Colorado Claims Dispute & Statutory Guide
Colorado operates an At-Fault automobile insurance framework under Title 10 of the Colorado Revised Statutes (C.R.S.). Insurers must include $5,000 in Medical Payments (MedPay) in every policy under C.R.S. § 10-4-635 unless rejected in writing. Unreasonable claim delays trigger two times the covered benefit plus attorney fees under C.R.S. § 10-3-1116, and subrogation is strictly controlled by C.R.S. § 10-1-135.
Statutory Framework & Jurisdiction
At-Fault / Traditional Tort (Mandatory $5,000 MedPay Offering & Statutory Bad-Faith Penalties)
Colorado combines an at-fault tort liability framework with a mandatory offering of first-party Medical Payments (MedPay) coverage. Under C.R.S. § 10-4-635, every automobile liability policy issued in Colorado must provide at least $5,000 in MedPay coverage unless the named insured rejects it in writing. The first $5,000 of MedPay is primary over private health insurance for trauma or medical care. Subrogation by auto or health insurers against third-party liability proceeds is strictly restricted under C.R.S. § 10-1-135 (Colorado's codified Made-Whole statute). Hospitals enforce statutory liens under C.R.S. § 38-27-101, subject to strict in-network billing prerequisites.
PIP / MedPay Coverage & Medical Fee Rules
mandatory Med Pay Offering
$5,000 statutory minimum per person for medical, surgical, dental, hospital, and ambulance expenses (C.R.S. § 10-4-635), with higher optional limits available
opt Out Requirement
Coverage is automatically included in every auto policy unless the named insured affirmatively opts out by signing a written rejection
codified Made Whole Statute
Under C.R.S. § 10-1-135, an insurer has no right of subrogation or reimbursement against a third-party recovery unless the injured person is fully compensated for all economic and non-economic damages, and the insurer must share attorney fees and litigation costs pro-rata
assignment Of Benefits
Healthcare providers routinely obtain patient assignments of MedPay benefits for direct claims submission
Official Medical Fee Schedule & Reimbursement Standards
name
Reasonable and Customary Fee Standard
rules
Colorado does not maintain a statutory fee schedule table for motor vehicle accident medical billing outside of workers' compensation. Providers bill standard reasonable and customary charges prevailing in the local medical community for comparable care.
cpt Basis
CPT/HCPCS itemized coding on standard CMS-1500 or UB-04 billing claims
Preauthorization & Decision Point Review
requirement
Preauthorization is not required by statute for emergency medical stabilization or initial acute trauma care. Elective surgical interventions and prolonged physical therapy regimens are evaluated under insurer medical necessity guidelines.
carrier Examinations
Under standard policy terms, insurers may request medical records or independent physician reviews to evaluate causal relationship to the motor vehicle crash.
Administrative Appeals & Dispute Mechanism
statutory Bad Faith Penalties
Under C.R.S. § 10-3-1115 and § 10-3-1116, an insurer that unreasonably delays or denies payment of a covered first-party claim is liable for two times the covered benefit, in addition to the benefit itself, plus reasonable attorney fees and court costs.
hospital Lien Statute
Under C.R.S. § 38-27-101 et seq., a hospital has a statutory lien upon damages recovered by an injured patient. Under Colorado law, a hospital cannot assert a lien if the patient has private commercial health insurance that the hospital is in-network with, unless the hospital timely bills the health plan first or the patient specifically requests lien billing. The lien attaches only to net settlement proceeds remaining after deducting attorney fees and litigation costs.
dispute Forum
Colorado District Court (or County Court for claims up to $25,000) for civil contract and statutory bad-faith actions.
Critical Statutory & Dispute Deadlines
| Dispute Phase / Trigger Event | Statutory Timeline / Deadline |
|---|---|
| Accident Notice | Notice to insurer as soon as reasonably practicable |
| MedPay Claim Submission | Submission within standard policy billing deadlines (typically 1 to 3 years) |
| Insurer Payment Window | Prompt adjudication upon complete proof of loss (C.R.S. § 10-3-1115) |
| Hospital Lien Notice | Notice served on liability insurer prior to disbursement of settlement proceeds (C.R.S. § 38-27-102) |
| Statute of Limitations | 3 years from accident date for motor vehicle personal injury tort claims (C.R.S. § 13-80-101); 3 years for contract claims |
Required Evidentiary Filing Checklist
- ✓Colorado MedPay Claim Application Form
- ✓Executed Assignment of Benefits (AOB) and medical records authorization
- ✓Itemized CMS-1500 or UB-04 billing form with CPT/HCPCS codes and ICD-10 diagnostic coding
- ✓Contemporaneous medical records, emergency trauma notes, operative reports, and imaging findings
- ✓Written Notice of Hospital Lien served in compliance with C.R.S. § 38-27-102 (for hospital claims)
- ✓Insurer Explanation of Benefits (EOB) or written explanation of claim determination
Official Primary Sources & Legislative Authorities
Governing Regulatory Authorities
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