Detailed Answer
When an insurance adjuster denies that your medical treatment relates to your car accident in Utah, you have multiple remedies under state law. Utah requires drivers to carry Personal Injury Protection (PIP) benefits to cover reasonable and necessary medical expenses resulting from auto accidents, regardless of fault. See Utah Code §31A-22-305.
Follow these steps to challenge the adjuster’s decision:
- Gather supporting documentation. Collect your medical records, treatment notes, and accident report to show the link between your injuries and the crash.
- Review your PIP policy. Confirm your coverage limits and the proof standards for causation.
- Submit a written appeal. Send a formal letter or email to the insurer. Reference your policy provisions and Utah Code §31A-22-305. Attach your documentation and a clear explanation of how your treatment stems from the accident.
- Request a peer review. Ask the insurer to have an independent medical professional review your treatment records.
- Initiate arbitration if needed. If the insurer still denies your claim, demand arbitration under Utah Code §31A-22-307. Arbitration offers a faster, lower-cost forum than court.
- Consult a qualified attorney. If arbitration fails or you need courtroom representation, an attorney can help you file a lawsuit. You may recover denied benefits plus interest and attorney fees under Utah Code §31A-22-307(6).
Helpful Hints
- Keep a detailed journal of your pain levels and treatment progress.
- Save copies of all correspondence with the insurer.
- Obtain your full PIP policy from your insurer or the Utah DMV.
- Consider an early second medical opinion to strengthen your causation proof.
- File your appeal within your policy’s deadline—often 30 days after denial.
- Monitor arbitration or court deadlines to safeguard your rights.
Disclaimer: This article provides general information on Utah law. It does not offer legal advice. To address your specific situation, consult a licensed attorney.