Disclaimer: This article provides general information only and does not constitute legal advice. Consult a qualified attorney for advice specific to your situation.
Detailed Answer
When an insurance adjuster questions whether your medical treatment relates to your Wisconsin car accident, you need solid proof and a clear strategy. Under Wis. Stat. § 632.32(4)(b), insurers must not engage in unfair claim settlement practices, including refusing claims without a reasonable basis (Wis. Stat. § 632.32(4)(b)).
First, gather complete medical records. Request your doctor’s notes, diagnostic tests and treatment plans. Ask your treating physician for a written opinion on causation and necessity. A physician’s affidavit linking your injuries and treatment directly to the collision carries significant weight.
Next, respond promptly to any adjuster requests. Turn over all documentation they need to evaluate causation. If they demand an independent medical examination (IME), Wisconsin law allows insurers to request one (Wis. Stat. § 632.42). Attend the IME, and follow the doctor’s instructions.
If the adjuster still denies coverage, escalate the matter. File a written complaint with the Wisconsin Office of the Commissioner of Insurance (OCI). The OCI reviews insurer practices under Wis. Stat. § 601.72 (OCI Complaint Process).
As a final step, consider legal action. You may file suit in Wisconsin small claims court for claims up to $10,000 or in circuit court for higher amounts. During litigation, a judge can order your insurer to pay reasonable and necessary medical expenses if you prove causation and cost through expert testimony and medical bills.
Helpful Hints
- Keep a detailed accident diary. Note pain levels, treatment dates and how injuries affect daily life.
- Obtain a narrative report from your treating doctor linking each injury to the crash.
- Respond to adjuster requests quickly to avoid claims of noncooperation under Wis. Stat. § 632.24 (Wis. Stat. § 632.24).
- Check your policy’s “medical payments” or “PIP” coverage. Those benefits may pay treatment costs regardless of fault.
- Consider retaining a personal injury attorney before filing suit. An attorney can handle settlement negotiations and court filings.