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Claim adjusters in pennsylvania

by Cathy

I was invovled in a rear end collision as I was just going to make a right-hand turn onto my driveway. A 19 year- old hit me from behind. I had severe neck pain and a partially torn rotator cup injury. My insurance review board is denying my medical bills.

I did not recieve a denial letter and my PCP informed me that I had been denied. I called my claims adjuster and he wouldn't tell me the reason that I have been denied for. My orthopedic surgeon told me that they never recieved any letter asking for any information due to the accident.

My adjuster told me that I shouldn't be calling the doctors and asking any questions. I feel that my insurance co. didn't give the proper information to the review board. I have 2 letters from a orthopedic doctor and my orthopedic surgeon saying that this inhjury was due from my accident.

I never had any neck or shoulder problems before this accident and my PCP has my records to proof this. What is your opinion?


Hi Cathy,

I am very sorry for this. Let me understand this. You are calling your own claim adjuster or the adjuster of the person that hit you?

If you are calling your own claim adjuster, they have a duty to you, to keep you inform and to tell you EXACTLY what is going on. Visit
for more information about claim rights and consumer protection.

If you are calling the 19 year old's claim adjuster, they can deny your claim without much explanation. They however must give you something on writing briefly telling you why the claim was denied (i.e. the 19 year old was not insured at the time). This is the type of general statement I am talking about.

In either scenario, you are not always entitled to talk to your doctors and ask questions. Do not allow them to tell you that you should not. There is nothing that prohibits you from doing this. Do not let them tell you that you are doing something wrong. You need to protect yourself and it sounds like you have a pretty severe injury.

There are couple of things you can do in this situation:

1. You can contact the office of the insurance commissioner in your state and file a formal complaint against the carrier, asking them to give an explanation of why your claim is denied and why they did not want to inform you.

2. Contact an attorney in your area to explore new options.

I hope this helps,

Good Luck,

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