Disclaimer: This article is for informational purposes only and does not constitute legal advice.
Detailed Answer
When an insurance adjuster denies that your medical treatment relates to your car accident, follow these steps:
- Request a Written Explanation: Ask the adjuster for a written denial detailing why they believe treatment is unrelated. Understanding their basis helps you target your response.
- Gather Supporting Medical Records: Obtain complete records, imaging reports, and treatment notes. Ask your treating physician to provide a statement confirming the link between your injuries and the accident.
- Submit a Demand Package: Put together a demand letter, medical documentation, and billing statements. Send this package via certified mail to ensure proof of receipt.
- Invoke Unfair Claim Settlement Practices: Under South Carolina’s Unfair Claim Settlement Practices Act (SC Code Ann. §38-75-140), insurers must promptly acknowledge and investigate claims. If they unreasonably delay or deny, you can file a complaint with the South Carolina Department of Insurance (doi.sc.gov).
- Review Your Medical Payments Coverage: If your auto policy includes Medical Payments (MedPay) coverage, you can claim under your own insurer regardless of fault. See SC Code Ann. §38-77-140 for details (scstatehouse.gov).
- Consider an Independent Medical Examination (IME): The insurer may request an IME. Prepare by reviewing all treatments and maintaining an accurate timeline of symptoms and doctor visits.
- Understand Statutes of Limitations: In South Carolina, you must file a personal injury lawsuit within three years of the accident (SC Code Ann. §15-3-530, scstatehouse.gov). Missing this deadline can bar your claim.
- Consult an Attorney: If the adjuster remains uncooperative, you may need a personal injury attorney to negotiate or file suit.
Helpful Hints
- Keep a detailed treatment journal, noting dates, symptoms, and doctor recommendations.
- Photograph any visible injuries and document your pain levels over time.
- Follow your doctor’s treatment plan closely to avoid gaps in care.
- Send and store all correspondence with the insurance company in writing.
- File a complaint with the South Carolina Department of Insurance if you suspect bad faith.
- Track all deadlines, including policy notice requirements and court filing dates.