Defending Medical Provider Claims in Court

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When an auto accident insurance case goes to court, the medical provider claims often come under fire. Find out what to expect, and how the medical provider attorneys at Christensen Law can defend your medical provider claims in court.

“Reasonableness” of Medical Provider Claims

When medical provider claims go to court, the question for the judge or jury comes down to reasonableness. The Michigan No-Fault Act allows medical providers like doctors, hospitals, and therapists, to collect benefits for “reasonable and necessary” medical treatment. They are allowed to charge a “reasonable” amount for those services. But what is “reasonable”?

Auto insurance defense attorneys are quick to claim that a medical provider’s claims are unreasonable. This defense can take many forms, including:

  • The treatment was not reasonably necessary for the condition suffered
  • The patient cannot be reasonably expected to benefit from the treatment
  • The amount charged is more than reasonable.

When an insurance provider challenges your medical decisions or your prescribed treatment plan, it will be up to you and your medical provider attorneys to fight back. Doctors, not insurance adjusters, should be deciding patients’ care. By developing a strong medical file ahead of time, you can give your medical provider attorney the tools he or she needs to defend your treatment decisions. Consider including:

  • History of previous treatments
  • Patient’s response to less expensive treatment options
  • Patient’s objective and subjective wellness, including prognosis and improvement or lack thereof
  • Why alternative treatments are not appropriate

When it’s your medical bill that’s up for debate, be prepared for the auto insurance defense attorney to claim your charges are unreasonably high. This should be measured against the industry standard. However, courts have also allowed insurance providers to question the markup on medical equipment. Insurance defense attorneys could question everything from your profit margins to your overhead costs.

Defending Medical Provider Claims

The Michigan No-Fault Act was never intended to put the insurance industry in charge of your business. When adjusters and auditors are trying to cut into your medical billing, you need an attorney dedicated to defending your medical provider claims. Plaintiffs’ attorneys can sometimes do the job, but their attention is necessarily divided between you and your patient’s best interest.

Don’t take a back seat to their claims. The medical provider attorneys at Christensen Law will put your needs first and make sure any settlement covers you and your costs. If you have outstanding auto accident account receivables, contact Christensen Law today to schedule a free consultation.