Disclaimer: This article is for general informational purposes only and does not constitute legal advice.
Detailed Answer
When an insurance adjuster in Tennessee disputes that your medical treatment relates to your car accident, follow these steps to protect your rights and prove the link. Tennessee law does not require personal injury protection, but most insurers must offer Medical Payments Coverage (Med Pay) under T.C.A. § 56-7-109 (link). Med Pay covers reasonable medical expenses regardless of fault. If your insurer denies coverage, take action immediately:
- Review Your Policy: Examine the declarations page for Med Pay limits, covered services, exclusions and claim deadlines.
- Gather Medical Records: Obtain all treatment notes, diagnostic reports, bills and payments. Ensure records mention the accident and your injuries.
- Obtain a Nexus Letter: Ask your treating physician to provide a letter stating that your injuries and necessary care are directly related to the crash.
- Create a Treatment Timeline: Draft a chronology showing accident date, onset of symptoms and each medical visit.
- Agree to an Independent Medical Exam (IME): If the adjuster disputes your doctor’s opinion, submit to a neutral IME to confirm causation.
- File a Formal Appeal: Write an appeal letter to the insurer citing policy language and T.C.A. § 56-7-109 (Med Pay). Attach your medical evidence and nexus letter.
- Watch the Limitation Period: Tennessee imposes a one-year statute of limitations for personal injury claims under T.C.A. § 28-3-104 (link). If denial persists, file suit before this deadline.
- Consult a Tennessee Attorney: If the insurer still refuses, consider a personal injury lawyer. An attorney can negotiate with the insurer or file a lawsuit for bad faith denial.
Helpful Hints
- Document every communication with the adjuster, including dates and names.
- Keep copies of all medical bills and proof of payment.
- Request detailed treatment notes that reference the accident.
- Check if you have supplemental coverages like Uninsured Motorist or additional Med Pay.
- Send all appeals via certified mail and retain tracking receipts.
- Monitor policy deadlines for claims and appeals to avoid forfeiture.
- If you suspect bad faith, track unreasonable delays or denials in writing.