How to Handle a Texas Insurance Adjuster Who Disputes Your Car Accident Medical Treatment
Disclaimer: This article is for educational purposes only and is not legal advice. Consult a qualified attorney about your specific situation.
Detailed Answer
After a car accident, Texas law requires insurers to promptly review and pay covered medical expenses. If your insurance adjuster insists your treatment isn’t related, take these steps:
1. Review Your Policy and Statutory Rights
First, check your auto-insurance policy for medical-payment or personal-injury protection coverage. Under Texas Insurance Code §542.055, an insurer must acknowledge your claim within 15 days of receipt. It must accept or deny your claim within 15 business days of receiving all required documentation. Failure to comply can trigger statutory penalties and interest. See Tex. Ins. Code §542.055.
2. Gather and Organize Medical Evidence
Obtain detailed records from your treating providers. Ask your doctor to issue a letter or report stating:
- Date and nature of your accident.
- Diagnosis and treatment plan.
- Explanation linking your injuries to the collision.
Include images (e.g., X-rays, MRIs) and billing statements that itemize services and dates.
3. Communicate in Writing
Send a written demand to your adjuster. Outline your accident date, injuries, treatment timeline, and costs. Attach medical records and provider statements. Request a formal decision within 10 business days. Maintain copies of all correspondence.
4. Cite Texas’ Unfair Settlement Practices
If your adjuster unreasonably denies your claim, they may violate the Texas Insurance Code’s prohibition against unfair practices. Under Tex. Ins. Code §541.060, an insurer must act in “good faith.” Misrepresenting facts or policy terms can constitute bad-faith handling.
5. File a Complaint with the Texas Department of Insurance
If communication fails, file a complaint online at the Texas Department of Insurance (TDI). TDI can investigate insurer conduct and may enforce statutory penalties for unreasonable delays or denials.
6. Consider an Independent Medical Examination
Your policy may allow the insurer to request an independent medical exam (IME). Attend the exam but prepare your own medical expert’s report to counter any unfavorable IME findings.
7. Consult a Texas Car Accident Attorney
An experienced attorney can help you demand payment, negotiate a settlement, or file a lawsuit. Texas law allows you to recover attorney’s fees and court costs if you prevail. See Tex. Civ. Prac. & Rem. Code §38.001.
Helpful Hints
- Keep a detailed accident journal including symptoms and pain levels.
- Send all letters by certified mail to create a paper trail.
- Follow your doctor’s treatment plan and attend every appointment.
- Obtain copies of all medical bills and liens.
- Stay polite but persistent in dealings with the adjuster.
- Explore mediation if direct negotiation stalls.