What dispute deadlines should providers track in Connecticut?

Accident Notice: Notice to insurer as soon as reasonably practicable; MedPay Claim Submission: Submission within standard policy billing deadlines (typically 1 to 3 years); Clean Claim Payment Window: 20 calendar days for electronic claims; 60 days for paper claims (C.G.S. § 38a-816(15)). Verify the trigger date, current agency notices, and any extension before acting.

Which agencies administer these rules in Connecticut?

The guide identifies Connecticut Insurance Department (CID). The correct agency depends on the plan and claim jurisdiction.

Auto Accident, PIP & Medical Billing State Guides

Connecticut Auto Accident, PIP & Medical Billing Laws

Connecticut operates an At-Fault automobile insurance framework under Title 38a and Title 52 of the Connecticut General Statutes (C.G.S.). Motor vehicle liability is governed by modified comparative negligence with a 51% bar under C.G.S. § 52-572h. Medical providers bill optional first-party Medical Payments (MedPay) and enforce statutory hospital liens on third-party settlements under C.G.S. § 49-73.

Accountability & Review

Reviewed by Millennova Legal Operational Integrity Team, Senior Audit and Arbitration Analysts

Last Reviewed

2026-03-01

Plain-language overview

At-Fault / Traditional Tort (Modified Comparative Fault & Connecticut Hospital Lien Act)

Connecticut repealed its former no-fault system in 1993, establishing a pure at-fault tort liability structure. Motor vehicle collision medical expenses are billed to optional first-party Medical Payments (MedPay) coverage, private health insurance, or third-party automobile liability insurance. Under C.G.S. § 52-572h, an injured claimant may recover damages if their negligence was not greater than the combined negligence of the defendants. Non-profit and state-aided hospitals secure treatment receivables against third-party liability proceeds through statutory liens under C.G.S. § 49-73.

PIP and MedPay coverage

Optional Med Pay Coverage

MedPay is optional in Connecticut (commonly written in limits of $1,000 to $10,000+ per person), providing no-fault reimbursement for reasonable medical, surgical, dental, hospital, and ambulance expenses resulting from an automobile collision

Collateral Source Rule

Under C.G.S. § 52-225a, collateral source reductions are made post-verdict by the court, except where a right of subrogation exists; under § 52-225c, insurers cannot bring direct actions for collateral source reimbursement unless authorized by contract

Assignment Of Benefits

Healthcare providers routinely obtain patient assignments of MedPay benefits for direct claims submission to automobile insurers

Medical fee schedule and reimbursement rules

Name

Reasonable and Customary Fee Standard

Rules

Connecticut does not enforce a statutory fee schedule table for motor vehicle accident medical bills 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 and utilization review

Requirement

Preauthorization is not required by statute for emergency trauma stabilization or initial acute management. Elective surgical interventions and prolonged physical therapy regimens are evaluated under insurer medical necessity guidelines.

Carrier Examinations

Under standard auto policy terms, insurers may request medical records or independent physician reviews to evaluate causal relationship to the collision.

Appeals and dispute resolution

Prompt Payment Statute

Under C.G.S. § 38a-816(15), insurers must pay clean claims within 20 calendar days for electronic claims (60 calendar days for paper claims). Claims not paid within these timeframes accrue statutory interest at the rate of 15% per year.

Hospital Lien Statute

Under C.G.S. § 49-73, any hospital receiving state aid or non-profit hospital has a statutory lien upon proceeds of any accident or liability policy or tort settlement for the reasonable value of hospital services. To perfect the lien, the hospital must file notice with the town clerk of the town where the hospital is located and serve the insurance company before payment.

Dispute Forum

Connecticut Superior Court (county superior court) for civil recovery actions.

Claim and dispute deadlines

Deadlines can depend on the trigger event and may be affected by agency relief notices. Confirm the live rule before filing.

Event	Timeframe
Accident Notice	Notice to insurer as soon as reasonably practicable
MedPay Claim Submission	Submission within standard policy billing deadlines (typically 1 to 3 years)
Clean Claim Payment Window	20 calendar days for electronic claims; 60 days for paper claims (C.G.S. § 38a-816(15))
Town Clerk Lien Filing	Must be filed with town clerk and served on insurer prior to settlement distribution (C.G.S. § 49-73)
Statute of Limitations	2 years from accident date for personal injury tort claims (C.G.S. § 52-584); 6 years for written contracts

Documentation checklist

Connecticut 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 intake documentation, operative reports, and imaging findings
Filed Notice of Hospital Lien with town clerk recording stamp (C.G.S. § 49-73)
Insurer Explanation of Benefits (EOB) or written explanation of claim determination

Responsible agencies

Connecticut Insurance Department (CID)Statewide Regulation of Auto Insurers, Rate Filings & Consumer Inquiries

Primary legal and regulatory sources

Connecticut General Statutes Title 49, Chapter 847, Section 49-73 (Liens on Accident and Liability Policies in Favor of Hospitals)Connecticut General Assembly · 2024
Connecticut General Statutes Title 52, Chapter 925, Section 52-572h (Negligence Actions; Comparative Fault)Connecticut General Assembly · 2024

This operational reference is educational, is not legal advice, and does not create an attorney-client relationship.

Common questions

What rules govern auto accident, pip & medical billing state guides in Connecticut?: Connecticut operates an At-Fault automobile insurance framework under Title 38a and Title 52 of the Connecticut General Statutes (C.G.S.). Motor vehicle liability is governed by modified comparative negligence with a 51% bar under C.G.S. § 52-572h. Medical providers bill optional first-party Medical Payments (MedPay) and enforce statutory hospital liens on third-party settlements under C.G.S. § 49-73.
What dispute deadlines should providers track in Connecticut?: Accident Notice: Notice to insurer as soon as reasonably practicable; MedPay Claim Submission: Submission within standard policy billing deadlines (typically 1 to 3 years); Clean Claim Payment Window: 20 calendar days for electronic claims; 60 days for paper claims (C.G.S. § 38a-816(15)). Verify the trigger date, current agency notices, and any extension before acting.
Which agencies administer these rules in Connecticut?: The guide identifies Connecticut Insurance Department (CID). The correct agency depends on the plan and claim jurisdiction.