Insurance Claim Dispute

Reviewed By: Pramod Kerkar, MD, FFARCSI

There are several reasons for insurance companies to dispute auto accident injury claim.  Auto accident causes vehicle damage and human injury. Vehicle damage is always evident and reported; vehicle is either replaced or repaired. Cost of repair or replacement is limited though various methods are used to cut cost. Less than 20% of patients need medical treatment. Cost of providing treatment, loss of wages and settlement for pain and suffering is substantial. Malingering can cost unnecessary expenses, which could be used for treatment of chronic pain and suffering of genuine patient.

Insurance Claim Dispute

Adjuster working for auto companies may suspect patient is malingerer and deny medical treatment. Denial of treatment will persuade dispute and legal proceeding. Denial for treatment may be because the cost of treatment is exceeding expectation or treating physician is involving several other physicians for second opinion and expensive investigations are performed. Treatment is often denied if it is considered as experimental. Some time if injured driver is demanding too many services and benefit which adjuster feels as unnecessary then the request is denied. Injured patient has right to have transportation to doctor’s office, ER or facility where investigation or surgery is performed. Some patient may extend the courtesy of services for grocery shopping or visiting relatives.

Insurance claim dispute will always leads to lengthy expensive legal battle for insurance provider and patient.

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Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: September 12, 2017

This article does not provide medical advice. See disclaimer

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