Detailed Answer
Under Tennessee law, North Carolina’s Rule 414 has no effect on insurance claims in Tennessee. Tennessee adjusters must follow state statutes and regulations. The Tennessee Unfair Claims Settlement Practices Act, Tenn. Code Ann. § 56-8-105, prohibits insurers and adjusters from misrepresenting policy terms, undervaluing claims or unreasonably delaying payments. See Tenn. Code Ann. § 56-8-105 (Chapter 8 PDF).
For medical payments coverage, Tenn. Code Ann. § 56-7-120 limits how much an insurer can pay under the “medical payments” portion of an auto policy. See Tenn. Code Ann. § 56-7-120 (Chapter 7 PDF). Adjusters may apply network discounts or negotiate usual and customary rates if your provider participates in a preferred network. They cannot unilaterally reduce your bills beyond those policy terms or statutory limits.
If an adjuster applies an improper reduction or violates the Unfair Claims Settlement Practices Act, you can file a complaint with the Tennessee Department of Commerce & Insurance (TDCI). You may also seek review from a private attorney to challenge any unlawful adjustments.
Helpful Hints
- Review your policy’s “medical payments” and PIP provisions to understand coverage limits.
- Obtain itemized bills and compare billed vs. paid amounts.
- Ask your health care provider whether they accept network rates or other discounts.
- Contact TDCI for guidance or to file a complaint: TDCI Consumer Help.
- Consider consulting a Tennessee-licensed attorney if you suspect improper claim handling.
Disclaimer: This article is for informational purposes only and does not constitute legal advice. Consult a qualified attorney for guidance on your specific situation.