina law:
- No statutory rule like NC Rule 414 applies.
- Adjusters tend to rely on your policy language, network contracts, and South Carolina fee guidelines.
- They must negotiate in good faith and cannot misrepresent coverage or benefits.
- You may challenge any unreasonable denial or reduction through internal appeal or by filing a complaint with the South Carolina Department of Insurance.
Helpful Hints
- Review your insurance policy’s medical-payment provisions to understand coverage limits and network discounts.
- Request an itemized medical bill and compare it against usual and customary rates in your area.
- Ask your provider if they will accept a lien or payment plan negotiated through your insurer.
- Document all communications with the adjuster, including dates, times, and summaries of conversations.
- If you suspect unfair claims practices, file a complaint with the South Carolina Department of Insurance at doi.sc.gov/fileacomplaint.
- Consider consulting a personal injury attorney if your insurer refuses to negotiate fairly or denies valid charges.