In every injury case prior to denying a claim for California Medical Pay benefits, the insurance carrier must provide the insured with a written explanation of coverage under the policy, and include a notice that the carrier may deny, limit or terminate benefits if the carrier determines that the medical or hospital services are:

1. Not reasonable;
2. Not necessary;
3. Not related to the accident; or
4. Not incurred within 3 years of the accident.

The insurance carrier’s decision to deny, limit, or terminate the claimant’s California Medical Pay benefits must be based on the review and opinion of a medical or healthcare professional. 

More Legal Questions About Car & Motorcycle Accidents?

Do you have more legal questions about car & motorcycle accident cases?  Return to the Auto & Motorcycle accidents in California Frequently Asked Legal Questions page.